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Lu T, Li L, Tang Y, Leavey G. ADHD and family life: A cross-sectional study of ADHD prevalence among pupils in China and factors associated with parental depression. PLoS One 2024; 19:e0281226. [PMID: 38483917 PMCID: PMC10939198 DOI: 10.1371/journal.pone.0281226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is increasingly recognized as a major problem for children and their families in China. However, its influence on parental mental health has been seldom explored. OBJECTIVE To examine the prevalence of attention deficit hyperactivity disorder in a community sample of children aged 6-13 years, and the extent to which it impacts parental mental health. METHOD Cross-sectional study of primary school pupils (number = 2497) in Deyang, Sichuan Province, South-West China. We used standardized instruments to identify children with ADHD symptoms and parent depression. RESULTS The prevalence of ADHD was 9.8%. Factors associated with the likelihood of ADHD, included family environment(P = 0.003), time spent with children(P = 0.01), parenting style(P = 0.01), and parental relationship, pupils self-harm and lower academic ability (P = 0.001). After controlling for other factors, having a child with ADHD increased the likelihood of parents' depression (OR = 4.35, CI = 2.68~7.07), additional factors included parent relationship. CONCLUSIONS ADHD may be a common disorder among Chinese children, the symptoms of which may increase the likelihood of parent depression. There is a need for greater detection of ADHD in schools, acknowledgement of the challenges the disorder creates for academic success and family wellbeing, and psychoeducational tools for supporting parents of children with ADHD.
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Affiliation(s)
- Tao Lu
- Department of Child Psychiatry, People’s Hospital of Deyang, Deyang, China
| | - Longlong Li
- Department of Child Psychiatry, People’s Hospital of Deyang, Deyang, China
| | - Ying Tang
- Deyang Institute of Education Science, Deyang, China
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Morgan PL, Woods AD, Wang Y. Sociodemographic Disparities in Attention-Deficit/Hyperactivity Disorder Overdiagnosis and Overtreatment During Elementary School. JOURNAL OF LEARNING DISABILITIES 2023; 56:359-370. [PMID: 35674454 PMCID: PMC10426255 DOI: 10.1177/00222194221099675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) overdiagnosis and overtreatment unnecessarily exposes children to potential harm and contributes to provider and community skepticism toward those with moderate or severe symptoms and significant impairments, resulting in less supportive care. Yet, which sociodemographic groups of children are overdiagnosed and overtreated for ADHD is poorly understood. We conducted descriptive and logistic regression analyses of a population-based subsample of 1,070 U.S. elementary schoolchildren who had displayed above-average levels of independently assessed behavioral, academic, or executive functioning the year prior to their initial ADHD diagnoses and who did not have prior diagnostic histories. Among these children, (a) 27% of White children versus 19% of non-White children were later diagnosed with ADHD and (b) 20% of White children versus 14% of non-White children were later using medication. In adjusted analyses, White children are more likely to later be diagnosed (odds ratio [OR] range = 1.70-2.62) and using medication (OR range = 1.70-2.37) among those whose prior behavioral, academic, and executive functioning suggested that they were unlikely to have ADHD.
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Trairatvorakul P, Meinzen-Derr J, Heydarian H, Mason K, Anixt JS. Stimulant Medication Treatment in Children with Congenital Heart Disease and Attention-Deficit/Hyperactivity Disorder: Cardiovascular Outcomes. J Dev Behav Pediatr 2023; 44:e247-e254. [PMID: 37081695 DOI: 10.1097/dbp.0000000000001187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Children with congenital heart disease (CHD) are at increased risk for attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to determine whether children with CHD and ADHD clinically treated with stimulant medication were at increased risk for changes in cardiovascular parameters or death compared with CHD-matched controls. METHODS In this retrospective cohort study, patients with CHD + ADHD treated with stimulant medication (exposed group [EG]) were matched by CHD diagnosis and visit age to patients not on stimulants (nonexposed group [NEG]). Cardiovascular parameters (heart rate [HR] and systolic and diastolic blood pressure [SBP and DBP]) and electrocardiograms (ECGs) from medical records over 12 months were compared using mixed effects models. RESULTS Cardiovascular parameters for 151 children with CHD (mean age 8 ± 4 years) were evaluated (N = 46 EG and N = 105 NEG). Stimulant medication use was not associated with sudden cardiac death. HR and SBP did not significantly change over time in the EG and remained similar between groups. EG children had higher DBP compared with NEG children over time ( p = 0.001). Group × time interactions for HR, SBP, and DBP were not different between the EG and NEG. QTc was not significantly different between the EG and NEG (447 ms vs 439 ms, p = 0.23). EG children demonstrated improvement in ADHD symptoms. CONCLUSION Stimulant medication use in children with CHD was not associated with clinically significant changes in cardiovascular parameters compared with controls. Stimulants should be considered for ADHD treatment in children with CHD when prescribed with appropriate monitoring and coordination with the cardiologist.
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Affiliation(s)
- Pon Trairatvorakul
- Division of Growth and Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence for Maximizing Children's Developmental Potential, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Haleh Heydarian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and
| | - Karen Mason
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julia S Anixt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment. J Atten Disord 2023; 27:669-697. [PMID: 36876491 PMCID: PMC10173356 DOI: 10.1177/10870547231158572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Among untreated adults, functional impairments associated with ADHD are widespread and cumulative, and can include social, educational, and professional impairments, increased risk of accidents and mortality, and reduced quality of life. Here, we review the most prominent functional impairments in adults with ADHD and summarize evidence describing the potential role of medication in improving outcomes. METHOD Articles related to the search terms "ADHD," "adult," and functional impairments were identified through Google Scholar and PubMed and selected for inclusion based on four criteria: strength of evidence, relevance to current challenges in adult ADHD, impact on the field, and recency of the results. RESULTS We identified 179 papers to support the conclusions on the relationship between ADHD and functional impairments, and the impact of pharmacological therapy on functional impairments. CONCLUSION This narrative review provides evidence that pharmacological treatment can be effective in minimizing not only the symptoms of ADHD, but its functional consequences as well.
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Affiliation(s)
| | - Oren Mason
- Attention MD, Grand Rapids, MI, USA and Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine, Midland, TX, USA
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Aral A, Onat M, Aydemir H. Functional outcomes of extended-release methylphenidate and atomoxetine in children: retrospective chart analysis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recent guidelines emphasize the importance of functional outcomes in children with attention-deficit/hyperactivity disorder (ADHD). Here, we assess the functional outcomes of the oral delivery system of osmotic-release methylphenidate (OROS-MPH) and atomoxetine (ATX) from the retrospective review of the chart for the last 2 years in the clinic.
Results
Linear mixed-effects models were performed with outcome measures of difference in ADHD symptoms and functional impairment. After 9–12 weeks, OROS-MPH and ATX were statistically equivalent for total Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) scores (difference in slope is β = 0.004, p = 1.000). However, OROS-MPH was superior to ATX in terms of school domain (difference in slope is β = 0.139, p < 0.001); ATX was superior in the family domain (slope difference in slope is β = 0.103, p < 0.001). The other domains of functioning both were not responsive to pharmacotherapy and were similar between the two medications.
Conclusions
Optimal management should monitor functional progress in ADHD beyond the core symptoms. As expected, ADHD medications provide a distinct pattern of functional improvement. Pharmacotherapy alone offers promising and reliable outcomes to improve school and family functions in ADHD. Some functional improvements did not respond to the medication; therefore, many of the techniques derived from behavioral interventions should be considered.
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Arruda MA, Arruda R, Guidetti V, Bigal ME, Landeira-Fernandez J, Portugal AC, Anunciação L. Associated Factors of Attention-Deficit/Hyperactivity Disorder Diagnosis and Psychostimulant Use: A Nationwide Representative Study. Pediatr Neurol 2022; 128:45-51. [PMID: 35066370 DOI: 10.1016/j.pediatrneurol.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/15/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Connections between epidemiological findings and children's and adolescents' mental health policies have not been properly made in Brazil, and such nationwide studies are scarce. This epidemiological study (1) estimated the prevalence and predictors of parent-reported attention-deficit/hyperactivity disorder (ADHD) (ADHD-report), (2) estimated the probable diagnosis and risk of ADHD based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria (ADHD-probable), and (3) estimated current psychostimulant use (ADHD-pst) in a representative nationwide sample of Brazilian school-aged children and adolescents. METHODS Data were obtained from 7114 school-aged children (49.9% boys) from 87 cities in 18 Brazilian states. Parents and teachers were interviewed using psychometrically sound questionnaires. Data and codes are available. RESULTS The prevalence of ADHD-report, ADHD-probable, and ADHD-pst were 7.1%, 3.9%, and 1.9%, respectively. The agreement was low between ADHD-probable and ADHD-report (22.6%) and between ADHD-report and ADHD-pst (15.6%). Logistic regression revealed that predictors of all three categories were male gender (odds ratio [OR] = 1.71, 2.32, and 1.96, respectively), divorced parents (OR = 1.47, 1.65, and 1.68, respectively), and below-expectation school performance (OR = 3.1, 13.74, and 3.95, respectively). Socioeconomic status was a significant predictor of ADHD-report, and participants from lower classes were less frequently diagnosed with ADHD than their peers from upper classes (OR = 0.57, 95% confidence interval = 0.37-0.88, P = 0.012). CONCLUSIONS The present findings provide an accurate description of ADHD in Brazil. We suggest disparities in agreement between report, risk, and psychostimulant use among children and adolescents and discrepancies between socioeconomic classes concerning the prevalence of an ADHD diagnosis.
