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Chen YC, Wu LK, Lee MS, Kung YL. The Efficacy of Acupuncture Treatment for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Complement Med Res 2021; 28:357-367. [PMID: 33508834 DOI: 10.1159/000513655] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to assess the efficacy of acupuncture for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. PATIENTS AND METHODS Systematic review and meta-analysis including randomized controlled trials that compared the effects of acupuncture treatment (AT) with pharmacotherapy (methylphenidate hydrochloride, MPH) among patients with ADHD. A total of 12 electronic databases were searched from inception until February 3, 2020. The main outcomes were the effective rate and post-treatment hyperactivity scores. We also assessed the incidence of adverse events and follow-up course. RESULTS A total of 10 studies involving 876 patients were included in this study. The meta-analysis revealed that AT yielded a significantly higher effective rate than MPH (odds ratio 2.239, 95% CI 1.438-3.487, p < 0.001, 8 studies), and that AT can reduce the hyperactivity scores to a lesser degree than MPH (standardized mean difference = -0.882, 95% CI -1.295 to -0.469, p < 0.001, 3 studies). Two studies reported no adverse events in the AT group, while one study suggested that AT can reduce adverse drug reactions. Furthermore, 3 studies concluded that the effects of AT were maintained, even after completion of treatment. CONCLUSION This study suggests that AT may be more beneficial than MPH therapy for ADHD patients. However, the evidence may be highly limited, especially considering the outcome of hyperactivity scores with the high risk of bias, very low GRADE, and small number of studies. Thus, further studies of rigorous design and high quality are needed to confirm and strengthen the results, especially in the Western part of the world. Additionally, well-designed randomized controlled trials that evaluate adverse events and include a long-term follow-up should be conducted to determine the efficacy, safety, and side effects of AT for ADHD in children and adolescents.
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Affiliation(s)
- Yi-Chen Chen
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Education and Human Potentials Development, National Dong Hwa University, Hualien, Taiwan
| | - Li-Kung Wu
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Shinn Lee
- Department of Education and Human Potentials Development, National Dong Hwa University, Hualien, Taiwan
| | - Yen-Lun Kung
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, .,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan,
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Boudreau A, Mah JWT. Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:26-32. [PMID: 32194649 PMCID: PMC7065566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore how well parental social cognitions, guided by the Theory of Reasoned Action (TRA), contribute to the uptake and continuation of stimulant medication for children with ADHD. No previous study has explored this model in predicting medication use in a clinical sample. METHOD Sixty-nine parents of children aged 6-13 years presenting to a tertiary ADHD clinic completed questionnaires, and a clinician documented their medication usage. RESULTS When controlling for medication status at baseline, both of the components of the TRA (i.e., attitudes and norms) predicted medication status following initial visit. Logistic regressions indicated that parents were more likely to enroll in or continue stimulant medication if they had lower stigma related to ADHD, a higher opinion of ADHD medications, and a greater knowledge of ADHD; this model classified 72.5% of the patients who started or continued stimulant medications. CONCLUSIONS Findings suggest that the parents' knowledge about ADHD, opinion about treatment, and ADHD-related stigma are key factors to target in order to increase the uptake and continued use of evidence-based pharmacological interventions for children with ADHD.
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Kim M, King MD, Jennings J. ADHD remission, inclusive special education, and socioeconomic disparities. SSM Popul Health 2019; 8:100420. [PMID: 31431914 PMCID: PMC6580433 DOI: 10.1016/j.ssmph.2019.100420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022] Open
Abstract
To understand how institutional environments and socioeconomic backgrounds may influence health outcomes, we examined the relationship among special education environments, socioeconomic status (SES), and likelihood of ADHD remission in children. While the majority of children experience remission by adulthood, the likelihood of remission varies across different SES levels and education environments. We find that for low SES children the likelihood of remission is higher in states that have more inclusive special education regimes. In contrast, for more advantaged children, the odds of remission do not depend on the level of special education inclusivity. Our findings suggest that providing more inclusive education can reduce disparities in behavioral disorders and are particularly important for less advantaged children. In doing so, this study contributes to the fundamental cause and health inequality literature by adding to a growing body of work showing how institutional environments can affect socioeconomic gradients in health treatment and outcomes.
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Affiliation(s)
- Margeum Kim
- Yale School of Management, 165 Whitney Avenue, New Haven, CT, 06511, USA
| | - Marissa D King
- Yale School of Management, 165 Whitney Avenue, New Haven, CT, 06511, USA
| | - Jennifer Jennings
- Department of Sociology, Princeton University, Wallace Hall, Princeton University, Princeton, NJ, 08544, USA
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Exploratory study of barriers to successful office contacts for attention deficit hyperactivity disorder. ACTA ACUST UNITED AC 2017; 10:237-243. [DOI: 10.1007/s12402-017-0246-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022]
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The effect of methylphenidate on neurofibromatosis type 1: a randomised, double-blind, placebo-controlled, crossover trial. Orphanet J Rare Dis 2014; 9:142. [PMID: 25205361 PMCID: PMC4172829 DOI: 10.1186/s13023-014-0142-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with an estimated prevalence of about 1/3000, independent of ethnicity, race, or gender. Attention Deficit Hyperactivity like Disorder (ADHD)-like characteristics are often reported in patients with NF1. We hypothesised that learning disabilities in NF1 children were related to ADHD symptoms. Treatment with methylphenidate (MPD) has improved learning disabilities in ADHD by acting on neurotransmitters. Our objective was to evaluate its efficacy on ADHD-like symptoms in neurofibromatosis type 1 children (7–12 years). Methods This was a randomised, double blind, placebo controlled, and crossover trial comparing 0.5 to 0.8 mg/kg/d of MPD as it is indicated for ADHD to placebo in NF1 children with ADHD-like symptoms. Children aged 7 to 12 years were eligible when their IQ was between 80 and 120. The total follow-up was 9 weeks including 4 weeks for each period and 1 week wash out. Fifty subjects (25 for each period) were required for testing the primary study hypothesis. The main outcome was an improvement in scores on the simplified Conners’ Parent Rating Scale. Results Thirty-nine patients were included between April 2004 and December 2010. Twenty participants received MPD and 19 placebo during the first period. They all completed the trial. MPD decreased the simplified Conners by 3.9 points (±1.1, p = 0. 0003). Conclusions This is the first randomised controlled trial showing the short-term benefit of MPD on simplified Conners scores in NF1 children. Trial registration ClinicalTrials.gov NCT00169611.
