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Isfandnia F, El Masri S, Radua J, Rubia K. The effects of chronic administration of stimulant and non-stimulant medications on executive functions in ADHD: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 162:105703. [PMID: 38718988 DOI: 10.1016/j.neubiorev.2024.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with executive function deficits that are improved with medications. However, meta-analyses of stimulant effects on cognition have mostly tested single-dose effects, and there is no meta-analysis of non-stimulant effects. This systematic review and meta-analysis tested the clinically more relevant longer-term effects of Methylphenidate (20 studies; minimum 1 week) and Atomoxetine (8 studies; minimum 3 weeks) on reaction time, attention, inhibition, and working memory, searching papers on PubMed, Embase, Ovid MEDLINE, and PsycINFO. The meta-analysis of 18 studies in 1667 subjects showed that methylphenidate was superior to placebo in all cognitive domains with small to medium effect sizes (Hedges g of 0.34-0.59). The meta-analysis of atomoxetine included 7 studies in 829 subjects and showed no effects in working memory, but superior effects in the other domains with medium to large effect sizes (Hedge's g of 0.36-0.64). Meta-regression analysis showed no drug differences on cognitive effects. The meta-analyses show for the first time that chronic Methylphenidate and Atomoxetine have comparable effects of improving executive functions in people with ADHD.
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Affiliation(s)
- Ferdous Isfandnia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sahid El Masri
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Child & Adolescent Psychiatry, University Hospital Carl Gustav Dresden, Dresden University of Technology, Germany.
| | - Joaquim Radua
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Child & Adolescent Psychiatry, University Hospital Carl Gustav Dresden, Dresden University of Technology, Germany.
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Raudeniece J, Vanags E, Justamente I, Skara D, Fredriksen PM, Brownlee I, Reihmane D. Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study). BMC Public Health 2024; 24:544. [PMID: 38383413 PMCID: PMC10882845 DOI: 10.1186/s12889-024-18055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects. METHODS This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays. RESULTS Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score. CONCLUSIONS The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.
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Affiliation(s)
- Jelena Raudeniece
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Edmunds Vanags
- Department of Psychology, Faculty of Education, Psychology and Art, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
| | - Ilze Justamente
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Dana Skara
- Department of Psychology, Faculty of Education, Psychology and Art, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia
| | - Per Morten Fredriksen
- Department of Biotechology, Faculty of Applied Ecology, Agricultural Sciences and Biotechnology, Inland Norway University of Applied Sciences, 2318, Hamar, Norway
| | - Iain Brownlee
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Dace Reihmane
- Department of Human and Animal Physiology, Faculty of Biology, University of Latvia, Jelgavas Street 1, Riga, LV-1004, Latvia.
- Department of Human Physiology and Biochemistry, Riga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia.
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3
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Kanevski M, Booth JN, Stewart TM, Rhodes SM. Cognition and maths in children with Attention-Deficit/Hyperactivity disorder with and without co-occurring movement difficulties. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 136:104471. [PMID: 36924616 DOI: 10.1016/j.ridd.2023.104471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/26/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Movement difficulties are common in ADHD, however, the implications of their co-occurrences on cognitive and maths performance is unknown. AIMS This study set out to examine whether cognitive and maths performance of children with high ADHD symptoms differs depending on the co-occurrence of movement difficulties given evidence that weaker visuospatial processing, known to be important for maths performance, differentiates ADHD and DCD. We also aimed to examine whether relationships between cognition and maths in ADHD differs depending on co-occurring movement difficulties. METHODS Participants were 43 drug naïve children between 6 and 12 years old (M = 101.53 months SD = 19.58). The ADHD-only group (n = 18) included children with high ADHD scores, and those in the ADHD+DCD group (n = 25) concurrently had high movement difficulty scores. All completed executive function and memory, including 2 visuo-spatial memory tasks from the CANTAB battery and Mathematics Problem Solving, Numeracy, and Maths Fluency tasks from the WIAT-III and specific factual, conceptual, and procedural maths component tasks. RESULTS Children in the ADHD+DCD group scored significantly lower on visuospatial working memory (WM) capacity, than those in the ADHD-only group. Both groups were comparable on all other cognitive assessments of executive functions, memory, and processing speed. The groups did not differ in their maths attainment scores, nor on more specific maths skills. Comparison of the correlations between cognitive processes and maths revealed that the association between visuospatial WM updating and procedural skill efficiency was stronger for the ADHD-only group. Moreover, associations between visuospatial WM and maths problem solving attainment were stronger in the ADHD+DCD group. CONCLUSIONS Despite similarities in maths performance, children with ADHD+DCD could be distinguished by lower visuospatial WM. Differential associations with some of the maths domain implicate recruitment of different cognitive processes for some aspects of maths. This distinction can be particularly useful for conceptualising cognitive characteristics of different clinical groups and understanding cognitive pathways of maths difficulties. Implications for interventions are discussed.