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Affiliation(s)
- Marco Antônio Arruda
- Glia Institute, Department of Child Neurology, Ribeirão Preto, São Paulo, Brazil
| | - Renato Arruda
- Department of Neuroscience and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Vicenzo Guidetti
- Department of Child and Adolescent Neurology, Psychiatry and Rehabilitation, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Luis Anunciação
- Pontifical Catholic University of Rio de Janeiro, Brazil; Marques de Sao Vicente, Gavea, Rio de Janeiro, Brazil.
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Effective but Not Feasible—What Support Staff in All-Day Primary Schools Think of Pedagogical Interventions with Regard to Children with ADHD. SUSTAINABILITY 2022. [DOI: 10.3390/su14031393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Children with attention deficit/hyperactivity disorder (ADHD) are faced with multiple challenges both in the classroom and in the homework situation. While there are many studies on pedagogical interventions by teachers in the classroom, this is hardly the case when it comes to support staff in after-school homework supervision. In this study, 196 support staff with different qualifications were asked not only about their knowledge of ADHD, their subjective level of stress, and whether they felt trained enough to work with children with ADHD, but also to assess the effectiveness and feasibility of 25 interventions in homework supervision. Overall, the respondents rated effectiveness higher than feasibility. Higher qualifications, greater knowledge, and better preparation went hand in hand with higher ratings of effectiveness. The more stressed the support staff feel themselves to be, the less feasible they rate the measures. The results underline the necessity of employing well-trained pedagogical staff to supervise children with ADHD. A number of interventions can be identified that the support staff deem to be both effective and feasible, and that promise a high level of implementation in practice. At the same time, more attention should be given to potential obstacles to using recommended measures in training and further education.
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Benham-Clarke S, Ford T, Mitchell SB, Price A, Newlove-Delgado T, Blake S, Eke H, Moore DA, Emma Russell A, Janssens A. Role of education settings in transition from child to adult health services for young people with ADHD. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2021. [DOI: 10.1080/13632752.2021.1989844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Anna Price
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Sharon Blake
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helen Eke
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Darren A Moore
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Astrid Janssens
- College of Medicine and Health, University of Exeter, Exeter, UK
- Center for Innovativ Medicinsk Teknologi, University of Southern Denmark, Odense, Denmark
- Center for Research in Partnership with Patients and Relatives, Odense University Hospital, Odense, Denmark
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Kaalund-Brok K, Houmann TB, Hebsgaard MB, Lauritsen MBG, Lundstrøm LH, Grønning H, Darling L, Reinert-Petersen S, Petersen MA, Jepsen JRM, Pagsberg AK, Plessen KJ, Rasmussen HB, Jeppesen P. Outcomes of a 12-week ecologically valid observational study of first treatment with methylphenidate in a representative clinical sample of drug naïve children with ADHD. PLoS One 2021; 16:e0253727. [PMID: 34673771 PMCID: PMC8530346 DOI: 10.1371/journal.pone.0253727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Randomized placebo-controlled trials have reported efficacy of methylphenidate (MPH) for Attention-deficit/hyperactivity disorder (ADHD); however, selection biases due to strict entry criteria may limit the generalizability of the findings. Few ecologically valid studies have investigated effectiveness of MPH in representative clinical populations of children. This independently funded study aims to describe treatment responses and their predictors during the first 12 weeks of MPH treatment using repeated measurements of symptoms and adverse reactions (ARs) to treatment in 207 children recently diagnosed with ADHD. The children were consecutively included from the Child and Adolescent Mental Health Centre, Mental Health Services, The Capital Region of Denmark. The children (mean age, 9.6 years [range 7–12], 75.4% males) were titrated with MPH, based on weekly assessments of symptoms (18-item ADHD-rating scale scores, ADHD-RS-C) and ARs. At study-end 187 (90.8%) children reached a mean end-dose of 1.0 mg/kg/day. A normalisation/borderline normalisation on ADHD-RS-C was achieved for 168 (81.2%) children on the Inattention and/or the Hyperactivity-Impulsivity subscale in week 12, and 31 (15.0%) children were nonresponders, which was defined as absence of normalisation/borderline normalisation (n = 19) or discontinuation due to ARs (n = 12), and eight (3.8%) children dropped out from follow-up. Nonresponders were characterised by more severe symptoms of Hyperactivity-Impulsivity and global impairment before the treatment. ARs were few; the most prominent were appetite reduction and weight loss. A decrease in AR-like symptoms during the treatment period questions the validity of currently available standard instruments designed to measure ARs of MPH. This ecologically valid observational study supports prior randomized placebo-controlled trials; 81.2% of the children responded favourably in multiple domains with few harmful effects to carefully titrated MPH. Clinical trial registration: ClinicalTrials.gov with registration number NCT04366609.
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Affiliation(s)
- Kristine Kaalund-Brok
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
- * E-mail:
| | - Tine Bodil Houmann
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Marie Bang Hebsgaard
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Maj-Britt Glenn Lauritsen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Louise Hyldborg Lundstrøm
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Helene Grønning
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Lise Darling
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Susanna Reinert-Petersen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Services Glostrup, The Capital Region of Denmark, Glostrup, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, The Capital Region of Denmark, Roskilde, Denmark
- Department of Science & Environment, Roskilde University, Roskilde, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Centre, Research Unit, Mental Health Services, The Capital Region of Denmark, Hellerup, Denmark
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Glasofer A, Dingley C. Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review. J Racial Ethn Health Disparities 2021; 9:2027-2048. [PMID: 34520001 DOI: 10.1007/s40615-021-01142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.
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Affiliation(s)
- Amy Glasofer
- School of Nursing, University of Nevada, Las Vegas, NV, USA.
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Pereira Ribeiro J, Arthur EJ, Gluud C, Simonsen E, Storebø OJ. Does Methylphenidate Work in Children and Adolescents with Attention Deficit Hyperactivity Disorder? Pediatr Rep 2021; 13:434-443. [PMID: 34449694 PMCID: PMC8396049 DOI: 10.3390/pediatric13030050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder diagnosed in increasing proportions of children and adolescents. The psychostimulant methylphenidate has been considered the first-line pharmacological treatment for children and adolescents with ADHD for more than 60 years. Considering recent publications on methylphenidate for ADHD, we here give an overview of its effects in children and adolescents with ADHD, elicited by a well-disputed Cochrane review and narratively synthesise the evidence in the field. METHOD We searched for systematic reviews and meta-analyses that investigated methylphenidate as an intervention for children and adolescence with ADHD compared with placebo or no treatment. We assessed the quality of the evidence using AMSTAR II. RESULTS We found 24 eligible systematic reviews and meta-analyses of which 11 were rated as high- quality evidence according to AMSTAR II. The evidence claiming that methylphenidate is beneficial in treating children and adolescents with ADHD was of very low certainty. The underreporting of adverse events in randomised clinical trials may impede an adequate depiction of the balance between benefits and harms. CONCLUSIONS It appears that there is uncertain evidence on group-level to support the claim that methylphenidate is beneficial in treating children and adolescents with ADHD. Future randomised clinical trials and systematic reviews should include individual participant data, which would allow us to assess intervention effects across modifiers, like age, sex, ADHD subtypes, comorbidities, and dose.
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Affiliation(s)
- Johanne Pereira Ribeiro
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (E.J.A.); (E.S.)
| | - Emma Jasmine Arthur
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (E.J.A.); (E.S.)
| | - Christian Gluud
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark;
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Erik Simonsen
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (E.J.A.); (E.S.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Ole Jakob Storebø
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark; (J.P.R.); (E.J.A.); (E.S.)
- Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, 4000 Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
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de Faria JCM, Duarte LJR, Ferreira LDA, da Silveira VT, Menezes de Pádua C, Perini E. "Real-world" effectiveness of methylphenidate in improving the academic achievement of Attention-Deficit Hyperactivity Disorder diagnosed students-A systematic review. J Clin Pharm Ther 2021; 47:6-23. [PMID: 34254328 DOI: 10.1111/jcpt.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Attention-deficit hyperactivity disorder (ADHD) symptoms usually impairs academic achievement and can trigger the onset of medication. Methylphenidate is a drug widely prescribed to treat ADHD. However, systematic reviews of randomized clinical trials suggest that it does not lead to great improvements in academic performance. Thus, we aimed to evaluate the evidence on the "real-world" effectiveness of methylphenidate in improving the academic achievement of ADHD students. METHODS We conducted a systematic review of observational studies retrieved from five electronic databases, besides a manual search and search in grey literature. Studies evaluating treatment with methylphenidate compared to no treatment or other pharmacological/non-pharmacological alternatives used in ADHD were included. The risk of bias of the selected studies was assessed using adapted versions of the Newcastle-Ottawa Scale. RESULTS AND DISCUSSION Nine studies (from ten reports) were included in the review: four cohorts, two before-and-after designs and three cross-sectional studies. They involved 12,269 children and adolescents aged 6-18 years. The doses of methylphenidate ranged from 10 to 72 mg/day, and the duration of the treatment from 2.6 months to 4.25 years. Five of these studies concluded that methylphenidate improves academic performance. However, three of the four lowest-bias risk studies concluded that the drug is ineffective. Five studies assessed the long-term use of methylphenidate, and four of them concluded that it does not result in better outcomes in the school setting. Most included studies had considerable limitations and significant heterogeneity regarding methodological design and academic performance measurement criteria. WHAT IS NEW AND CONCLUSION Although some studies indicate that the short-term use of methylphenidate may improve outcomes in the school environment, the available evidence does not support the establishment of adequate conclusions about the real benefits of methylphenidate in the academic improvement of ADHD students.
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Affiliation(s)
| | | | | | | | | | - Edson Perini
- Federal University of Minas Gerais, Belo Horizonte, Brazil
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14
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Tallberg P, Rastam M, Perrin S, Hallin AL, Gustafsson P. A longitudinal investigation of cognitive functioning and its relationship to symptom severity and academic functioning in treatment seeking youth with AHDH. Scand J Child Adolesc Psychiatr Psychol 2021; 9:52-63. [PMID: 33928054 PMCID: PMC8077411 DOI: 10.21307/sjcapp-2021-007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Children with ADHD tend to present with poorer cognitive functioning leaving them more vulnerable to a range of negative outcomes. To date, only a handful of longitudinal studies have examined the stability of Wechsler composite scores in children and adolescents with ADHD, and none of them used a more recent version of the Wechsler Intelligence Scales for Children (WISC), than the WISC-III. Objective: The present study investigates the cognitive stability and its longitudinal relationship with the severity of the child’s ADHD symptoms and school grades. Method: Cognitive functioning was measured with the fourth editions of the WISC-IV or the Wechsler Adult Intelligence Scales (WAIS-IV) at baseline and at a 3-4-year follow-up in children with ADHD (n = 125, mean age = 11.40 years, SD = 3.27) and a Control group of schoolchildren (n = 59, mean age = 11.97 years, SD = 2.15). The stability of cognitive functioning and the relationship between cognitive functioning, ADHD and grades were evaluated using linear mixed models and logistic regression. Results: Standardized composite scores of Full scale IQ, Verbal Comprehension, and Processing Speed declined between baseline and follow-up in the ADHD group. ADHD symptom scores were associated with Working Memory scores. Together, the severity of concurrent ADHD symptoms and lower scores for verbal comprehension at baseline and follow-up were associated with an increased risk of not achieving grades at follow-up in youth with ADHD. Conclusions: Youth with ADHD often present with cognitive impairments, not improved over time. Together these increase the risk of poorer academic outcomes. Concurrent evaluation of symptom severity and cognitive functions can add potentially useful information in terms of treatment planning, and school supports to prevent school failure.
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Affiliation(s)
- Pia Tallberg
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Maria Rastam
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.,Department of Psychiatry and Neurochemistry, Gillberg Neuropsychiatry Centre, University of Gothenburg, Göteborg, Sweden
| | - Sean Perrin
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Anne-Li Hallin
- Child and Adolescent Psychiatry, Region Skåne, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Skåne University Hospital, Lund University, Lund, Sweden
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15
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Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4:e215335. [PMID: 33843998 PMCID: PMC8042533 DOI: 10.1001/jamanetworkopen.2021.5335] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCE This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.
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Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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16
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Bet P, Oosterlaan J. Methylphenidate-Related Improvements in Math Performance Cannot Be Explained by Better Cognitive Functioning or Higher Academic Motivation: Evidence From a Randomized Controlled Trial. J Atten Disord 2020; 24:1824-1835. [PMID: 28608744 PMCID: PMC7543012 DOI: 10.1177/1087054717713640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: This study investigated whether improvements in working memory, reaction time, lapses of attention, interference control, academic motivation, and perceived competence mediated effects of methylphenidate on math performance. Method: Sixty-three children (ADHD diagnosis; methylphenidate treatment; age 8-13; IQ > 70) were randomly allocated to a 7-day methylphenidate or placebo treatment in this double-blind placebo-controlled crossover study and compared with 67 controls. Data were collected at schools and analyzed using mixed-model analysis. Methylphenidate was hypothesized to improve all measures; all measures were evaluated as potential mediators of methylphenidate-related math improvements. Results: Controls mostly outperformed the ADHD group. Methylphenidate did not affect measures of cognitive functioning (p = .082-.641) or academic motivation (p = .199-.865). Methylphenidate improved parent ratings of their child's self-perceived competence (p < .01), which mediated methylphenidate efficacy on math productivity. Conclusion: These results question the necessity of improvements in specific cognitive and motivational deficits associated with ADHD for medication-related academic improvement. They also stimulate further study of perceived competence as a mediator.
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Affiliation(s)
- Anne Fleur Kortekaas-Rijlaarsdam
- Vrije Universiteit Amsterdam, The Netherlands,Anne Fleur Kortekaas-Rijlaarsdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
| | | | | | - Pierre Bet
- VU University Medical Centre, Amsterdam, The Netherlands
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17
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Heinze K, Cumming J, Dosanjh A, Palin S, Poulton S, Bagshaw AP, Broome MR. Neurobiological evidence of longer-term physical activity interventions on mental health outcomes and cognition in young people: A systematic review of randomised controlled trials. Neurosci Biobehav Rev 2020; 120:431-441. [PMID: 33172601 DOI: 10.1016/j.neubiorev.2020.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate putative neurobiological mechanisms that link longer-term physical activity interventions to mental health and cognitive outcomes using randomised controlled trials in children, adolescents and young adults. DATA SOURCES A range of medical and psychological science electronic databases were searched (MEDLINE, EMBASE, Scopus, Web of Science, PsychINFO). REVIEW METHODS Original research studies were selected, data were extracted and quality was appraised. RESULTS Sixteen primary papers were included, ranging from healthy and community samples to subclinical and clinical populations across a variety of age ranges and using different neurobiological measures (e.g. magnetic resonance imaging, electroencephalography, cortisol, brain-derived neurotropic factor). DISCUSSION The majority of studies report improvement in mental health and cognition outcomes following longer-term physical activity interventions which coincide with neurobiological alterations, especially neuroimaging alterations in activation and electrophysiological parameters in frontal areas. Future research should include measures of pre-existing fitness and target those who would benefit the most from this type of intervention (e.g. those with a lower level of fitness and at risk for or with mental health problems).
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Affiliation(s)
- Kareen Heinze
- School of Psychology, University of Birmingham, Edgbaston, UK; Institute for Mental Health, University of Birmingham, Edgbaston, UK; Centre for Human Brain Health, University of Birmingham, Edgbaston, UK.
| | - Jennifer Cumming
- Institute for Mental Health, University of Birmingham, Edgbaston, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, UK.
| | - Amrita Dosanjh
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Sophia Palin
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Shannen Poulton
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Andrew P Bagshaw
- School of Psychology, University of Birmingham, Edgbaston, UK; Centre for Human Brain Health, University of Birmingham, Edgbaston, UK.
| | - Matthew R Broome
- School of Psychology, University of Birmingham, Edgbaston, UK; Institute for Mental Health, University of Birmingham, Edgbaston, UK; Centre for Human Brain Health, University of Birmingham, Edgbaston, UK.
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18
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Matta M, Volpe RJ, Briesch AM, Owens JS. Five direct behavior rating multi-item scales: Sensitivity to the effects of classroom interventions. J Sch Psychol 2020; 81:28-46. [PMID: 32711722 DOI: 10.1016/j.jsp.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/24/2019] [Accepted: 05/22/2020] [Indexed: 11/16/2022]
Abstract
Direct Behavior Rating (DBR) is a tool designed for the assessment of behavioral changes over time. Unlike methods for summative evaluations, the development of progress monitoring tools requires evaluation of sensitivity to change. The present study aimed to evaluate this psychometric feature of five newly developed DBR Multi-Item Scales (DBR-MIS). Teachers identified students with behaviors interfering with their learning or the learning of others and implemented a Daily Report Card (DRC) intervention in the classroom settings for two months. The analyses were performed on 31 AB single case studies. Change metrics were calculated at an individual level by using Tau-UA vs. B + trend B and Hedges' g and at a scale-level by using Mixed Effect Meta-Analysis, Hierarchical Linear Models (HLMs), and Between-Case Standardized Mean Difference (BC-SMD). HLMs were estimated considering both fixed and random effects of intervention and linear trend within the intervention phase. The results supported sensitivity to change for three DBR-MIS (i.e., Academic Engagement, Organizational Skills, and Disruptive Behavior), and the relative magnitudes were consistent across the metrics. Sensitivity to change of DBR-MIS Interpersonal Skills received moderate support. Conversely, empirical evidence was not provided for sensitivity to change of DBR-MIS Oppositional Behavior. Particular emphasis was placed on the intervention trend in that responses to behavioral interventions might occur gradually or require consistency over time in order to be observed by raters. Implications for the use of the new DBR-MIS in the context of progress monitoring of social-emotional behaviors are discussed.