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Corkum P, Bessey M, McGonnell M, Dorbeck A. Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2014; 7:49-74. [PMID: 25055885 DOI: 10.1007/s12402-014-0152-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 07/08/2014] [Indexed: 01/09/2023]
Abstract
A number of evidence-based treatments are available for attention-deficit/hyperactivity disorder (ADHD), including pharmacological, psychosocial, or a combination of the two treatments. For a significant number of children diagnosed with ADHD, however, these treatments are not utilized or adhered to for the recommended time period. Given that adherence to treatment regimens is necessary for reducing the symptoms of ADHD, it is crucial to develop a comprehensive understanding of why adherence rates are so low. The current review examines the literature to date that has directly explored utilization and adherence issues related to the treatment of ADHD in order to identify the key barriers to treatment. This review focused on four main factors that could account for the poor rates of treatment utilization and adherence: personal characteristics (socio-demographic characteristics and diagnostic issues), structural barriers, barriers related to the perception of ADHD, and barriers related to perceptions of treatment for ADHD. This review included 63 papers and covered a variety of barriers to treatment that have been found in research to have an impact on treatment adherence. Based on this review, we conclude that there are complex and interactive relationships among a variety of factors that influence treatment utilization and adherence. Four main gaps in the literature were identified: (1) there is limited information about barriers to psychosocial interventions, compared to pharmacological interventions; (2) there is a limited variety of research methodology being utilized; (3) treatment barrier knowledge is mostly from parents' perspectives; and (4) treatment utilization and treatment adherence are often studied jointly. Information from this review can help practitioners to identify potential barriers to their clients being adherent to treatment recommendations.
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Affiliation(s)
- Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada,
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Hong J, Novick D, Treuer T, Montgomery W, Haynes VS, Wu S, Haro JM. Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia. Patient Prefer Adherence 2013; 7:987-95. [PMID: 24124351 PMCID: PMC3794850 DOI: 10.2147/ppa.s50628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder (ADHD) from Central Europe and East Asia. PATIENTS AND METHODS Data for this post-hoc analysis were taken from a 1-year prospective, observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia. Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale, and then dichotomized into either adherent or non-adherent. Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity (CGI-ADHD) scale and the Child Symptom Inventory-4 (CSI-4) Checklist. Health-Related Quality of Life (HRQoL) was measured using the Child Health and Illness Profile-Child Edition (CHIP-CE). Regression analyses were used to assess baseline predictors of overall adherence during follow-up, and the impact of time-varying adherence on subsequent outcomes: response (defined as a decrease of at least 1 point in CGI), changes in CGI-ADHD, CSI-4, and the five dimensions of CHIP-CE. RESULTS Of the 860 patients analyzed, 64.5% (71.6% in Central Europe and 55.5% in East Asia) were rated as adherent and 35.5% as non-adherent during follow-up. Being from East Asia was found to be a strong predictor of non-adherence. In East Asia, a family history of ADHD and parental emotional distress were associated with non-adherence, while having no other children living at home was associated with non-adherence in Central Europe as well as in the overall sample. Non-adherence was associated with poorer response and less improvement on CGI-ADHD and CSI-4, but not on CHIP-CE. CONCLUSION Non-adherence to medication is common in the treatment of ADHD, particularly in East Asia. Non-adherence was associated with poorer response and less improvement in clinical severity. A limitation of this study is that medication adherence was assessed by the treating clinician using a single item question.
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Affiliation(s)
- Jihyung Hong
- Eli Lilly and Company, Windlesham, Surrey, UK
- Correspondence: Jihyung Hong, Eli Lilly and Company, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, UK, GU20 6PH, Tel +44 1276 483 260, Fax +44 1276 483 192, Email
| | | | - Tamás Treuer
- Eli Lilly and Company, Neuroscience Research, Budapest, Hungary
| | | | | | - Shenghu Wu
- Eli Lilly China, Shanghai, People’s Republic of China
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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Ferrin M, Ruiz-Veguilla M, Blanc-Betes M, Abd SE, Lax-Pericall T, Sinclair M, Taylor E. Evaluation of attitudes towards treatment in adolescents with attention deficit hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 2012; 21:387-401. [PMID: 22714140 DOI: 10.1007/s00787-012-0277-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 04/09/2012] [Indexed: 11/26/2022]
Abstract
A substantial proportion of adolescents with attention deficit hyperactivity disorder (ADHD) do not appropriately adhere to prescribed treatments, especially to pharmacological treatments. It is important to disentangle the specific attitudes that contribute to treatment adherence. A 33-item questionnaire was applied to 120 adolescents diagnosed with ADHD and their respective parents. Reliability of the scale was explored using factor analysis, Cronbach's alpha, and test-retest. Validity was explored by face validity and the known-groups method. For the young people's version, three main dimensions (preoccupations, insight and self-concept) emerged. The parents' version showed six main dimensions (child's personal attitudes, worries, social stigma, insight, future side effects and knowledge). The potential of this questionnaire to explore the attitudes of patients and their families towards treatments and for clinicians to predict treatment adherence is discussed.
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Affiliation(s)
- Maite Ferrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Sunshine House (Neurodevelopmental Team) 27 Peckham Road, London, SE5 8UH, UK.
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Moses T. Adolescents' commitment to continuing psychotropic medication: a preliminary investigation of considerations, contradictions, and correlates. Child Psychiatry Hum Dev 2011; 42:93-117. [PMID: 20953829 DOI: 10.1007/s10578-010-0209-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these "less committed" youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to "committed" youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths' concerns about medication and maximizing their participation in treatment decision-making.
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Affiliation(s)
- Tally Moses
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706, USA.