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Affiliation(s)
| | - Josephine N Booth
- University of Edinburgh, Moray House School of Education and Sport, Edinburgh, UK
| | - Tracy M Stewart
- University of Edinburgh, Moray House School of Education and Sport, Edinburgh, UK
| | - Sinead M Rhodes
- University of Edinburgh, Clinical Brain Sciences, Edinburgh, UK.
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4
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Mckenzie A, Meshkat S, Lui LMW, Ho R, Di Vincenzo JD, Ceban F, Cao B, McIntyre RS. The effects of psychostimulants on cognitive functions in individuals with attention-deficit hyperactivity disorder: A systematic review. J Psychiatr Res 2022; 149:252-259. [PMID: 35303614 DOI: 10.1016/j.jpsychires.2022.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/09/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of deficits in cognitive functions which has significant implications for quality of life. Psychostimulants are demonstrated to improve symptoms of inattention and hyperactivity/impulsivity, however, their impact on cognition remains incompletely characterized. Herein, the aim of this systematic review is to synthesize the extant literature reporting on the effects of psychostimulants on cognitive function in individuals with ADHD. METHOD A systematic search of PubMed, Scopus, and Web of Science from inception to July 2021 was conducted. Additional studies were identified through Google Scholar and a manual search of the reference lists of relevant articles. Inclusion criteria were original studies that evaluated the cognitive function of individuals with ADHD taking psychostimulants drugs. We assessed the quality of the included papers using the Newcastle-Ottawa scale (NOS). RESULTS A total of 10 studies involving 753 subjects with ADHD and 194 healthy controls were identified and eligible for inclusion. Nine studies evaluated the impact of methylphenidate on cognitive function and one study investigated the use of lisdexamfetamine. Results indicated that attentional deficits such as memory, vigilance, divided attention, phasic and tonic alertness, and focused attention were improved in ADHD patients treated with psychostimulants. The efficacy of psychostimulants in improving other domains of cognition remains inconclusive due to conflicting evidence or insignificant findings (ie. academic performance and executive function). Overall, results indicate that psychostimulants may improve only select domains of cognition (ie. memory and attention). CONCLUSION Psychostimulants are reported to improve several disparate aspects of cognition among individuals with ADHD. Further research is needed to better understand the complex relationships between cognition and behavior in ADHD, as well as the impact of medication on these distinct aspects of functioning. Further research is also needed to determine whether the pro-cognitive effect of stimulants would be transferable to other mental disorders.
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Affiliation(s)
- Andrea Mckenzie
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
| | - Shakila Meshkat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger Ho
- Department of Psychological Medicine, National University Health System, Singapore; Institute for Health Innovation and Technology (iHealthtech, National University of Singapore, Singapore
| | - Joshua D Di Vincenzo
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Felicia Ceban
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, PR China
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
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Heal DJ, Gosden J, Smith SL. New Drugs to Treat ADHD: Opportunities and Challenges in Research and Development. Curr Top Behav Neurosci 2022; 57:79-126. [PMID: 35507283 DOI: 10.1007/7854_2022_332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Since the landmark MTA (Multimodal Treatment of ADHD) trial unequivocally demonstrated the efficacy of methylphenidate, catecholaminergic drugs, especially stimulants, have been the therapeutic mainstay in treatment of Attention-Deficit Hyperactivity Disorder (ADHD). We review the new drugs which have entered the ADHD formulary. The lessons learned from drug-candidates that have succeeded in clinical trials together with those that have not have also been considered. What emerges confirms and consolidates the hypothesis that clinically effective ADHD drugs indirectly or directly increase catecholaminergic neurotransmission in the prefrontal cortex (PFC). Attempts to enhance catecholaminergic signalling through modulatory neurotransmitter systems or cognitive-enhancing drugs have all failed. New drugs approved for ADHD are catecholaminergic reuptake inhibitors and releasing agents, or selective noradrenaline reuptake inhibitors. Triple reuptake inhibitors with preferential effects on dopamine have not been successful. The substantial number of failures probably accounts for a continued focus on developing novel catecholaminergic and noradrenergic drugs, and a dearth of drug-candidates with novel mechanisms entering clinical development. However, substantial improvements in ADHD pharmacotherapy have been achieved by the almost exclusive use of once-daily medications and prodrugs, e.g. lisdexamfetamine and Azstarys®, which improve compliance, deliver greater efficacy and reduce risks for diversion and abuse.