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Affiliation(s)
- Michael Matta
- Department of Psychological, Health, and Learning Sciences, University of Houston, United States of America.
| | - Robert J Volpe
- Department of Applied Psychology, Northeastern University, United States of America
| | - Amy M Briesch
- Department of Applied Psychology, Northeastern University, United States of America
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19
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Barnard-Brak L, Roberts B, Valenzuela E. Examining Breaks and Resistance in Medication Adherence Among Adolescents With ADHD as Associated With School Outcomes. J Atten Disord 2020; 24:1148-1155. [PMID: 29562848 DOI: 10.1177/1087054718763738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: Pharmacological interventions combined with behavioral treatment have been associated with better outcomes for children with ADHD. Yet, as children age into adolescence and gain autonomy, they may choose not to adhere to taking a prescribed medication. The purpose of the current study was to examine school outcomes among adolescents with ADHD who take medication breaks versus resisting medication with respect to grades and school behaviors. Method: We statistically controlled for a variety of variables such as the child's age, sex, the presence of side effects, and parent's relationship with child. Approximately half of the sample of adolescents with ADHD exhibited some form of medication nonadherence. Results: The results of the current study suggest that more positive school outcomes in terms of behaviors and grades are associated with adolescents taking breaks from their ADHD medication rather than resisting their medication. Conclusion: This result would indicate that not all forms of medication nonadherence have the same association with school outcomes in terms of grades and behaviors.
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20
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Shang CY, Shih HH, Pan YL, Lin HY, Gau SSF. Comparative Efficacy of Methylphenidate and Atomoxetine on Social Adjustment in Youths with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:148-158. [PMID: 31794244 DOI: 10.1089/cap.2019.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Although methylphenidate and atomoxetine have positive effects in reducing core symptoms and emotional/behavioral problems of attention-deficit/hyperactivity disorder (ADHD), little is known about their efficacy in improving social adjustment problems among youths with ADHD. Methods: A total of 168 drug-naive youths, 7-16 years of age, with DSM-IV-defined ADHD, were recruited and randomly assigned to osmotic-release oral system methylphenidate (n = 83) and atomoxetine (n = 85) in a 24-week, open-label, head-to-head clinical trial. Efficacy measurement was based on the parent-rated and self-rated Social Adjustment Inventory for Children and Adolescents (SAICA). Evaluation time points were set at baseline and weeks 8, 16, and 24. Results: At week 24, methylphenidate was associated with improvement in school functions (parent report: Cohen d = -0.82; self-report: Cohen d = -0.66) and peer relationships (parent report: Cohen d = -0.50; self-report: Cohen d = -0.25); and atomoxetine was associated with improvement in school functions (parent report: Cohen d = -0.62; self-report: Cohen d = -0.34) and peer relationships (parent report: Cohen d = -0.33; self-report: Cohen d = -0.65). In terms of parent-reported and self-reported ratings, there were no significant differences between the two treatment groups in mean reduction in the severity of school dysfunctions, impaired peer relationships, and behavioral problems at home at week 24. Conclusions: Our findings lend evidence to support that both methylphenidate and atomoxetine were comparably effective in improving social adjustment in youths with ADHD, including school functions and peer relationships.
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Affiliation(s)
- Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Hsueh Shih
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Yun-Ling Branch, Yun-Ling, Taiwan
| | - Yi-Lei Pan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Child and Adolescent Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Hsiang-Yuan Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences and Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
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21
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Sayal K, Merrell C, Tymms P, Kasim A. Academic Outcomes Following a School-Based RCT for ADHD: 6-Year Follow-Up. J Atten Disord 2020; 24:66-72. [PMID: 25555626 DOI: 10.1177/1087054714562588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: For children with high levels of ADHD symptoms, to investigate the impact of early school-based interventions on academic outcomes in mid-childhood. Method: A 6-year follow-up of 4- to 5-year-olds (N = 52,075) whose schools participated in a cluster randomized controlled trial for children at risk of ADHD. School-level interventions involved the provision of a booklet with evidence-based information (book) and/or feedback of names (identification) of children with high levels of ADHD symptoms. At ages 10 to 11 years, outcome measures were scores in English and mathematics tests. Results: For children with high levels of ADHD symptoms, the interventions had no impact on academic outcomes. When all children were analyzed, the book intervention had a positive impact on mathematics. Baseline inattention was associated with poorer academic outcomes, whereas impulsiveness was associated with better academic outcomes. Conclusion: The provision of evidence-based information about helping children with ADHD at school may have wider academic benefits.
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Affiliation(s)
- Kapil Sayal
- University of Nottingham, UK.,CANDAL (Centre for ADHD and Neuro-Developmental Disorders Across the Lifespan), Institute of Mental Health, Nottingham, UK
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22
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Roberts GJ, Cho E, Garwood JD, Goble GH, Robertson T, Hodges A. Reading Interventions for Students with Reading and Behavioral Difficulties: a Meta-analysis and Evaluation of Co-occurring Difficulties. EDUCATIONAL PSYCHOLOGY REVIEW 2019. [DOI: 10.1007/s10648-019-09485-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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23
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Jangmo A, Stålhandske A, Chang Z, Chen Q, Almqvist C, Feldman I, Bulik CM, Lichtenstein P, D'Onofrio B, Kuja-Halkola R, Larsson H. Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication. J Am Acad Child Adolesc Psychiatry 2019; 58:423-432. [PMID: 30768391 PMCID: PMC6541488 DOI: 10.1016/j.jaac.2018.11.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for poor school performance, and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance. METHOD A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum. RESULTS ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio = 0.80, 95% confidence interval (CI) = 0.76-0.84, and a higher grade point sum (range, 0.0-320.0) of 9.35 points, 95% CI = 7.88-10.82; standardized coefficient = 0.20. CONCLUSION ADHD has a substantial negative impact on school performance, whereas pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.
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Affiliation(s)
| | - Amanda Stålhandske
- Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Clinic, Stockholm County Council, Stockholm, Sweden
| | | | - Qi Chen
- Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Cynthia M Bulik
- Karolinska Institutet, Stockholm, Sweden; University of North Carolina at Chapel Hill, NC
| | | | - Brian D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, IN
| | | | - Henrik Larsson
- Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
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24
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Kortekaas-Rijlaarsdam AF, Luman M, Sonuga-Barke E, Oosterlaan J. Does methylphenidate improve academic performance? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2019; 28:155-164. [PMID: 29353323 DOI: 10.1007/s00787-018-1106-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD. Previous reviews on stimulant-related academic improvements are inconclusive and focus on task engagement. Recent literature suggests outcome-domain-specific medication effects that are larger for productivity than for accuracy. The aims of this study are quantifying methylphenidate effects on academic productivity and accuracy for math, reading, spelling; exploring the mediating or moderating effects of symptom improvements, demographic-, design- and disorder-related variables. PubMed, EMBASE, ERIC and PsycINFO were searched for articles reporting methylphenidate effects on academic productivity and accuracy. Thirty-four studies met entry criteria. Methylphenidate improved math productivity (7.8% increase, p < .001); math accuracy (3.0% increase, p = .001); increased reading speed (SMD .47, p < .001) but not reading accuracy. None of the mediators or moderators tested affected methylphenidate efficacy. Academic improvements were small compared to symptom improvements; qualitative changes limited to math. Clinicians should take this discrepancy into account when prescribing medication for ADHD.
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Affiliation(s)
| | - Marjolein Luman
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Jaap Oosterlaan
- Clinical Neuropsychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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25
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Fleischmann A, Dabbah S. Negev Bedouin Teachers' Attitudes Toward ADHD and Its Pharmacological Treatment. QUALITATIVE HEALTH RESEARCH 2019; 29:418-430. [PMID: 30293479 DOI: 10.1177/1049732318803892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about the attitudes of Negev Bedouin toward attention-deficit/hyperactivity disorder (ADHD) and its pharmacological treatment. This study examines the perspectives of Negev Bedouin teachers on pharmacological treatment. Thirty-six teachers are asked to consider how their views influence the way they relate to pupils' parents. A grounded-theory analysis of semistructured interviews illuminates ambivalence in teachers' attitudes. Teachers, like the rest of their community, when asked about the implications of an ADHD evaluation for their children, respond that ADHD and its pharmacological treatment cause dishonor. When asked what ADHD means when it is their pupils who are diagnosed and treated, however, teachers, like the education establishment, accept the need for medication. However, they fail to communicate this need to parents because their attempts to do so show parents that they consider their children "flawed"-causing parents to oppose treatment even more lest they succumb to social stigma.