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Demidovich M, Kolko DJ, Bukstein OG, Hart J. Medication refusal in children with oppositional defiant disorder or conduct disorder and comorbid attention-deficit/hyperactivity disorder: medication history and clinical correlates. J Child Adolesc Psychopharmacol 2011; 21:57-66. [PMID: 21288119 PMCID: PMC3037195 DOI: 10.1089/cap.2010.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED Abstract Objective: This study examines the characteristics of 96 children with attention-deficit/hyperactivity disorder (ADHD) and their families who refused a recommendation for medication as part of their treatment for disruptive disorders. METHODS The ADHD cases were taken from a sample of 139 youth (age 6-11) who were recruited for a clinical trial that compared the administration of a modular psychosocial treatment in an outpatient clinic or community settings. Medication management was an optional treatment module for children with ADHD in both conditions. Children who were (vs. were not) taking medication at intake, and children who accepted (vs. refused) medication recommendations during the study were compared on diagnostic and clinical measures related to child, school, parent, and family domains of functioning. RESULTS Parents of 30% of the children refused study medication for ADHD. Parental medication acceptability and intake correlated highly with both medication history and study refusal of medication. Increased parental self-efficacy and emotional support for their youth correlated with medication refusal. No demographics and few child or school factors were associated with medication refusal. Medication use was associated with reductions in some key ADHD symptoms, but did not affect disruptive behaviors as did the psychosocial interventions. CONCLUSION Medication refusers remain poorly understood but certain correlates, such as parental self-efficacy, parental emotional support for their youth, and medication acceptability, warrant further evaluation.
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Affiliation(s)
| | - David J. Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Jonathan Hart
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Calvert SC, Johnston C. Acceptability of Treatments for Child Behavior Problems: issues and Implications for Future Research. ACTA ACUST UNITED AC 2010. [DOI: 10.1207/s15374424jccp1901_8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mautone JA, DuPaul GJ, Jitendra AK, Tresco KE, Junod RV, Volpe RJ. The relationship between treatment integrity and acceptability of reading interventions for children with Attention-Deficit/Hyperactivity Disorder. PSYCHOLOGY IN THE SCHOOLS 2009. [DOI: 10.1002/pits.20434] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Schlander M. Is NICE infallible? A qualitative study of its assessment of treatments for attention-deficit/hyperactivity disorder (ADHD). Curr Med Res Opin 2008; 24:515-35. [PMID: 18186971 DOI: 10.1185/030079908x260808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Conclusions of the recent NICE technology appraisal of treatments for attention-deficit/hyperactivity disorder (ADHD) differ from recommendations by other Health Technology Assessment (HTA) agencies, such as the Scottish Medicines Consortium (CMS) and the Australian Pharmaceutical Benefits Advisory Committee (PBAC). NICE did not identify differences on grounds of clinical effectiveness between treatment options studied and issued technology guidance based on clinical profiles of compounds and on drug acquisition costs. The aim of the present study was to explore the robustness of NICE assessment methods when addressing a complex clinical problem such as the evaluation of ADHD treatment strategies. This robustness will be of interest to international policy-makers, given the widespread perception of NICE as a role model for the implementation of HTAs including economic evaluation. METHODS A qualitative case study was performed to critically appraise the technology assessment report (AR) underlying NICE conclusions, including a systematic search for and analysis of relevant literature. RESULTS The AR produced on behalf of NICE was found to exhibit a range of anomalies. Search criteria were not applied consistently, and the available clinical evidence was not used optimally; selection of clinical endpoints and clinical trials for analysis were idiosyncratic. The primary cost-effectiveness model relied on six short-term studies only, and secondary extensions combined heterogeneous study designs and different clinical endpoints. Neither the distinction between efficacy and effectiveness nor the role of treatment compliance in ADHD was addressed adequately. Long-term extensions of the model were impaired by use of inappropriate discount rates and absence of consideration of long-term sequelae associated with ADHD. CONCLUSION A review of the literature strongly suggests that the NICE assessment of ADHD treatment strategies was incomplete and likely prone to bias. It is concluded that NICE did not adequately accommodate a complex clinical decision problem. Although the present qualitative case study of one assessment cannot, and was not designed to, invalidate the NICE approach to economic evaluation of healthcare programs, this observation may have potentially far-reaching implications for the generalizability of NICE-like approaches.
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Affiliation(s)
- Michael Schlander
- Institute for Innovation & Valuation in Health Care (InnoVal HC), Eschborn, Germany.
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Faraone SV, Biederman J, Zimmerman B. An analysis of patient adherence to treatment during a 1-year, open-label study of OROS methylphenidate in children with ADHD. J Atten Disord 2007; 11:157-66. [PMID: 17494833 DOI: 10.1177/1087054706295663] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Treatment adherence is an important aspect of ADHD symptom management, but there are many factors that may influence adherence. METHOD This analysis assessed adherence to OROS methylphenidate during a 1-year, open-label study in children. Adherence was defined as the number of days medication was taken divided by the number of days in the study and determined to be high if > or =75%. Possible clinical and demographic factors associated with adherence, including use of planned medication breaks, were assessed. RESULTS Mean adherence was 86.4%. It was 91.6% for the subgroup of patients who reported not taking planned medication breaks (n = 252) and 77.7% for the subgroup taking planned medication breaks (n = 155). Overall, 75% of patients showed high adherence. Older age, low starting dose, minority ethnic status, and fewer ADHD symptoms were associated with low adherence. CONCLUSION Various factors were found to be associated with low adherence, and the results of this analysis provide guidance to physicians seeking to identify those patients with ADHD most likely not be adherent to stimulant therapy
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Affiliation(s)
- Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Daly BP, Creed T, Xanthopoulos M, Brown RT. Psychosocial treatments for children with attention deficit/hyperactivity disorder. Neuropsychol Rev 2007; 17:73-89. [PMID: 17260167 DOI: 10.1007/s11065-006-9018-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.
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Affiliation(s)
- Brian P Daly
- Department of Public Health, Temple University, 3307 North Broad Street, Philadelphia, PA 19140, USA.