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Affiliation(s)
- David J Heal
- DevelRx Ltd, Nottingham, UK.
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
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Gutiérrez-Casares JR, Quintero J, Jorba G, Junet V, Martínez V, Pozo-Rubio T, Oliva B, Daura X, Mas JM, Montoto C. Methods to Develop an in silico Clinical Trial: Computational Head-to-Head Comparison of Lisdexamfetamine and Methylphenidate. Front Psychiatry 2021; 12:741170. [PMID: 34803764 PMCID: PMC8595241 DOI: 10.3389/fpsyt.2021.741170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Regulatory agencies encourage computer modeling and simulation to reduce the time and cost of clinical trials. Although still not classified in formal guidelines, system biology-based models represent a powerful tool for generating hypotheses with great molecular detail. Herein, we have applied a mechanistic head-to-head in silico clinical trial (ISCT) between two treatments for attention-deficit/hyperactivity disorder, to wit lisdexamfetamine (LDX) and methylphenidate (MPH). The ISCT was generated through three phases comprising (i) the molecular characterization of drugs and pathologies, (ii) the generation of adult and children virtual populations (vPOPs) totaling 2,600 individuals and the creation of physiologically based pharmacokinetic (PBPK) and quantitative systems pharmacology (QSP) models, and (iii) data analysis with artificial intelligence methods. The characteristics of our vPOPs were in close agreement with real reference populations extracted from clinical trials, as did our PBPK models with in vivo parameters. The mechanisms of action of LDX and MPH were obtained from QSP models combining PBPK modeling of dosing schemes and systems biology-based modeling technology, i.e., therapeutic performance mapping system. The step-by-step process described here to undertake a head-to-head ISCT would allow obtaining mechanistic conclusions that could be extrapolated or used for predictions to a certain extent at the clinical level. Altogether, these computational techniques are proven an excellent tool for hypothesis-generation and would help reach a personalized medicine.
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Affiliation(s)
- José Ramón Gutiérrez-Casares
- Unidad Ambulatoria de Psiquiatría y Salud Mental de la Infancia, Niñez y Adolescencia, Hospital Perpetuo Socorro, Badajoz, Spain
| | - Javier Quintero
- Servicio de Psiquiatría, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
| | - Guillem Jorba
- Anaxomics Biotech, Barcelona, Spain
- Research Programme on Biomedical Informatics (GRIB), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Valentin Junet
- Anaxomics Biotech, Barcelona, Spain
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | | | | | - Baldomero Oliva
- Research Programme on Biomedical Informatics (GRIB), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Daura
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | | | - Carmen Montoto
- Medical Department, Takeda Farmacéutica España, Madrid, Spain
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Kanevski M, Booth JN, Oldridge J, McDougal E, Stewart TM, McGeown S, Rhodes SM. The relationship between cognition and mathematics in children with attention-deficit/hyperactivity disorder: a systematic review. Child Neuropsychol 2021; 28:394-426. [PMID: 34724883 DOI: 10.1080/09297049.2021.1985444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive processes play an imperative role in children's mathematics learning. Difficulties in cognitive functioning are a core feature of Attention Deficit Hyperactivity Disorder (ADHD) in children, who also tend to show lower levels of mathematics attainment than their typically developing peers. This review (registration number: CRD42020169708) sought to aggregate findings from studies assessing the relationship between cognition and mathematics in children with a clinical ADHD diagnosis aged 4-12 years. A total of 11,799 studies published between 1992 and August 2020 were screened for eligibility using various database (PsycINFO, PubMed, SCOPUS, EMBASE, ERIC, Web of Science, and additional sources), from which four studies met inclusion criteria. A narrative synthesis was conducted on the correlations between mathematics and cognitive domains, including an evaluation of the risk of bias within the studies. Across four studies meeting inclusion criteria, memory, inhibitory control, and processing speed were assessed. The results showed a positive association between cognition and mathematics performance in this population. The strength of associations across these studies varied as a function of the cognitive domain in question, means by which mathematics performance was assessed, as well as whether confounding factors such as age and IQ were controlled for. Collectively, this review demonstrates a lack of research in this area and points to various methodological considerations for identifying the association between cognition and mathematics performance in ADHD.