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26
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Hawk LW, Fosco WD, Colder CR, Waxmonsky JG, Pelham WE, Rosch KS. How do stimulant treatments for ADHD work? Evidence for mediation by improved cognition. J Child Psychol Psychiatry 2018; 59:1271-1281. [PMID: 29733106 PMCID: PMC10043810 DOI: 10.1111/jcpp.12917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stimulant medications such as methylphenidate (MPH) are the frontline treatment for Attention-Deficit/Hyperactivity Disorder (ADHD). Despite their well-documented efficacy, the mechanisms by which stimulants improve clinical outcomes are not clear. The current study evaluated whether MPH effects on classroom behavior were mediated by improved cognitive functioning. METHODS Children with ADHD (n = 82; 9-12 years old) participated in a week-long summer research camp, consisting of cognitive testing, classroom periods, and recreational activities. After a baseline day, participants completed a 3-day randomized, double-blind, placebo-controlled trial of MPH (at doses approximating 0.3 and 0.6 mg/kg of immediate-release MPH dosed TID). Cognitive domains included inhibitory control (Stop Signal Task and prepulse inhibition of startle), attention (Continuous Performance Task and reaction time variability), and working memory (forward and backward spatial span). Clinical outcomes included math seatwork productivity and teacher-rated classroom behavior. A within-subjects path-analytic approach was used to test mediation. MPH-placebo and dose-response contrasts were used to evaluate drug effects. RESULTS Methylphenidate improved seatwork productivity and teacher ratings (ds = 1.4 and 1.1) and all domains of cognition (ds = 0.3-1.1). Inhibitory control (Stop Signal Task, SST) and working memory backward uniquely mediated the effect of MPH (vs. placebo) on productivity. Only working memory backward mediated the impact of MPH on teacher-rated behavior. The dose-response (0.6 vs. 0.3 mg/kg) effects were more modest for clinical outcomes (ds = 0.4 and 0.2) and cognition (ds = 0-0.3); there was no evidence of cognitive mediation of the clinical dose-response effects. CONCLUSIONS These findings are novel in demonstrating that specific cognitive processes mediate clinical improvement with stimulant treatment for ADHD. They converge with work on ADHD theory, neurobiology, and treatment development in suggesting that inhibitory control and working memory may be mechanisms of stimulant treatment response in ADHD. More work is necessary to evaluate the degree to which these findings generalize to chronic treatment, a broader array of clinical outcomes, and nonstimulant treatments.
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Affiliation(s)
- Larry W Hawk
- Departments of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA.,Center for Children and Families, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Whitney D Fosco
- Departments of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Craig R Colder
- Departments of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - James G Waxmonsky
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - William E Pelham
- Department of Psychology, Florida International University, Miami, FL, USA.,Center for Children and Families, Florida International University, Miami, FL, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Orban SA, Karamchandani TA, Tamm L, Sidol CA, Peugh J, Froehlich TE, Brinkman WB, Estell N, Mii AE, Epstein JN. Attention-Deficit/Hyperactivity Disorder-Related Deficits and Psychostimulant Medication Effects on Comprehension of Audiovisually Presented Educational Material in Children. J Child Adolesc Psychopharmacol 2018; 28:727-738. [PMID: 30148660 PMCID: PMC6306678 DOI: 10.1089/cap.2018.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: We aimed to (1) examine differences in observed visual attention and motor activity, as well as comprehension of a science video between children with and without attention-deficit/hyperactivity disorder (ADHD) and (2) explore if psychostimulant medication improves ADHD behaviors and comprehension of a science video in children with ADHD. Method: Children aged 7-11 with (n = 91) and without (n = 45) ADHD watched a science video and then completed a comprehension test. Then, children with ADHD began a 4-week within-subject, randomized, double-blind crossover trial of methylphenidate (MPH). At post-testing, children were randomized to receive placebo or their optimal dosage, watched another science film, and completed a comprehension test. Results: Children with ADHD exhibited higher rates of motor activity during, and worse comprehension of material discussed within, the science video. Mediation models revealed that increased motor activity suppressed between-group differences in comprehension. MPH improved comprehension and visual attention, but not motor activity during the science video. Conclusion: Children with ADHD may benefit from MPH to improve comprehension of and sustained attention during audiovisually presented learning material.
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Affiliation(s)
- Sarah A. Orban
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,Address correspondence to: Sarah A. Orban, PhD, Department of Psychology, University of Tampa, 401 W. Kennedy Blvd. SC 253, Tampa, FL, 33606
| | - Tanya A. Karamchandani
- Department of Rehabilitation Psychology/Neuropsychology, TIRR Memorial Hermann Rehabilitation Network, Houston, Texas.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Baylor University, Houston, Texas
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Craig A. Sidol
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
| | - James Peugh
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tanya E. Froehlich
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - William B. Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Estell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio
| | - Akemi E. Mii
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio
| | - Jeffery N. Epstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Center for ADHD, Cincinnati, Ohio.,College of Medicine, University of Cincinnati, Cincinnati, Ohio
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28
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Feldman ME, Charach A, Bélanger SA. Le TDAH chez les enfants et les adolescents, partie 2 : le traitement. Paediatr Child Health 2018; 23:473-484. [PMCID: PMC6199638 DOI: 10.1093/pch/pxy114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Le trouble de déficit de l’attention/hyperactivité (TDAH) est un trouble neurodéveloppemental chronique. La Société canadienne de pédiatrie a préparé trois documents de principes après avoir effectué des analyses bibliographiques systématiques. Leurs objectifs s’établissent comme suit : 1) Résumer les données probantes cliniques à jour sur le TDAH. 2) Établir une norme pour les soins du TDAH. 3) Aider les cliniciens canadiens à prendre des décisions éclairées et fondées sur des données probantes pour rehausser la qualité des soins aux enfants et aux adolescents qui présentent cette affection. La partie 2, axée sur le traitement, porte sur les données probantes et le contexte entourant diverses approches cliniques, la combinaison des interventions comportementales et pharmacologiques pour assurer un traitement plus efficace, le rôle de la formation des parents et des enseignants (ou des autres personnes qui s’occupent de l’enfant), le recours aux stimulants et aux non-stimulants, leurs effets et leurs risques, leur posologie et les protocoles de surveillance. Les recommandations thérapeutiques reposent sur les lignes directrices à jour, les données probantes tirées de publications scientifiques et le consensus d’experts.
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Affiliation(s)
- Mark E Feldman
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Alice Charach
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Stacey A Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
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29
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Feldman ME, Charach A, Bélanger SA. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health 2018; 23:462-472. [PMID: 30681665 DOI: 10.1093/pch/pxy113] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 2, which focuses on treatment, include: evidence and context for a range of clinical approaches, combining behavioural and pharmacological interventions to address impairment more effectively, the role of parent and teacher (or other caregiver) training, the use of stimulant and nonstimulant medications, with effects and risks, and dosing and monitoring protocols. Treatment recommendations are based on current guidelines, evidence from the literature, and expert consensus.
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Affiliation(s)
- Mark E Feldman
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Stacey A Bélanger
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
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30
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Froehlich T, Fogler J, Barbaresi WJ, Elsayed NA, Evans SW, Chan E. Using ADHD Medications to Treat Coexisting ADHD and Reading Disorders: A Systematic Review. Clin Pharmacol Ther 2018; 104:619-637. [PMID: 30053315 PMCID: PMC6141313 DOI: 10.1002/cpt.1192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD), the most common pediatric neurobehavioral disorder, frequently presents with coexisting reading disorders (RDs). Despite this, it is unclear whether medication improves symptoms and function in children with comorbid ADHD and RD. We present a systematic review of studies investigating the effects of ADHD medications on ADHD symptoms, academic outcomes, and neuropsychological measures in this important group.
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Affiliation(s)
- Tanya Froehlich
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
| | - William J. Barbaresi
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
| | - Nada A. Elsayed
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine
| | | | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston MA
- Harvard Medical School, Boston, MA
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31
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Burk JA, Blumenthal SA, Maness EB. Neuropharmacology of attention. Eur J Pharmacol 2018; 835:162-168. [PMID: 30092180 PMCID: PMC6140347 DOI: 10.1016/j.ejphar.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022]
Abstract
Early philosophers and psychologists defined and began to describe attention. Beginning in the 1950's, numerous models of attention were developed. This corresponded with an increased understanding of pharmacological approaches to manipulate neurotransmitter systems. The present review focuses on the knowledge that has been gained about these neurotransmitter systems with respect to attentional processing, with emphasis on the functions mediated within the medial prefrontal cortex. Additionally, the use of pharmacotherapies to treat psychiatric conditions characterized by attentional dysfunction are discussed. Future directions include developing a more comprehensive understanding of the neural mechanisms underlying attentional processing and novel pharmacotherapeutic targets for conditions characterized by aberrant attentional processing.