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Leslie LK, Plemmons D, Monn AR, Palinkas LA. Investigating ADHD treatment trajectories: listening to families' stories about medication use. J Dev Behav Pediatr 2007; 28:179-88. [PMID: 17565284 DOI: 10.1097/dbp.0b013e3180324d9a] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Policymakers, federal agencies, and researchers have called for more in-depth investigation of contextual mechanisms that may explain differences in medication use among youths with attention-deficit/hyperactivity disorder (ADHD). METHOD We conducted qualitative interviews with 28 families from varied socioeconomic and racial/ethnic and linguistic backgrounds regarding diagnostic and treatment trajectories for their children with symptoms consistent with ADHD, with a particular focus on whether and how medication use became a part of the trajectory. RESULTS Four longitudinal patterns of help-seeking trajectories emerged: (1) a pattern characterized by delay to diagnosis, common among youths with complicated clinical and/or environmental pictures or primarily inattentive ADHD symptoms; (2) an initial nonmedication treatment pattern in which parents at first chose to use other modalities of treatment; (3) a reluctant receipt of an ADHD diagnosis and/or treatment pattern, mainly seen among the low-income, Spanish-speaking families; and (4) a rapid engagement in medication use pattern, characterized by directed movement to and maintenance of medication use. These patterns resulted from a dynamic interplay of explanatory models regarding the cause, course, and cure of a child's problems; the influence of extended social networks; and factors previously examined in medical utilization models. Additional themes included (1) parents' need for more information about ADHD, (2) families' desire for additional mental health and school services making medications less necessary, and (3) the importance of cultural sensitivity and a longitudinal relationship between the caregiver and clinician to enhance communication between families and clinicians. CONCLUSIONS These findings deserve further study in a larger, more diverse sample.
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Affiliation(s)
- Laurel K Leslie
- Child and Adolescent Services Research Center, Children's Hospital, San Diego, CA 92123-0282, USA.
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Hoza B, Johnston C, Pillow DR, Ascough JC. Predicting treatment response for childhood attention-deficit/hyperactivity disorder: Introduction of a heuristic model to guide research. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.appsy.2005.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AIM To get more insight into factors that influence compliance with the use of methylphenidate. METHODS 22 pharmacies detected children who used methylphenidate. Their parents were sent a questionnaire on the use of methylphenidate. In a case-control study, the influence of patient- and drug-related factors on compliance, as reported by parents, was determined. RESULTS Parents returned 117 (75%) of 157 questionnaires sent out. Of these, 47.8% of the children missed a dose two times a month or more. Forgetting to take the medication (87.9%) was the most important reason. The case-control study showed that children of 16-18 y were more likely to miss doses. Other patient- and drug-related factors did not influence the missing of doses. CONCLUSION A number of known determinants for compliance do not influence the missing of doses of methylphenidate. With about 80% of the parents reporting that their child missed doses of methylphenidate less than 5 times per month, compliance was quite good for the majority of the children.
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Affiliation(s)
- Jacqueline G Hugtenburg
- Department of Medical Pharmacology, VU University Medical Centre, Amsterdam, the Netherlands.
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Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder. ACTA ACUST UNITED AC 2006. [DOI: 10.1300/j184v09n04_02] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gau SSF, Shen HY, Chou MC, Tang CS, Chiu YN, Gau CS. Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharmacol 2006; 16:286-97. [PMID: 16768636 DOI: 10.1089/cap.2006.16.286] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between adherence to immediate-release methylphenidate (IR MPH) and maternal psychological distress, parenting style, parent- child relationship, and perceived family support. METHODS The sample consisted of 307 children with attention-deficit hyperactivity disorder (ADHD) (271 boys and 36 girls), 6-17 years of age, who had been treated with IR MPH for the past 6 months. The measures included the Chinese Health Questionnaire, Parental Bonding Instrument, Family APGAR, and Home Behaviors of the Social Adjustment Inventory for Children and Adolescents. RESULTS Reasons for poor adherence (n = 79; 25.7%) included forgetting medication (72.7%), the medication having no effect (20.0%), and refusing medication (12.7%). Increased age and three-times-daily administration were the major predictors for poor adherence to IR MPH. Poor adherence was associated with increased degree of maternal psychological distress, indifferent parenting, maternal overprotection/control, poor family support, decreased interaction with parents, and increased problems at home. CONCLUSIONS Findings indicate that multiple daily dosing of MPH increases the likelihood of poor adherence, particularly in adolescents, and that poor adherence is associated with impaired maternal/family process. Once-daily administration of MPH is necessary to improve adherence and to decrease the possible exacerbation of tense parent-child relationships caused by poor drug adherence.
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Affiliation(s)
- Susan S F Gau
- Department of Psychiatry, National Taiwan University, No. 1 Jen-Ai Road Section 1, Taipei, Taiwan 10051.
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Hugtenburg JG, Griekspoor JE, De Boer I, Heerdink ER, Tso YH, Egberts ACG. Methylphenidate: use in daily practice. ACTA ACUST UNITED AC 2006; 27:197-201. [PMID: 16096887 DOI: 10.1007/s11096-004-2848-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE With the aim of getting more insight into compliance of children using methylphenidate, we studied the day-to-day use of the drug. In addition, the efficacy and side effects of treatment, stopping, switching to other drugs and the use of additional psychoactive drugs in daily practice were studied. METHOD On the basis of pharmacy records, the use of methylphenidate by 52 children was studied. Two parameters for compliance were calculated. By means of a questionnaire, parents were asked about their children's compliance with the use of methylphenidate as well as about their experience with treatment. MAIN OUTCOME MEASURE Compliance, use of methylphenidate in weekends and holidays, self-reported efficacy, side effects, stopping and switching to other drugs. RESULTS Depending on the parameter calculated, the percentage of children with a good compliance varied from 25 to 47%. About 65% of the children used less or no methylphenidate in the weekends and holidays. Sixty-five percent of the parents reported to pass over a dose once in a while. According to 61% of the parents (n = 28) the efficacy of methylphenidate was good or very good. Nine (33%) of 28 children stopped using methylphenidate. Seven children stopped using the drug because of side-effects or lack of efficacy. Seven children switched to other psychoactive drugs. Fifty-seven percent of all children used additional psychoactive drugs. CONCLUSION The percentage of children having a good compliance calculated on the basis of pharmacy records is rather low. This is partly the result of the decreased use of methylphenidate in the weekends and holidays.
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Affiliation(s)
- Jacqueline G Hugtenburg
- Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. J.G.Hugtenburg@ pharm.uu.nl
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Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ. Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 2005; 30:95-114. [PMID: 16013783 DOI: 10.1007/s10484-005-4305-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.
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Johnston C, Ohan JL. The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders. Clin Child Fam Psychol Rev 2005; 8:167-82. [PMID: 16151616 DOI: 10.1007/s10567-005-6663-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent-child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.