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Affiliation(s)
- Margarita Kanevski
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Josephine N Booth
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Emily McDougal
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tracy M Stewart
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Sarah McGeown
- Institute of Education, Community and Society, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Rotem A, Ben-Sheetrit J, Newcorn J, Danieli Y, Peskin M, Golubchik P, Ben-Hayun R, Weizman A, Manor I. The Placebo Response in Adult ADHD as Objectively Assessed by the TOVA Continuous Performance Test. J Atten Disord 2021; 25:1311-1320. [PMID: 31965885 DOI: 10.1177/1087054719897819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We compared the placebo response (PR) as measured by the Test of Variables of Attention (TOVA) and the Conners' Adult ADHD Rating Scale (CAARS) scores. Method: A retrospective data analysis from a double-blind placebo-controlled study of metadoxine-ER in adults with ADHD. An additional database was used for comparison to TOVA response after methylphenidate challenge (TOVA-MPH-R). Results: PR was highest when calculated from the TOVA-Attention Composite Score (ACS). The PR showed significantly fewer variables improving concomitantly compared with MPH-R. The most prominent correlation between the CAARS-PR and the TOVA-PR was in the Omissions score (p = .032), which was age-dependent (b = .0007, p <.001). Discussion: TOVA-PR has an index-specific profile compared with CAARS-PR and TOVA-MPH-R. The partial correlation of TOVA-PR with CAARS-PR suggests that a composite score of TOVA specific indices and CAARS could have a synergic impact to improve the reliability of the response assessment in adult ADHD.
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Affiliation(s)
- Ann Rotem
- Geha Mental Health Center, Petah Tikva, Israel
| | | | | | | | - Miriam Peskin
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Pavel Golubchik
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Rachel Ben-Hayun
- Rambam Health Care Campus, Haifa, Israel.,Bar-Ilan University, Ramat Gan, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel.,The Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
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Efficacy and acceptability of a second dose of ecological executive skills training for children with ADHD: a randomized controlled study and follow-up. Eur Child Adolesc Psychiatry 2021; 30:921-935. [PMID: 32596788 DOI: 10.1007/s00787-020-01571-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/01/2020] [Indexed: 01/18/2023]
Abstract
To explore the efficacy and acceptability of a second dose of the 12-session ecological executive skills training (EEST) 1 year after the initial training in children with ADHD. A total of 97 children (aged 6-12) with ADHD who finished the first dose for about 1 year were recruited in the current study. 70 children who agreed to participate the second dose were randomized to the second dose or waitlist group. Both groups were followed up 1 year after the second dose. Executive function, core symptoms were assessed at the time of pre-intervention first dose, pre-intervention second dose, post-intervention second dose and follow-up 1 year after second dose (phase 0-3). For the immediate efficacy, the improvements in the second dose group were greater than the waitlist group on planning by Stockings of Cambridge and delay aversion by Cambridge gambling task (P = 0.02-0.04, η2 = 0.07-0.08). The parent rating of symptoms assessed by ADHD-RS-IV of the second dose group were also greater than the waitlist group rated by self-report. For long term efficacy, Linear mixed model indicated that there was significant time effect for both groups between phase 3 and phase 1, phase 1 and phase 0 on Behavior Rating Scales of Executive Function and ADHD-RS-IV (F = 2.849-21.560, P = 0.001-0.048). The compliance rate was 94.3% for the second dose group and 49% for waitlist group. A second dose of EEST program might bring further efficacy of EF and core symptoms for children with ADHD and it was well accepted.