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Affiliation(s)
- Joshua A Burk
- Department of Psychological Sciences, College of William and Mary, Williamsburg, VA 23187, USA.
| | - Sarah A Blumenthal
- Department of Psychological Sciences, College of William and Mary, Williamsburg, VA 23187, USA
| | - Eden B Maness
- Department of Psychological Sciences, College of William and Mary, Williamsburg, VA 23187, USA
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32
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AlZaben FN, Sehlo MG, Alghamdi WA, Tayeb HO, Khalifa DA, Mira AT, Alshuaibi AM, Alguthmi MA, Derham AA, Koenig HG. Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia. Saudi Med J 2018; 39:52-58. [PMID: 29332109 PMCID: PMC5885121 DOI: 10.15537/smj.2018.1.21288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To determine the prevalence of attention deficit hyperactivity disorder (ADHD), subtypes of ADHD, and psychiatric, academic, and behavioral comorbidity in public primary school students in Jeddah, Saudi Arabia. Methods: This is a cross-sectional study. A simple random sample of 6 primary government schools in Jeddah, Saudi Arabia, was identified (3 male, 3 female), and a random sample of classes in each of grades 1-6 were selected. Between July and November 2016, teachers in these classes were asked to complete the Vanderbilt ADHD scale on all students in their classes. Results: A total of 929 students were screened. The overall prevalence of ADHD was 5% (5.3% in girls, 4.7% in boys). The most prevalent subtype of ADHD was combined type (2.7%), followed by hyperactive type (1.2%), and inattentive type (1.1%). The highest prevalence of ADHD overall was in grade 3 (7.1%) and the lowest prevalence in grade 6 (3.4%). Among students with ADHD, prevalence of comorbid psychiatric, academic, and behavioral problems was widespread (56.5% oppositional defiant disorder/conduct disorder, 54.4% impaired academic performance, 44.4% classroom behavioral problems, 41.3% depression/anxiety). Comorbid problems were especially prevalent in combined ADHD subtype and in boys. Conclusions: Attention deficit hyperactivity disorder is common in primary school children in Jeddah, and is associated with widespread psychiatric, academic, and behavioral problems, especially in boys. These findings have implications for the diagnosis and treatment of this serious neurobehavioral disorder.
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Affiliation(s)
- Faten N AlZaben
- Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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33
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Moreira-Maia CR, Massuti R, Tessari L, Campani F, Akutagava-Martins GC, Cortese S, Augusto Rohde L. Are ADHD medications under or over prescribed worldwide?: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10923. [PMID: 29901582 PMCID: PMC6023876 DOI: 10.1097/md.0000000000010923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, characterized by age inappropriate and impairing levels of inattention and/or hyperactivity/impulsivity. Pharmacotherapy is an important part of the ADHD multimodal treatment. The extent to which ADHD is pharmacologically over or under treated worldwide is controversial. We aimed to estimate the pooled worldwide rate of ADHD pharmacological treatment in individuals with and without the disorder. METHOD AND ANALYSIS We will include published or unpublished studies reporting the rates of ADHD pharmacological treatment in participants with and without ADHD of any age group. Population-based, cohort, or follow-up studies, as well as data from insurance health system and third-party reimbursements will be eligible. Searches will be performed in a large number of electronic databases, including Medline, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Scopus. The primary outcome will be the prevalence of ADHD pharmacological treatment in individuals with ADHD and without ADHD. Two independent reviewers will perform the screening, and data extraction process. Study quality/bias will be assessed with the Newcastle-Ottawa scale by 2 independent reviewers. To test the robustness of the findings, we will perform a series of sensitivity and meta-regression analysis. Analyses will be performed with R and STATA software. ETHICS AND DISSEMINATION No IRB approval will be necessary. The results of this systematic review and meta-analysis will be presented at international conferences and published in peer-reviewed journals. REGISTRATION AND STATUS PROSPERO 2018 CRD42018085233.
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Affiliation(s)
- Carlos Renato Moreira-Maia
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Massuti
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luca Tessari
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton; Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton
| | - Fausto Campani
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Glaucia Chiyoko Akutagava-Martins
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- College of Medicine, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | - Samuele Cortese
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton; Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York, NY
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Luis Augusto Rohde
- ADHD Outpatient Program (PRODAH), Child and Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Porto Alegre, Brazil
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L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neurenf.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Lystad GO, Johannessen B. Acupuncture and Methylphenidate Drugs in Adults with Attention Deficit Hyperactivity Disorder: A Pilot Study of Self-Reported Symptoms. Complement Med Res 2017; 25:198-200. [DOI: 10.1159/000476064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallon S, Luis EO, Zallo NA, de Castro-Manglano P, Soutullo C, Arrondo G. Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e018027. [PMID: 28951416 PMCID: PMC5623547 DOI: 10.1136/bmjopen-2017-018027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Attention-deficit hyperactivity disorder (ADHD) has been related to increased rates of unintentional injuries. However, the magnitude of the effect and to which extent variables such as sex, age or comorbidity can influence this relationship is unknown. Additionally, and importantly, it is unclear if, and to which degree, ADHD medications can decrease the number of unintentional injuries. Due to the amount of economic and social resources invested in the treatment of injuries, filling these gaps in the literature is highly relevant from a public health standpoint. Here, we present a protocol for a systematic review and meta-analysis to estimate the relationship between ADHD and unintentional injuries and assess the impact of pharmacological treatment for ADHD METHODS AND ANALYSIS: We will combine results from 114 bibliographic databases for studies relating ADHD and risk of injuries. Bibliographic searches and data extraction will be carried out independently by two researchers. The studies' risk of bias will be assessed using the Newcastle-Ottawa Scale. Articles reporting ORs or HRs of suffering an injury in ADHD compared with controls (or enough data to calculate them) will be combined using Robust Variance Estimation, a method that permits to include multiple non-independent outcomes in the analysis. All analyses will be carried out in Stata. Age, sex and comorbid conduct disorders will be considered as potential causes of variance and their effect analysed through meta-regression and subgroup analysis. Sensitivity analyses will exclude articles with longer follow-ups, non-stringent definitions of ADHD or controls and statistically uncontrolled/controlled outcomes. Studies implementing a self-controlled case series methodology to investigate if ADHD drugs reduce the risk of injuries will be combined with a generalised linear mixed model using the Poisson distribution and a log link function. REGISTRATION DETAILS PROSPERO-Prospective Register of Systematic Reviews (CRD42017064967).
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Affiliation(s)
- Maite Ruiz-Goikoetxea
- Servicio Navarro de Salud-Osasunbidea, Servicio de Urgencias Extrahospitalarias, Pamplona, Spain
| | - Samuele Cortese
- Center for Innovation in Mental Health, University of Southampton, Academic Unit of Psychology, Southampton, UK
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK
- Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Sara Magallon
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain
| | - Elkin O Luis
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain
| | - Noelia Alvarez Zallo
- Servicio Navarro de Salud-Osasunbidea, Servicio de Urgencias Extrahospitalarias, Pamplona, Spain
| | - Pilar de Castro-Manglano
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cesar Soutullo
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gonzalo Arrondo
- Instituto Cultura y Sociedad (ICS), Grupo Mente-Cerebro, Universidad de Navarra, Pamplona, Spain
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Fostick L. The Effect of Attention-Deficit/Hyperactivity Disorder and Methylphenidate Treatment on the Adult Auditory Temporal Order Judgment Threshold. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2124-2128. [PMID: 28672285 DOI: 10.1044/2017_jslhr-h-16-0074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/04/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition notes that attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood will persist into adulthood among at least some individuals. There is a paucity of evidence, however, regarding whether other difficulties that often accompany childhood ADHD will also continue into adulthood, specifically auditory processing deficits. The aim of this study was to examine the effect of ADHD and the stimulant medication methylphenidate on auditory perception performance among adults. METHOD A total of 33 adults diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria (ADHD group) and 48 adults without ADHD (non-ADHD group) performed an auditory temporal order judgment task. Participants with ADHD performed the task twice: with and without taking methylphenidate (Ritalin), in random order. RESULTS Temporal order judgment thresholds of the ADHD group were significantly higher than those of the non-ADHD group. Methylphenidate significantly decreased temporal order judgment thresholds within the ADHD group, making their performance similar to the non-ADHD participants. CONCLUSIONS Auditory processing difficulties of those diagnosed with ADHD seem to persist into adulthood. Similar to findings with children, methylphenidate treatment improves performance on tasks requiring this ability among adults. Therefore, given the association between auditory temporal processing and linguistic skills, the beneficial effect of methylphenidate on adults' academic achievement may be accomplished by positively affecting auditory temporal processing. Further studies in this line of research are needed.