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Affiliation(s)
- Charlotte Johnston
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
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Sanchez RJ, Crismon ML, Barner JC, Bettinger T, Wilson JP. Assessment of Adherence Measures with Different Stimulants Among Children and Adolescents. Pharmacotherapy 2005; 25:909-17. [PMID: 16006269 DOI: 10.1592/phco.2005.25.7.909] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE To examine adherence measures with different stimulants in children and adolescents. DESIGN Retrospective analysis. DATA SOURCE Texas Medicaid prescription claims database. PATIENTS A total of 9549 patients aged 5-18 years with attention-deficit-hyperactivity disorder. MEASUREMENTS AND MAIN RESULTS Paid prescription claims for newly started stimulants during the 2001-2002 school year were extracted from a database; 28,344 prescriptions (9549 patients) were available for analysis. Adherence was evaluated based on the drug therapy prescribed (i.e., mixed amphetamine salts, immediate-release methylphenidate, and extended-release methylphenidate-OROS [oral-osmotic formulation]) and the age and sex of the patient. Adherence measures were persistence and medication possession ratio (MPR). Persistence was higher for extended-release methylphenidate-OROS (0.50 +/- 0.33) than for mixed amphetamine salts (0.42 +/- 0.29) or immediate-release methylphenidate (0.37 +/- 0.26; p < 0.001). The MPR was also higher for extended-release methylphenidate-OROS (0.76 +/- 0.37) than for mixed amphetamine salts (0.73 +/- 0.37) or immediate-release methylphenidate (0.69 +/- 0.37; p < 0.001). Patients aged 5-9 years had equal or better persistence and MPR than those aged 10-14 and 15-18 years (p < 0.001). No sex-related differences in adherence were observed. CONCLUSION Adherence measures in our study were low. Although they were significantly better for extended-release methylphenidate-OROS than the other stimulants, the clinical significance of these differences are unclear. Further research should be conducted regarding pharmaceutical products, administration methods, and clinical interventions that may enhance adherence.
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Affiliation(s)
- Robert J Sanchez
- College of Pharmacy, University of Texas at Austin; Texas Department of State Health Services, Austin, Texas 78712, USA
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Miller AR, Lalonde CE, McGrail KM. Children's persistence with methylphenidate therapy: a population-based study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:761-8. [PMID: 15633854 DOI: 10.1177/070674370404901107] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine persistence with methylphenidate (MPH) therapy among children and youth in the general population. METHOD We conducted a retrospective analysis of longitudinally organized, individual-specific anonymous data from linked prescription and health databases covering the population of British Columbia for 1990 through 1996. No prescriptions being filled for 4 months indicated cessation of one bout of therapy. RESULTS Among 16,945 identified MPH patients aged 19 years or under, overall duration of therapy was 584 days, and the average number of prescriptions received was 6.6. One-third of patients received 2 or fewer prescriptions, while 18% followed a chronic, continuous course. Among patients receiving more than 2 prescriptions, 50% of discrete therapy bouts lasted 4 months or less, and one-third of cases had multiple bouts of therapy (range 2 to 6 bouts). Younger age (that is, children aged 0 to 8 years, vs those aged 10 to 19 years), male sex, and receipt of initial prescription from a psychiatrist were associated with greater persistence. CONCLUSIONS Enormous variability in persistence with MPH therapy and often-occurring low rates of persistence raises questions about the diligence with which MPH patients are selected, prepared, and followed in the general population. Special attention to the needs of older children and to the needs of girls is required, and discontinuities during children's therapy courses require explication.
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Affiliation(s)
- Anton R Miller
- Centre for Community Child Health Research, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia.
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Arcia E, Fernández MC, Jáquez M. Latina mothers' stances on stimulant medication: complexity, conflict, and compromise. J Dev Behav Pediatr 2004; 25:311-7. [PMID: 15502547 DOI: 10.1097/00004703-200410000-00002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study was undertaken to understand and describe Latina mothers' cognitions and attitudes toward the use of medication for their young children's behavior problems under the premise that these factors are determinants of noncompliance and inadequate adherence to medication treatments. Quantitative and qualitative data were extracted from a multimethod study of professional help seeking. Participants were 62 mothers from Cuba, Puerto Rico, and the Dominican Republic. Findings indicated that mothers overwhelmingly preferred treatment options other than medication primarily because they understood medication to be addictive, dulling of cognitive processes, and inappropriate for behavior problems. Inadequate adherence was common and logically consistent with maternal cognitions. Maternal choices with respect to the use of medication were transactional and quite complex in nature and changed over time. The strongest agents in this process were schools and the mothers' immediate family. Implications for clinical practice are presented.
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Affiliation(s)
- Emily Arcia
- Department of Research, Mt. Sinai Medical Center, Miami Beach, Florida, USA.
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Donnelly M, Haby MM, Carter R, Andrews G, Vos T. Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder. Aust N Z J Psychiatry 2004; 38:592-601. [PMID: 15298581 DOI: 10.1080/j.1440-1614.2004.01422.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice. METHOD Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental cost-effectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted. RESULTS The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100-22 000). DEX is more costly than MPH for the government, but much less costly for the patient. CONCLUSIONS MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.
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Affiliation(s)
- Marie Donnelly
- Health Surveillance and Evaluation Section, Public Health, Department of Human Services, Melbourne, Australia
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Charach A, Ickowicz A, Schachar R. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry 2004; 43:559-67. [PMID: 15100562 DOI: 10.1097/00004583-200405000-00009] [Citation(s) in RCA: 196] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years. METHOD Seventy-nine of 91 participants in a 12-month randomized controlled trial of methylphenidate and parent groups enrolled in a follow-up study. Adherence to stimulants, treatment response, and adverse effects were evaluated annually for 5 years. Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2, 3, 4, and 5 years for 3 groups: adherents, nonadherents on medication, or nonadherents off medication. Controlling for age, gender, and baseline severity, adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses. RESULTS At 2 years, adherents (n = 41) showed greater improvement in teacher-reported symptoms than those off medication (n = 16) and equivalent response to nonadherents on stimulants (n = 16) (p =.02). At 5 years, adherents (n = 16) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants (n = 15) and those off medication (n = 14) (p =.04). At year 2 medication status (beta = 4.67 [0.40-8.95, p =.033]) and at year 5 adherence status (beta = 7.23 [3.01-11.44, p =.001]) correlated with higher teacher-reported symptom scores. Clinically significant adverse effects were present for 5 years, most commonly loss of appetite. CONCLUSIONS Psychostimulants improve ADHD symptoms for up to 5 years, but adverse effects persist.
