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Arnold VK, López FA, Childress AC, Po MD, Uchida CL, Cuthbertson L, Sallee FR, Incledon B. A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials. J Atten Disord 2024; 28:1186-1197. [PMID: 38600754 PMCID: PMC11107132 DOI: 10.1177/10870547241243155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE DR/ER-MPH (formerly HLD200) is an evening-dosed delayed-release and extended-release methylphenidate approved for the treatment of ADHD in patients ≥6 years. Post hoc analyses of two pivotal Phase 3 trials: HLD200-107 (NCT02493777) and HLD200-108 (NCT02520388) evaluated emotional lability (EL) with DR/ER-MPH treatment. METHODS Differences in Conners Global Index-Parent (CGI-P) EL subscale scores and age- and gender-adjusted T-scores over an open-label titration phase (HLD200-107) and between treatment and placebo groups at endpoint (HLD200-108) were evaluated. RESULTS In HLD200-107 (N = 117) mean CGI-P EL subscale scores improved from 5.3 to 1.3 (p < .0001) after 6 weeks; in HLD200-108 significant improvements were observed in the treatment group (n = 81) versus placebo (n = 80; 3.11 vs. 4.08; p = .0053). T-scores showed an improvement with DR/ER-MPH treatment in both trials. Few emotional adverse events (AEs) were reported. CONCLUSION DR/ER-MPH treatment resulted in statistically significant improvements in EL to the level of non-ADHD peers as contextualized by T-scores.
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Affiliation(s)
| | - Frank A. López
- Pediatrix Neurology and Epilepsy Research Center, Winter Park, FL, USA
| | - Ann C. Childress
- Center for Psychiatry and Behavioral Medicine Inc., Las Vegas, NV, USA
| | | | | | | | | | - Bev Incledon
- Ironshore, Camana Bay, Grand Cayman, Cayman Islands
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Milojevich HM, Lindquist KA, Sheridan MA. Adversity and Emotional Functioning. AFFECTIVE SCIENCE 2021; 2:324-344. [PMID: 36059901 PMCID: PMC9382958 DOI: 10.1007/s42761-021-00054-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/03/2021] [Indexed: 04/15/2023]
Abstract
Exposure to early adversity has been linked to variations in emotional functioning. To date, however, the precise nature of these variations has been difficult to pinpoint given widespread differences in the ways in which aspects of emotional functioning are defined and measured. Here, more consistent with models of emotional functioning in typically developing populations (e.g., Halberstadt et al., 2001), we propose defining emotional functioning as consisting of distinct domains of emotion expression, perception, knowledge, reactivity, and regulation. We argue that this framework is useful for guiding hypothesis generation about the specific impact of early adversity on children's emotional functioning. We operationalize the construct of emotional functioning, highlight what is currently known about the association between adversity exposure and each domain of emotional functioning, propose potential mechanisms for these associations, and set the stage for future research examining the development of emotional functioning in the context of early adversity.
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Affiliation(s)
- Helen M. Milojevich
- Department of Pediatrics, University of Oklahoma Health Sciences Center, 1000 NE 13th Street, Nicholson Tower Suite 4976, OK 73104 Oklahoma City, USA
| | - Kristen A. Lindquist
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC USA
| | - Margaret A. Sheridan
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC USA
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Breaux R, Langberg JM, Swanson CS, Eadeh HM, Becker SP. Variability in Positive and Negative Affect Among Adolescents with and without ADHD: Differential Associations with Functional Outcomes. J Affect Disord 2020; 274:500-507. [PMID: 32663982 PMCID: PMC8010584 DOI: 10.1016/j.jad.2020.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/25/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study examined whether adolescents with and without attention-deficit/hyperactivity disorder (ADHD) differed in affect variability and whether variability in positive and negative affect was associated with functional outcomes. METHOD Participants were 302 adolescents (12-14 years, Mage=13.17, 55% male; 54% diagnosed with ADHD; 82% white) and their caregivers who each completed the 10-item Positive and Negative Affect Scale via daily diaries for approximately two weeks. Multi-informant ratings of emotional, behavioral, social, and academic outcomes were assessed. RESULTS Adolescents with ADHD were found to experience greater variability in self- and parent-reported positive affect, fear, and distress. For adolescents with ADHD, greater variability in self- and parent-reported positive affect, fear, and distress were associated with more internalizing symptoms, greater variability in parent-reported positive affect was associated with worse social functioning, and greater variability in self- and parent-reported fear was associated with more externalizing symptoms. In contrast, greater variability in self- and parent-reported positive affect, fear, and distress were associated with better social functioning in adolescents without ADHD. LIMITATIONS Future work should examine affect variability in adolescents with ADHD within the same day rather than across days. The limited age range and demographic diversity of our sample may limit generalizability of findings. CONCLUSIONS Findings suggest the significant affect variability found among children with ADHD is also present in adolescents with ADHD and is associated with social and behavior impairment. Interventions for adolescents with ADHD should target emotion regulation abilities to help reduce the extremes of and shifts in affective experiences in this population.