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Najib J, Didenko E, Meleshkina D, Yusupov K, Maw K, Ramnarain J, Tabassum M. Review of lisdexamfetamine dimesylate in children and adolescents with attention deficit/hyperactivity disorder. Curr Med Res Opin 2020; 36:1717-1735. [PMID: 32845786 DOI: 10.1080/03007995.2020.1815002] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lisdexamfetamine dimesylate is a stimulant prodrug with low abuse and diversion potential that is used in treatment of attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults. This current literature review article aims to examine safety and efficacy of LDX in children and adolescents for the treatment of ADHD based on currently available data. METHODS Relevant English language articles were identified through computerized searches of the MEDLINE database (PubMed and EMBASE) and clinical trials registry up to January 2020 using the following search terms: lisdexamfetamine dimesylate, pro-drug stimulant, attention-deficit and hyperactivity disorders, ADHD, safety, efficacy, children, adolescents, Vyvanse. Forty-two articles were reviewed, 34 of which were included into this review, selected by the limit "clinical trials". This article represents the pharmacological profile, efficacy and safety data of LDX for the treatment of ADHD in children and adolescents. RESULTS The collection of studies reviewed identified that LDX was both safe and efficacious in the treatment of ADHD. The most commonly exhibited side effects were appetite suppression, weight loss, headache and insomnia. In comparison to placebo, LDX significantly improved ADHD symptoms and overall quality of life in children and adolescents. In comparison to atomoxetine, LDX showed statistically significant improvements in inattention, impulsivity, and activities of daily living. In comparison to OROS-MPH and placebo, LDX and OROS-MPH showed improvements with the CGI-I score, and ADHD-RS-IV, however, LDX was superior. CONCLUSION Patients have seen statistically significant improvements in their ADHD symptomatology in the classroom environment, health related quality of life, and their overall behavior in comparison to placebo, atomoxetine, and OROS-MPH. However, clinical judgment should be utilized when prescribing LDX due to patient specific needs and the side effect profile.
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Affiliation(s)
- Jadwiga Najib
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
- Departments of Pharmacy and Psychiatry, Mount Sinai West Hospital Center, New York, NY, USA
| | - Ekaterina Didenko
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
| | - Daria Meleshkina
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
| | - Kamila Yusupov
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
| | - Kateryna Maw
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
| | - Justin Ramnarain
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
| | - Maliha Tabassum
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
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Ichikawa H, Miyajima T, Yamashita Y, Fujiwara M, Fukushi A, Saito K. Long-term study of lisdexamfetamine dimesylate in Japanese children and adolescents with attention-deficit/hyperactivity disorder. Neuropsychopharmacol Rep 2019; 40:52-62. [PMID: 31814294 PMCID: PMC7292222 DOI: 10.1002/npr2.12091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/15/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS As an extension of a phase 2/3 study evaluating the efficacy and safety of lisdexamfetamine dimesylate (LDX) 30, 50, or 70 mg/d for 4 weeks in Japanese patients aged 6-17 years with attention-deficit/hyperactivity disorder (ADHD), this study evaluated its long-term safety and efficacy. METHODS This was a multicenter, open-label study of LDX for 53 weeks. Safety was assessed by regular medical examination for treatment-emergent adverse events (TEAEs); regular recording of body weight, vital signs, and laboratory test values; and completion of dependence questionnaires. Efficacy was assessed using Japanese versions of the ADHD-Rating Scale-IV (ADHD-RS-IV) and Conners' 3rd edition Parent Rating Scale (Conners 3); plus Clinical Global Impression-Improvement (CGI-I), Clinical Global Impression-Severity, and Parent Global Assessment (PGA) scales. RESULTS Of 132 enrolled patients, 104 completed the trial. Most frequent treatment-related TEAEs were decreased appetite (73.5%), initial insomnia (39.4%), and weight decrease (22.0%). Most TEAEs were mild (82.6% of patients). There were no serious or severe TEAEs or deaths. No treatment-related TEAEs were associated with blood pressure or pulse rate, and no patient had a QTcF interval >500 ms. Statistically significant improvement from baseline to week 53 was observed in the mean ADHD-Rating Scale-IV total score and mean Conners 3 subscale scores. Most patients showed improvement on the CGI-I (78%) and PGA (76.5%) scales. CONCLUSIONS No significant safety issues were observed with LDX 30, 50, or 70 mg/d administered for 1 year in Japanese children and adolescents with ADHD. LDX was associated with long-term reductions in ADHD symptoms and severity.