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Affiliation(s)
- Alice Charach
- Department of Psychiatry, The Hospital for Sick Children and the University of Toronto, Research Institute, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
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McCracken JT, Biederman J, Greenhill LL, Swanson JM, McGough JJ, Spencer TJ, Posner K, Wigal S, Pataki C, Zhang Y, Tulloch S. Analog classroom assessment of a once-daily mixed amphetamine formulation, SLI381 (Adderall XR), in children with ADHD. J Am Acad Child Adolesc Psychiatry 2003; 42:673-83. [PMID: 12921475 DOI: 10.1097/01.chi.0000046863.56865.fe] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This investigation was conducted primarily to assess the safety and efficacy of SLI381 (Adderall XR), developed as a once-daily treatment for children with attention-deficit/hyperactivity disorder (ADHD). Secondary objectives included examination of the time course, pharmacokinetic, and pharmacodynamic properties of SLI381. METHOD This was a randomized, double-blind, crossover study of three doses of SLI381 (10, 20, and 30 mg), placebo, and an active control (Adderall 10 mg) given once daily to 51 children with ADHD. Weekly assessments in an analog classroom setting included blind ratings of attention and deportment and a performance measure (math test) obtained every 1.5 hours over a 12-hour period. RESULTS SLI381 was well tolerated. All active treatment conditions displayed significant time course effects and were superior to placebo in improving efficacy measures. Dose-dependent improvements were evident for SLI381. SLI381 20 and 30 mg and Adderall all showed rapid improvements by 1.5 hours, but only the SLI381 20- and 30-mg doses showed continued activity at 10.5 and 12 hours for classroom behavior and math test performance versus placebo. CONCLUSIONS These data provide support for the benefit of this novel, once-daily amphetamine preparation in the treatment of ADHD. The longer duration of action of SLI381 has the potential to simplify psychostimulant dosing, thus reducing dose diversion and eliminating the need for in-school administration. SLI381 appears to be a useful treatment option for many children with ADHD.
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Affiliation(s)
- James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, Division of Child andAdolescent Psychiatry, UCLA Neuropsychiatric Institute, Los Angeles, CA 90024-1759, USA.
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) affects approximately 8-10% of school-aged children in the US and for many individuals persists into adolescence and adulthood. Both pharmacological and nonpharmacological (behavioural) therapies are used to treat individuals with ADHD. Treatment with stimulant medications, which include methylphenidate and amphetamine, typically requires multiple daily doses to maintain efficacy. The frequency of treatment, coupled with the importance of timing of doses and the long-term nature of treatment, make noncompliance a particular issue in the treatment of ADHD. Studies report noncompliance rates of 20-65% with stimulant treatment, although there are only limited published studies and these show considerable individual variation. Noncompliance can arise through inadequate supervision of those receiving medication, leading to delayed or missed doses, or through the reluctance of individuals to take medication, which is influenced by a number of factors (e.g. social attitudes, pressures or worries surrounding medication use and the inconvenience of multiple daily doses). Two approaches are likely to increase compliance with stimulant treatment: effective once-daily formulations of medication and improved treatment information. The development of effective once-daily formulations for stimulant treatments removes the need for multiple daily doses, with the associated problems of ensuring adequate treatment supervision and personal privacy. Improved provision of education and information for individuals with ADHD, as well as their families and teachers, should help them address the issues surrounding stimulant medication and allow full participation in the treatment process. Together, these strategies should improve treatment compliance for individuals with ADHD.
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Affiliation(s)
- James Swanson
- University of California - Irvine, Irvine, California 92612, USA.
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Chronis AM, Pelham WE, Gnagy EM, Roberts JE, Aronoff HR. The impact of late-afternoon stimulant dosing for children with ADHD on parent and parent-child domains. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2003; 32:118-26. [PMID: 12573937 DOI: 10.1207/s15374424jccp3201_11] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Examined the impact of late-afternoon stimulant dosing on parent and parent-child domains. Twenty-one children with attention deficit hyperactivity disorder (ADHD) participated in a double-blind, placebo-controlled medication assessment comparing varying doses of methylphenidate (MPH) and Adderall in the context of an intensive treatment program. Children received varying doses of stimulant medication, including active medication or placebo at 3:30 p.m. daily. Parent ratings of their mood, pleasantness of parent-child interactions, and perceived parenting effectiveness and successfulness were obtained each evening. Effective medication doses had a beneficial impact on parent-child domains (e.g., parent-child interactions) but did not significantly affect non-child-related parent variables (e.g., negative affect [NA]). Findings suggested that doses with beneficial effects lasting into the evening improved parent reports of the pleasantness of parent-child interactions but were insufficient to produce positive changes in parent functioning.
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Rieppi R, Greenhill LL, Ford RE, Chuang S, Wu M, Davies M, Abikoff HB, Arnold LE, Conners CK, Elliott GR, Hechtman L, Hinshaw SP, Hoza B, Jensen PS, Kraemer HC, March JS, Newcorn JH, Pelham WE, Severe JB, Swanson JM, Vitiello B, Wells KC, Wigal T. Socioeconomic status as a moderator of ADHD treatment outcomes. J Am Acad Child Adolesc Psychiatry 2002; 41:269-77. [PMID: 11886021 DOI: 10.1097/00004583-200203000-00006] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore whether socioeconomic status (SES) variables moderate treatment response of attention-deficit/hyperactivity disorder (ADHD) to medication management (MedMgt), behavioral treatment (Beh), combined intervention (Comb), and routine community care (CC). METHOD The MTA Cooperative Group's intent-to-treat (ITT) analyses were repeated, covarying for composite Hollingshead SES, education, occupation, income, and marital status. RESULTS Individual SES variables were more informative than the composite Hollingshead Index. Treatment response of children from less educated households paralleled ITT outcomes: no significant difference was found between Comb and MedMgt (both better than Beh and CC) for core ADHD symptoms. However, children from more educated families showed superior reduction of ADHD symptoms with Comb. For oppositional-aggressive symptoms, children from blue-collar, lower SES households benefited most from Comb, whereas those from white-collar, higher SES homes generally showed no differential treatment response. Household income and marital status failed to influence outcomes. Controlling for treatment attendance attenuated the moderating effects of the SES variables only for MedMgt. CONCLUSIONS Investigators are encouraged to use independent SES variables for maximal explanation of SES effects. Clinicians should prioritize target symptoms and consider the mediating role of treatment adherence when determining an ADHD patient's optimal intervention plan.