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Affiliation(s)
- Rosanna Breaux
- Virginia Polytechnic Institute and State University, Department of Psychology.
| | | | - Courtney S Swanson
- Virginia Polytechnic Institute and State University, Department of Psychology
| | - Hana-May Eadeh
- University of Iowa, Department of Psychological and Brain Sciences
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology; University of Cincinnati College of Medicine, Department of Pediatrics
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Simon MAVP, Reed UC, Vaughan B, Simon VA, Casella EB. Validation of the Expression and Emotion Scale for Children with attention deficit hyperactivity disorder into Brazilian Portuguese. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:563-569. [PMID: 28813087 DOI: 10.1590/0004-282x20170105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To validate the parent-rated Expression and Emotion Scale for Children (EESC) for patients with attention-deficit/hyperactivity disorder (ADHD). METHODS The EESC was applied to parents of children with and without ADHD. The children were divided into age groups: Group A, between six and eight years old; Group B, between nine and 11 years old; and Group C, between 12 and 15 years old. The validation was carried out according to the steps proposed by Guillemin et al. For the statistical calculation, Cronbach's α, Pearson's correlation, the ICC and ROC curve were used. RESULTS The statistical tests showed satisfactory coefficients: Cronbach's α = 0.76; Pearson's correlation r = 0.91 with CI 95%; replicability ICC = 0.66; sensitivity 0.75; specificity 0.67; accuracy 71%. CONCLUSION According to psychometric data on internal and external consistency (reliability, reproducibility), sensitivity, and specificity, the parent-rated EESC for ADHD is useful in assessing emotional expression.
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Affiliation(s)
- Margarete Andreozzi Vaz Pereira Simon
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Distúrbios de Aprendizado do Instituto da Criança, São Paulo SP, Brasil
| | - Umbertina Conti Reed
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Brigette Vaughan
- University of Nebraska Medical Center, Munroe Meyer Institute, Department of Developmental and Pediatric Behavioral, Nebraska, United States
| | - Valdecir Antonio Simon
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
| | - Erasmo Barbante Casella
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Distúrbios de Aprendizado do Instituto da Criança, São Paulo SP, Brasil
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder defined by persistent inattention and/or hyperactivity and impulsivity. These symptoms occur more frequently and are more severe in individuals with ADHD compared with those at a similar developmental level without ADHD, and can be conceptualized as deficits in executive functioning (EF). EF includes domains of metacognition and inhibition, which influence the ability to regulate responses elicited by emotional stimuli. EF deficits can lead to emotional lability (EL), which is characterized by sudden changes in emotion and behaviors of inappropriately high intensity that may include sudden bouts of anger, dysphoria, sadness, or euphoria. EL is common and estimated to occur in about 3.3-10% of the population. Recent estimates of EL prevalence in children and adolescents with ADHD range from 38 to 75%. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not include EL in diagnostic criteria for ADHD, but does include ADHD-associated features of low frustration tolerance, irritability, or mood lability. The neurobiological basis of EL is not well understood, but brain imaging studies support dividing EF into "cool" cognitive networks encompassing attention and planning activities, and "hot" motivational networks involved in temporal discounting, reward processing, and reward anticipation. Dysfunction in "hot" networks is thought to be related to EL. EL symptoms are associated with more severe ADHD and co-morbidities, have significant impact on functioning, and may respond to treatment with medications frequently used to treat ADHD. Treatment outcomes and areas for future research are discussed.
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Silva D, Houghton S, Hagemann E, Jacoby P, Jongeling B, Bower C. Child attention deficit hyperactive disorder co morbidities on family stress: effect of medication. Community Ment Health J 2015; 51:347-53. [PMID: 25154408 DOI: 10.1007/s10597-014-9770-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 07/20/2014] [Indexed: 11/27/2022]
Abstract
We examined the degree of parental and child mental health in a community sample of children diagnosed with Attention Deficit Hyperactive Disorder and the effect on family stress prior to and during treatment using a community retrospective questionnaire study. In total 358 questionnaires were returned for analysis where 92 % of children had at least one co-morbid condition and mental health conditions in parents was common. Overall, the Family Strain Index was significantly reduced after commencement of medication (p < 0.0001), but remained higher in families where the children had either externalizing disorders or autism spectrum disorder.