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Affiliation(s)
- Leah Fostick
- Department of Communication Disorders, Ariel University, Israel
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Fleishmann A, Kaliski A. Personal Autonomy and Authenticity: Adolescents’ Discretionary Use of Methylphenidate. NEUROETHICS-NETH 2017. [DOI: 10.1007/s12152-017-9338-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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40
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Holmskov M, Storebø OJ, Moreira-Maia CR, Ramstad E, Magnusson FL, Krogh HB, Groth C, Gillies D, Zwi M, Skoog M, Gluud C, Simonsen E. Gastrointestinal adverse events during methylphenidate treatment of children and adolescents with attention deficit hyperactivity disorder: A systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. PLoS One 2017; 12:e0178187. [PMID: 28617801 PMCID: PMC5472278 DOI: 10.1371/journal.pone.0178187] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/08/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To study in more depth the relationship between type, dose, or duration of methylphenidate offered to children and adolescents with attention deficit hyperactivity disorder and their risks of gastrointestinal adverse events based on our Cochrane systematic review. METHODS AND FINDINGS We use data from our review including 185 randomised clinical trials. Randomised parallel-group trials and cross-over trials reporting gastrointestinal adverse events associated with methylphenidate were included. Data were extracted and quality assessed according to Cochrane guidelines. Data were summarised as risk ratios (RR) with 95% confidence intervals (CI) using the inverse variance method. Bias risks were assessed according to domains. Trial Sequential Analysis (TSA) was used to control random errors. Eighteen parallel group trials and 43 cross-over trials reported gastrointestinal adverse events. All trials were at high risk of bias. In parallel group trials, methylphenidate decreased appetite (RR 3.66, 95% CI 2.56 to 5.23) and weight (RR 3.89, 95% CI 1.43 to 10.59). In cross-over trials, methylphenidate increased abdominal pain (RR 1.61, 95% CI 1.27 to 2.04). We found no significant differences in the risk according to type, dose, or duration of administration. The required information size was achieved in three out of four outcomes. CONCLUSION Methylphenidate increases the risks of decreased appetite, weight loss, and abdominal pain in children and adolescents with attention deficit hyperactivity disorder. No differences in the risks of gastrointestinal adverse events according to type, dose, or duration of administration were found.
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Affiliation(s)
- Mathilde Holmskov
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
- Psychological Institute, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Erica Ramstad
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Frederik Løgstrup Magnusson
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Helle B. Krogh
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Denmark
| | - Camilla Groth
- Pediatric Department E, Herlev University Hospital, Herlev, Denmark
| | - Donna Gillies
- Western Sydney Local Health District; Mental Health, Parramatta, Australia
| | - Morris Zwi
- Islington CAMHS, Whittington Health, London, United Kingdom
| | - Maria Skoog
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Fourneret P, Poissant H. [Learning disorders in ADHD: How are they related?]. Arch Pediatr 2017; 23:1276-1283. [PMID: 28492169 DOI: 10.1016/j.arcped.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 08/03/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
Learning difficulties in general and learning disabilities in particular are almost constant in attention deficit disorder with or without hyperactivity (ADHD). Despite a major research effort, the extent and diversity of these comorbid events still raise many questions about the exact nature of their pathogenetic condition (simple consequences of ADHD or specific related disorders?) and consequently the best way to support them. This article aims to present a brief review of the current data.
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Affiliation(s)
- P Fourneret
- Service psychopathologie du développement, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Laboratoire L2C2 UMR 5304 CNRS, université Claude-Bernard-Lyon 1, 69677 Bron, France; Département d'éducation et de pédagogie, faculté des sciences humaines, institut des sciences cognitives, UQAM, Montréal, Canada.
| | - H Poissant
- Département d'éducation et de pédagogie, faculté des sciences humaines, institut des sciences cognitives, UQAM, Montréal, Canada
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de Zeeuw EL, van Beijsterveldt CEM, Ehli EA, de Geus EJC, Boomsma DI. Attention Deficit Hyperactivity Disorder Symptoms and Low Educational Achievement: Evidence Supporting A Causal Hypothesis. Behav Genet 2017; 47:278-289. [PMID: 28191586 PMCID: PMC5403868 DOI: 10.1007/s10519-017-9836-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) and educational achievement are negatively associated in children. Here we test the hypothesis that there is a direct causal effect of ADHD on educational achievement. The causal effect is tested in a genetically sensitive design to exclude the possibility of confounding by a third factor (e.g. genetic pleiotropy) and by comparing educational achievement and secondary school career in children with ADHD who take or do not take methylphenidate. Data on ADHD symptoms, educational achievement and methylphenidate usage were available in a primary school sample of ~10,000 12-year-old twins from the Netherlands Twin Register. A substantial group also had longitudinal data at ages 7-12 years. ADHD symptoms were cross-sectionally and longitudinally, associated with lower educational achievement at age 12. More ADHD symptoms predicted a lower-level future secondary school career at age 14-16. In both the cross-sectional and longitudinal analyses, testing the direct causal effect of ADHD on educational achievement, while controlling for genetic and environmental factors, revealed an association between ADHD symptoms and educational achievement independent of genetic and environmental pleiotropy. These findings were confirmed in MZ twin intra-pair differences models, twins with more ADHD symptoms scored lower on educational achievement than their co-twins. Furthermore, children with ADHD medication, scored significantly higher on the educational achievement test than children with ADHD who did not use medication. Taken together, the results are consistent with a direct causal effect of ADHD on educational achievement.
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Affiliation(s)
- Eveline L de Zeeuw
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- Amsterdam Public Health research institute, VU Medical Centre, Amsterdam, The Netherlands.
| | - Catharina E M van Beijsterveldt
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, VU Medical Centre, Amsterdam, The Netherlands
| | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, SD, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, VU Medical Centre, Amsterdam, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, VU Medical Centre, Amsterdam, The Netherlands
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Short-Term Effects of Methylphenidate on Math Productivity in Children With Attention-Deficit/Hyperactivity Disorder are Mediated by Symptom Improvements: Evidence From a Placebo-Controlled Trial. J Clin Psychopharmacol 2017; 37:210-219. [PMID: 28145999 DOI: 10.1097/jcp.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although numerous studies report positive effects of methylphenidate on academic performance, the mechanism behind these improvements remains unclear. This study investigates the effects of methylphenidate on academic performance in children with attention-deficit/hyperactivity disorder (ADHD) and the mediating and moderating influence of ADHD severity, academic performance, and ADHD symptom improvement. METHODS Sixty-three children with ADHD participated in a double-blind placebo-controlled crossover study comparing the effects of long-acting methylphenidate and placebo. Dependent variables were math, reading, and spelling performance. The ADHD group performance was compared with a group of 67 typically developing children. RESULTS Methylphenidate improved math productivity and accuracy in children with ADHD. The effect of methylphenidate on math productivity was partly explained by parent-rated symptom improvement, with greater efficacy for children showing more symptom improvement. Further, children showing below-average math performance while on placebo profited more from methylphenidate than children showing above-average math performance. CONCLUSIONS The results from this study indicate positive effects of methylphenidate on academic performance, although these were limited to math abilities. In light of these results, expectations of parents, teachers, and treating physicians about the immediate effects of methylphenidate on academic improvement should be tempered. Moreover, our results implicate that positive effects of methylphenidate on math performance are in part due directly to effects on math ability and in part due to reductions in ADHD symptoms.
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Methylphenidate use and school performance among primary school children: a descriptive study. BMC Psychiatry 2017; 17:116. [PMID: 28356095 PMCID: PMC5371237 DOI: 10.1186/s12888-017-1279-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/18/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is no conclusive evidence that stimulants have beneficial effects on major associated outcome parameters, particularly school performance. We assessed the differences in school performance among children using methylphenidate at the end of primary school in relation to various parameters of methylphenidate use. METHODS We linked children from a pharmacy prescription database with standardized achievement test results at the end of primary school. We explored differences in test scores between current methylphenidate users versus never users and methylphenidate users who stopped treatment at least 6 months before the test, early versus late starters, different dosage of methylphenidate, and concurrent antipsychotic or asthma treatment. RESULTS Out of the 7736 children, 377 (4.9%) children were treated with methylphenidate at the time of the test. After adjusting for confounders the methylphenidate users (532.58 ± .48) performed significantly lower on the test than never users (534.72 ± .11). Compared with late starters of methylphenidate treatment (536.94 ± 1.51) we found significantly lower test scores for the early starters (532.33 ± .50). CONCLUSION Our study indicates that children using methylphenidate still perform less at school compared to their peers. Our study also suggests that earlier start of methylphenidate treatment is associated with a lower school performance compared to children starting later with the treatment. This result could either indicate a limited effect of long term treatment or a more strongly affected group of early starters.