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Affiliation(s)
| | - Tasuku Miyajima
- Department of Education for Childcare, Tokyo Kasei University, Saitama, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Akimasa Fukushi
- Clinical Research I Division, Clinical Research Department, Shionogi & Co., Ltd, Osaka, Japan
| | - Kazuhiko Saito
- Aiiku Counselling Office, Aiiku Research Institute, Imperial Gift Foundation Boshi-Aiiku-Kai, Tokyo, Japan
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Coghill D. Debate: Are Stimulant Medications for Attention-Deficit/Hyperactivity Disorder Effective in the Long Term? (For). J Am Acad Child Adolesc Psychiatry 2019; 58:938-939. [PMID: 31515164 DOI: 10.1016/j.jaac.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
Long-term effectiveness studies for ADHD medications are complicated to design well, and no single study design will capture the entire picture. Although randomized controlled trials are the highest level of evidence, most authorities agree that, when you have treatments as efficacious as the ADHD medications (methylphenidate and amphetamine derivatives and prodrugs, atomoxetine, guanfacine, and clonidine), it is neither practical nor ethical to conduct long-term placebo-controlled RCTs. As a consequence, almost all of the RCT evidence for ADHD medications relates to short-term studies. Although these provide strong evidence for short-term efficacy,1 they do not speak to long-term effectiveness. The European Medicines Agency (EMA) recognized the need for additional evidence of long-term effects before granting licenses for medications that will usually be required to be taken for several years. They therefore introduced a requirement for companies to demonstrate longer-term efficacy. This has generally been done through the use of randomized withdrawal designs that are designed to demonstrate continued efficacy over a period of 6 to 12 months. Several of these have been completed and published, all of which, as expected, demonstrate continued efficacy.2 The EMA also insisted that all new ADHD medications demonstrate continued effectiveness, and that adverse effects and safety be assessed up to 2 years. Again the studies completed so far support continued effectiveness, and, although highlighting the presence of common, expected adverse effects, have not identified any new safety signals or unexpected problems in targeted areas such as growth and cognition.3.
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Affiliation(s)
- David Coghill
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
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Wong ICK, Banaschewski T, Buitelaar J, Cortese S, Döpfner M, Simonoff E, Coghill D. Emerging challenges in pharmacotherapy research on attention-deficit hyperactivity disorder-outcome measures beyond symptom control and clinical trials. Lancet Psychiatry 2019; 6:528-537. [PMID: 31122482 DOI: 10.1016/s2215-0366(19)30096-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/24/2022]
Abstract
Although pharmacological therapies are recommended as a key component in the treatment of attention-deficit hyperactivity disorder, their use continues to prompt intense debate. Despite considerable research efforts, several gaps in the knowledge base and several questions over the quality of evidence exist. Particular issues surrounding pharmacological treatments include uncertainties about long-term effectiveness and safety, safety profiles in adults, and the comparative effectiveness of different medications. In this Review, we focus on four key methodological issues for future research: (1) the use of appropriate trial designs; the need for (2) outcome measures targeting effectiveness beyond symptom control and (3) safety outcome measures; and (4) the application of clinical and administrative research databases to assess real-world outcomes. Potential solutions include increased use of randomised placebo-controlled withdrawal trials and large pharmacoepidemiological studies that use electronic health-care records on the long-term effectiveness and safety of medications. Pragmatic head-to-head randomised trials would also provide direct evidence on comparative effectiveness and safety profiles.
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Affiliation(s)
- Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, University College London, School of Pharmacy, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research Maudsley Biomedical Research Centre for Mental Health, London, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, and Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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Abstract
Lisdexamfetamine dimesylate (lisdexamfetamine; Elvanse®; Tyvense®), an orally-active dexamfetamine prodrug, is indicated in the EU for the treatment of attention-deficit hyperactivity disorder (ADHD) in children aged ≥ 6 years (including adolescents) when the response to previous methylphenidate (MPH) treatment is clinically inadequate. The original approval of the drug was based on the results of phase III trials in children and adolescents with ADHD who had an inadequate response to previous pharmacotherapy (e.g. MPH) or were treatment naïve. In these studies, short-term treatment with flexibly-dosed lisdexamfetamine demonstrated greater efficacy than atomoxetine, based on a prospective comparison, and osmotic-release oral system (OROS)-MPH, based on a post hoc comparison. Improvements in ADHD symptoms were accompanied by improvements in health-related quality of life and functioning that were maintained as long as treatment with lisdexamfetamine was continued in a long-term extension of one of these trials. In subsequent phase IV head-to-head studies in adolescents with ADHD and an inadequate response to previous pharmacotherapy, lisdexamfetamine demonstrated greater efficacy than OROS-MPH when both medications were force-titrated, but not when they were flexibly-titrated. Lisdexamfetamine was generally well tolerated, with an adverse event profile (e.g. decreased appetite, headache, weight reduction, insomnia and irritability) typical of that reported for other stimulants. Thus, lisdexamfetamine provides an alternative option for the treatment of children and/or adolescents with ADHD who have not responded adequately to previous ADHD pharmacotherapies.
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Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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