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Affiliation(s)
- Ricardo Rieppi
- Department of Psychology, St. Johns University, Jamaica, NY 11439, USA.
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Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry 2001; 40:922-8. [PMID: 11501692 DOI: 10.1097/00004583-200108000-00014] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify moderators and mediators of long-term adherence to stimulant medication in children with attention-deficit hyperactivity disorder (ADHD). METHOD Seventy-one children with ADHD were prescribed methylphenidate, followed prospectively on an annual basis for 3 years, and evaluated for adherence to stimulant treatment. The study occurred in Toronto between 1993 and 1997. Adherents were those who took methylphenidate, or another psychostimulant, for 5 or more days per week throughout the follow-up period, except for "drug holidays." Children who adhered at consecutive evaluations were compared with those who did not. Severity of ADHD, presence of oppositional defiant disorder/conduct disorder, learning difficulties, anxiety, age, family dysfunction, and socioeconomic adversity at baseline were investigated as moderators of adherence. Response to treatment at school, measured at 12 months, was investigated as a mediator of adherence. RESULTS Fifty-two percent of children adhered to stimulant treatment for 3 years. Absence of teacher-rated oppositional defiant disorder, more teacher-rated ADHD symptoms, and younger age at baseline predicted adherence. CONCLUSIONS Adherence to stimulant medications is a significant factor in the long-term treatment of children with ADHD.
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Affiliation(s)
- D Thiruchelvam
- Department of Psychiatry, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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Abstract
OBJECTIVE To investigate side effects, medication compliance, and assumption of medication assignment in adolescents taking imipramine versus placebo in a clinical trial. METHOD Sixty-three anxious-depressed adolescents in an 8-week double-blind study of imipramine versus placebo, each in combination with cognitive-behavioral therapy for school refusal, were evaluated. Measures of side effects, global improvement, family functioning, medication compliance based on pill counts, and guesses of drug assignment (imipramine versus placebo) were analyzed. RESULTS Mean side effects ratings were significantly higher for the imipramine group compared with the placebo group (p = .001). Side effects were not associated with noncompliance or with dropping out. Oppositional defiant disorder (ODD) in the adolescents was significantly associated with medication noncompliance (p = .036). On the Family Adaptability and Cohesion Evaluation Scale II (FACES II), low family adaptability (i.e., rigidity), low family cohesion (i.e., disengagement), and extreme family type were significantly associated with greater noncompliance with medications. Accuracy rates for guessing medication assignment (imipramine versus placebo) were 66% for subjects, 62.5% for mothers, and 79.5% for the psychiatrist. Logistic regression demonstrated that side effects (p = .005) and global improvement scores (p = .06) predicted the psychiatrist's guesses of drug assignment. CONCLUSIONS Side effects were not associated with noncompliance. Nonadherence with taking medications was associated with ODD in the adolescents and problematic family functioning on FACES II. The psychiatrist, who was blind to treatment condition, guessed the subjects' medication assignments with high accuracy. Thus, because of expectancy bias, the data support the use of blind independent evaluators for rating changes in medication trials.
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Affiliation(s)
- G A Bernstein
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA
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Pelham WE, Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. JOURNAL OF CLINICAL CHILD PSYCHOLOGY 1998; 27:190-205. [PMID: 9648036 DOI: 10.1207/s15374424jccp2702_6] [Citation(s) in RCA: 483] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Reviews and evaluates psychosocial treatments for attention deficit hyperactivity disorder (ADHD) in children and adolescents according to Task Force Criteria (Lonigan, Elbert, & Johnson, this issue). It is concluded that behavioral parent training and behavioral interventions in the classroom meet criteria for well-established treatments. Cognitive interventions do not meet criteria for well-established or probably efficacious treatments. Issues regarding the evaluative process are discussed and future directions for psychosocial treatment for ADHD are outlined.
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Affiliation(s)
- W E Pelham
- Department of Psychology, State University of New York at Buffalo 14260-4110, USA.
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Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36:85S-121S. [PMID: 9334567 DOI: 10.1097/00004583-199710001-00007] [Citation(s) in RCA: 314] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
These practice parameters review the literature on children, adolescents, and adults with attention-deficit/hyperactivity disorder (ADHD). There are three types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Together, they occur in as many as 10% of boys and 5% of girls of elementary school age. Prevalence declines with age, although up to 65% of hyperactive children are still symptomatic as adults. Frequency in adults is estimated to be 2% to 7%. Assessment includes clinical interviews and standardized rating scales from parents and teachers. Testing of intelligence and academic achievement usually are required. Comorbidity is common. The cornerstones of treatment are support and education of parents, appropriate school placement, and pharmacology. The primary medications are psychostimulants, but antidepressants and alpha-adrenergic agonists are used in special circumstances. Other treatments such as behavior modification, school consultation, family therapy, and group therapy address remaining symptoms.
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Ialongo N, Lopez M, Horn W, Pascoe J, Greenberg G. Effects of psychostimulant medication on self-perceptions of competence, control, and mood in children with attention deficit hyperactivity disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 1994. [DOI: 10.1207/s15374424jccp2302_6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Williams RA, Horn S, Daley SP, Nader PR. Evaluation of access to care and medical and behavioral outcomes in a school-based intervention program for attention-deficit hyperactivity disorder. THE JOURNAL OF SCHOOL HEALTH 1993; 63:294-297. [PMID: 8246460 DOI: 10.1111/j.1746-1561.1993.tb06147.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Project for Attention-Related Disorders (PARD), instituted by the San Diego (Calif.) School District. represents a unique approach to identification, referral, and management of children with Attention-Deficit Hyperactivity Disorder. As a school-based program, PARD coordinates medical, psychosocial, behavioral, and educational interventions for each child, and provides resources for school personnel caring for children with ADHD. Three years after instituting PARD, about 60% to 70% of the children showed improvement after enrollment, evaluation, and treatment. Parental involvement in and acceptance of intervention for their children represented a significant follow-up problem. Both medical and nonmedical interventions such as counseling, special programs, and behavior modification helped improve the educational life of these children.