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Marx I, Weirich S, Berger C, Herpertz SC, Cohrs S, Wandschneider R, Höppner J, Häßler F. Living in the Fast Lane: Evidence for a Global Perceptual Timing Deficit in Childhood ADHD Caused by Distinct but Partially Overlapping Task-Dependent Cognitive Mechanisms. Front Hum Neurosci 2017; 11:122. [PMID: 28373837 PMCID: PMC5357633 DOI: 10.3389/fnhum.2017.00122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 03/03/2017] [Indexed: 11/13/2022] Open
Abstract
Dysfunctions in perceptual timing have been reported in children with ADHD, but so far only from studies that have not used the whole set of timing paradigms available from the literature, with the diversity of findings complicating the development of a unified model of timing dysfunctions and its determinants in ADHD. Therefore, we employed a comprehensive set of paradigms (time discrimination, time estimation, time production, and time reproduction) in order to explore the perceptual timing deficit profile in our ADHD sample. Moreover, we aimed to detect predictors responsible for timing task performance deficits in children with ADHD and how the timing deficits might be positively affected by methylphenidate. Male children with ADHD and healthy control children, all aged between 8 and 13 years, participated in this longitudinal study with three experimental sessions, where children with ADHD were medicated with methylphenidate at the second session but discontinued their medication at the remaining sessions. The results of our study reveal that children with ADHD were impaired in all timing tasks, arguing for a general perceptual timing deficit in ADHD. In doing so, our predictor analyses support the notion that distinct but partially overlapping cognitive mechanisms might exist for discriminating, estimating/producing, and reproducing time intervals. In this sense, working memory deficits in terms of an abnormally fast internal counting process might be common to dysfunctions in the time estimation/time production tasks and in the time reproduction task, with attention deficits (e.g., in terms of disruptions of the counting process) additionally contributing to time estimation/time production deficits and motivational alterations additionally contributing to time reproduction deficits. Methylphenidate did not significantly alter performance of the ADHD sample, presumably due to limited statistical power of our study. The findings of our study demonstrate a pivotal role of disturbed working memory processes in perceptual timing task performance in childhood ADHD, at the same time broadening the view for additional attentional and motivational determinants of impaired task performance.
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Affiliation(s)
- Ivo Marx
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Steffen Weirich
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Christoph Berger
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Stefan Cohrs
- Department of Psychiatry and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Roland Wandschneider
- Department of Psychiatry and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Jacqueline Höppner
- Department of Psychiatry and Psychotherapy, University Medicine Rostock Rostock, Germany
| | - Frank Häßler
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock Rostock, Germany
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VP190 A Review Of Best Practices In Five Mental Disorders In Youth. Int J Technol Assess Health Care 2017. [DOI: 10.1017/s0266462317004184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION:In order to support service planning of the youth program of the East of Montreal Health and Social Services Board, and potentially of the other twenty-five programs across the Quebec province, our hospital-based Health Technology Assessment (HTA) unit was asked to bring evidence of the effective interventions for five most common mental disorders in children and young populations, namely anxio-depressive disorders, attention deficit and hyperactivity disorder, oppositional and conduct disorders, substance abuse disorders, and suicide attempts.METHODS:A review of reviews was conducted for the five disorders in young populations aged 6 to 25 years. This was based exclusively on systematic reviews and meta-analysis of a minimum two randomized-controlled trials. The review was completed with examples of Quebec's good practices in youth mental health gathered from personal research experience of clinical researchers involved in the project. The project involved collaboration with three other hospital units and provincial HTA agencies.RESULTS:No review supporting screening and early detection for the five disorders was identified. Prevention, however, was better covered in the literature, and a clear distinction was made between universal, targeted and indicated interventions. In general, targeted and indicated prevention interventions were effective in the case of anxio-depressive (1) and substance use disorders, while universal prevention strategies seemed to reduce suicide attempts and suicide ideation (2). Effective treatments also exist for these mental disorders. In general, psychotherapies dominated for anxio-depressive and substance use disorders; parental skills dominated in oppositional disorders, whilst pharmacological treatment dominated in attention deficit and hyperactivity disorder (3). Evidence was limited for suicide attempts. The overview of Quebec's good practices allowed identification of interventions or practices already in use in the province.CONCLUSIONS:The review summarized effective interventions for five most common mental disorders in young populations. It also permitted to identify several research gaps, and therefore research recommendations were formulated for the province's health research agency.
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Tannock R, Frijters JC, Martinussen R, White EJ, Ickowicz A, Benson NJ, Lovett MW. Combined Modality Intervention for ADHD With Comorbid Reading Disorders: A Proof of Concept Study. JOURNAL OF LEARNING DISABILITIES 2016; 51:55-72. [PMID: 27895238 DOI: 10.1177/0022219416678409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Sixty-five children (7-11 years in age) were assigned randomly to one of three intensive remedial academic programs (phonologically or strategy-based reading instruction, or general academic strategy and social skills training) in combination with either immediate-release methylphenidate or placebo. Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction in 10 weeks, taught by a trained teacher in a separate school classroom, in small matched groups of 2 to 3. Children's behavior and reading abilities were assessed before and after intervention. Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral symptoms (reported by classroom teachers) but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Intensive reading instruction, regardless of treatment with stimulant medication, may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.
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Affiliation(s)
- Rosemary Tannock
- 1 The Hospital for Sick Children, Toronto, ON, Canada
- 2 University of Toronto, ON, Canada
| | | | | | | | - Abel Ickowicz
- 1 The Hospital for Sick Children, Toronto, ON, Canada
- 2 University of Toronto, ON, Canada
| | | | - Maureen W Lovett
- 1 The Hospital for Sick Children, Toronto, ON, Canada
- 2 University of Toronto, ON, Canada
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Dougherty DM, Olvera RL, Acheson A, Hill-Kapturczak N, Ryan SR, Mathias CW. Acute effects of methylphenidate on impulsivity and attentional behavior among adolescents comorbid for ADHD and conduct disorder. J Adolesc 2016; 53:222-230. [PMID: 27816696 DOI: 10.1016/j.adolescence.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 01/24/2023]
Abstract
Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) experience deficits in neuropsychological measures of attention, inhibition, and reward processes. Methylphenidate treatment for ADHD and CD has acute effects on these processes. Some of these same aspects of performance are separately described in the Behavioral Model of Impulsivity, which uses a modified approach to measurement. This study characterized the acute effects of methylphenidate attention, initiation, inhibition, and reward processes described in this model of impulsivity. Thirty-one adolescents from the United States of America with comorbid ADHD and CD completed measures of impulsivity (response initiation, response inhibition, and consequence) and attention following placebo, 20 mg, and 40 mg of a long-acting dose of methylphenidate. Methylphenidate effects on attentional performance was more robust than on any of the measures of impulsivity. Adolescent performance from this behavioral perspective is interpreted in the context of divergence from previous neuropsychological tests of acute methylphenidate effects.
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Affiliation(s)
- Donald M Dougherty
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Rene L Olvera
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ashley Acheson
- Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacy R Ryan
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Charles W Mathias
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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McCracken JT, McGough JJ, Loo SK, Levitt J, Del'Homme M, Cowen J, Sturm A, Whelan F, Hellemann G, Sugar C, Bilder RM. Combined Stimulant and Guanfacine Administration in Attention-Deficit/Hyperactivity Disorder: A Controlled, Comparative Study. J Am Acad Child Adolesc Psychiatry 2016; 55:657-666.e1. [PMID: 27453079 PMCID: PMC4976782 DOI: 10.1016/j.jaac.2016.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/14/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Because models of attention-deficit/hyperactivity disorder (ADHD) therapeutics emphasize benefits of both enhanced dopaminergic and noradrenergic signaling, strategies to enhance D1 and α2A agonism may yield enhanced clinical and cognitive responses. This study tested the hypothesis that combined effects of a dopamine and noradrenergic agonist, d-methylphenidate extended-release (DMPH) with guanfacine (GUAN), an α2A receptor agonist, would be clinically superior to either monotherapy and would have equal tolerability. METHOD An 8-week, double-blind, 3-arm, comparative trial randomized 7- to 14-year-olds with DSM-IV ADHD to GUAN (1-3 mg/day), DMPH (5-20 mg/day), or a combination (COMB) with fixed-flexible dosing. Outcome measures were the ADHD Rating Scale IV (ADHD-RS-IV) and the Clinical Global Impression-Improvement (CGI-I) scale. Data on adverse events and safety measures were obtained. RESULTS A total of 207 participants were randomized and received drug. Analyses showed significant treatment group main effects for ADHD-RS-IV ADHD total (p = .0001) and inattentive symptoms (p = .0001). COMB demonstrated small but consistently greater reductions in ADHD-RS-IV Inattentive subscale scores versus monotherapies (DMPH: p = .05; f(2) = .02; and GUAN: p = .02; f(2) = .02), and was associated with a greater positive response rate by CGI-I (p = .01). No serious cardiovascular events occurred. Sedation, somnolence, lethargy, and fatigue were greater in both guanfacine groups. All treatments were well tolerated. CONCLUSION COMB showed consistent evidence of clinical benefits over monotherapies, possibly reflecting advantages of greater combined dopaminergic and α2A agonism. Adverse events were generally mild to moderate, and COMB treatment showed no differences in safety or tolerability. CLINICAL TRIAL REGISTRATION INFORMATION Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder (Project1); http://clinicaltrials.gov/; NCT00429273.
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Affiliation(s)
- James T. McCracken
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - James J. McGough
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Sandra K. Loo
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Jennifer Levitt
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Melissa Del'Homme
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Jennifer Cowen
- Semel Institute for Neuroscience and Human Behavior at UCLA
| | | | - Fiona Whelan
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Gerhard Hellemann
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Catherine Sugar
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.,UCLA School of Public Health
| | - Robert M. Bilder
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.,UCLA College of Letters and Science
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Approaches to learning and medicated ADHD: The potential impact on learning and assessment. LEARNING AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.lindif.2015.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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