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Rostain AL, Power TJ, Atkins MS. Assessing parents' willingness to pursue treatment for children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1993; 32:175-81. [PMID: 8428869 DOI: 10.1097/00004583-199301000-00025] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study investigated parents' willingness to pursue treatment for attention-deficit-hyperactivity-disorder (ADHD). METHOD A self-administered questionnaire (the ADHD Knowledge and Opinion Scale--AKOS) was developed and administered to a sample of 116 families attending an outpatient ADHD clinic. Socioeconomic status, parenting stress, family adaptability and cohesion, degree of child's externalizing behavior, and treatment history were obtained for each family. RESULTS Parents' willingness to use medication or to pursue counseling were not related to family factors. History of the child receiving medication was mildly correlated with willingness to use medication. History of counseling was mildly correlated with willingness to use medication and to pursue counseling. Mothers who viewed their family as "enmeshed" reported significantly higher sense of competence than those viewing the family as "connected" or "disengaged." CONCLUSION The AKOS is an instrument that may help clinicians identify and address parents' concerns about treatment for ADHD as well as parents' perceptions about their parenting skills.
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Affiliation(s)
- A L Rostain
- University of Pennsylvania School of Medicine, Philadelphia
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Ialongo NS, Horn WF, Pascoe JM, Greenberg G, Packard T, Lopez M, Wagner A, Puttler L. The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: a 9-month follow-up. J Am Acad Child Adolesc Psychiatry 1993; 32:182-9. [PMID: 8428870 DOI: 10.1097/00004583-199301000-00026] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Using a double-blind, placebo design, we evaluated 96 attention-deficit hyperactivity disordered children for the effects of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction. Seventy one of the children completed the treatment protocol. As reported previously, main effects were found for medication at posttest; however, there was no evidence of additive effects. Nine months after the termination of the behavioral interventions and the withdrawal of the stimulant medication, we found limited support for the hypothesis that the combined conditions would produce greater maintenance of treatment gains than would medication alone.
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Affiliation(s)
- N S Ialongo
- School of Hygiene and Public Health, Department of Mental Hygiene, Johns Hopkins University, Baltimore, MD 21205
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Brown RT, Jaffe SL, Silverstein J, Magee H. Methylphenidate and hospitalized adolescents with conduct disorder: Dose effects on classroom behavior, academic performance, and impulsivity. J Youth Adolesc 1991; 20:501-18. [DOI: 10.1007/bf01540634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/1990] [Accepted: 11/21/1990] [Indexed: 10/25/2022]
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Brown RT, Jaffe SL, Silverstein J, Magee H. Methylphenidate and Adolescents Hospitalized With Conduct Disorder: Dose Effects on Classroom Behavior, Academic Performance, and Impulsivity. ACTA ACUST UNITED AC 1991. [DOI: 10.1207/s15374424jccp2003_7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Horn WF, Ialongo NS, Pascoe JM, Greenberg G, Packard T, Lopez M, Wagner A, Puttler L. Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children. J Am Acad Child Adolesc Psychiatry 1991; 30:233-40. [PMID: 2016227 DOI: 10.1097/00004583-199103000-00011] [Citation(s) in RCA: 123] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Utilizing a double-blind, placebo design, the effects of a high (0.8 mg/kg) and a low (0.4 mg/kg) dose of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction were evaluated with 96 attention deficit hyperactivity disorder children. No evidence of the superiority of the combined conditions relative to medication alone was found. Some limited support was found for the hypothesis that the effects of a high dose of psychostimulant medication could be achieved by combining the low dose with a behavioral intervention. The importance of the latter finding is highlighted by the fact that both the benefits and untoward effects of the psychostimulants appear to increase with the dose.
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Affiliation(s)
- W F Horn
- Department of Health and Human Services, Washington, D.C
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Brown RT, Sexson SB. Effects of methylphenidate on cardiovascular responses in attention deficit hyperactivity disordered adolescents. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1989; 10:179-83. [PMID: 2715089 DOI: 10.1016/0197-0070(89)90229-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The short-term dose effects of methylphenidate were examined on cardiovascular measures in 11 black male adolescents diagnosed as having attention deficit hyperactivity disorder (ADHD). In a double-blind, cross-over design with randomized order, the subjects received placebo and each of three methylphenidate doses (0.15, 0.3, and 0.5 mg/kg) for a period of 2 weeks per medication dosage. Significant main effects were found for diastolic and systolic blood pressure; however, pairwise comparisons revealed a significant linear increase in diastolic blood pressure only. Because of the unexpected increase in diastolic blood pressure, careful monitoring of black adolescents who are receiving methylphenidate is recommended.
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Affiliation(s)
- R T Brown
- Department of Pediatrics and Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
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Affiliation(s)
- R K Deuel
- Edward Mallinckrodt Department of Pediatrics and Neurology, Washington University Medical Center, St. Louis, MO 63110
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Brown RT, Sexson SB. A controlled trial of methylphenidate in black adolescents. Attentional, behavioral, and physiological effects. Clin Pediatr (Phila) 1988; 27:74-81. [PMID: 3338232 DOI: 10.1177/000992288802700204] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The short-term effects of methylphenidate were examined on behavioral, laboratory, academic, and physiological measures in 11 black male adolescents diagnosed as having attention deficit disorder (ADD). In a double-blind, crossover design with randomized order, the subjects received placebo and each of three methylphenidate doses (0.15 mg/kg, 0.30 mg/kg, and 0.50 mg/kg) for a period of 2 weeks per medication dosage. Significant drug effects were found for the majority of measures. In general, the higher doses resulted in the most beneficial response in behavioral, academic, and laboratory measures of attention and impulsivity. However, a significant linear increase occurred in diastolic blood pressure. The results suggest that methylphenidate is an effective adjunct to the treatment of ADD in adolescents.
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Affiliation(s)
- R T Brown
- Division of Child and Adolescent Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
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