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Affiliation(s)
- Desiree Silva
- Telethon Kids Institute, University of Western Australia, Perth, Australia,
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Houghton S, Hunter SC, Trewin T, Glasgow K, Carroll A. The multidimensional anxiety scale for children: a further validation with Australian adolescents with and without ADHD. J Atten Disord 2014; 18:402-11. [PMID: 22427253 DOI: 10.1177/1087054712439100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the factor structure of the Multidimensional Anxiety Scale for Children (MASC) with Australian adolescents with and without ADHD. METHOD The MASC was administered to 210 high school-aged adolescents (109 males, 101 females), 115 of whom were clinically diagnosed as ADHD (86 males, 29 females). The remaining 95 were non-ADHD community comparisons. RESULTS Analyses supported a three-factor model, with a reduced item pool, which combined the Harm Avoidance and Separation Anxiety scales together. This model was invariant across younger and older participants, and across boys and girls. The model was largely invariant across ADHD and non-ADHD groups. The ADHD group had significantly higher Physical Symptom factor scores than the non-ADHD group. CONCLUSION The MASC is useful for assessing anxiety in adolescents with and without ADHD, but items reflecting the Harm Avoidance and Separation Anxiety scales may need revising.
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Affiliation(s)
| | | | - Toby Trewin
- The University of Western Australia, Crawley, Australia
| | - Ken Glasgow
- The University of Western Australia, Crawley, Australia
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Findings from the observational COMPLY study in children and adolescents with ADHD: core symptoms, ADHD-related difficulties, and patients’ emotional expression during psychostimulant or nonstimulant ADHD treatment. ACTA ACUST UNITED AC 2014; 6:291-302. [DOI: 10.1007/s12402-014-0136-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
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Childress AC, Arnold V, Adeyi B, Dirks B, Babcock T, Scheckner B, Lasser R, Lopez FA. The effects of lisdexamfetamine dimesylate on emotional lability in children 6 to 12 years of age with ADHD in a double-blind placebo-controlled trial. J Atten Disord 2014; 18:123-32. [PMID: 22740112 DOI: 10.1177/1087054712448252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of lisdexamfetamine dimesylate (LDX) on emotional lability (EL) in children with ADHD. METHOD Post hoc analyses of a placebo-controlled trial of LDX-stratified children (aged 6-12 years) with ADHD to prominent and not prominent EL at baseline (score >3 or ≤3, respectively, on Conners' Parent Rating Scale [CPRS] items of anger, loss of temper, and irritability). Efficacy was assessed by change in CPRS EL scores and ADHD Rating Scale-IV (ADHD-RS-IV) total and subscale scores. Safety measures included treatment-emergent adverse events (TEAEs). RESULTS LDX showed improvement versus placebo (p < .0005) for EL item least squares (LS) mean change scores at endpoint and throughout the day. At baseline, 138 and 73 participants randomized to LDX treatment and having baseline and endpoint CPRS scores were categorized with CPRS-derived prominent and not prominent baseline EL, respectively; 41 and 31 participants randomized to placebo were categorized with CPRS-derived prominent and not prominent baseline EL, respectively. ADHD-RS-IV total and subscale scores decreased with LDX regardless of baseline EL severity. TEAEs included decreased appetite, insomnia, upper abdominal pain, headache, and irritability. CONCLUSION EL and ADHD symptoms improved with LDX regardless of baseline EL symptom severity. LDX demonstrated a safety profile consistent with long-acting psychostimulant use.
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Affiliation(s)
- Ann C Childress
- 1Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA
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Skirrow C, McLoughlin G, Kuntsi J, Asherson P. Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother 2014; 9:489-503. [DOI: 10.1586/ern.09.2] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cortical activation deficits during facial emotion processing in youth at high risk for the development of substance use disorders. Drug Alcohol Depend 2013; 131:230-7. [PMID: 23768841 PMCID: PMC3740548 DOI: 10.1016/j.drugalcdep.2013.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/15/2013] [Accepted: 05/13/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent longitudinal studies demonstrate that addiction risk may be influenced by a cognitive, affective and behavioral phenotype that emerges during childhood. Relatively little research has focused on the affective or emotional risk components of this high-risk phenotype, including the relevant neurobiology. METHODS Non-substance abusing youth (N=19; mean age=12.2) with externalizing psychopathology and paternal history of a substance use disorder and demographically matched healthy comparisons (N=18; mean age=11.9) were tested on a facial emotion matching task during functional MRI. This task involved matching faces by emotions (angry, anxious) or matching shape orientation. RESULTS High-risk youth exhibited increased medial prefrontal, precuneus and occipital cortex activation compared to the healthy comparison group during the face matching condition, relative to the control shape condition. The occipital activation correlated positively with parent-rated emotion regulation impairments in the high-risk group. CONCLUSIONS These findings suggest a preexisting abnormality in cortical activation in response to facial emotion matching in youth at high risk for the development of problem drug or alcohol use. These cortical deficits may underlie impaired affective processing and regulation, which in turn may contribute to escalating drug use in adolescence.
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Katic A, Dirks B, Babcock T, Scheckner B, Adeyi B, Richards C, Findling RL. Treatment outcomes with lisdexamfetamine dimesylate in children who have attention-deficit/hyperactivity disorder with emotional control impairments. J Child Adolesc Psychopharmacol 2013; 23:386-93. [PMID: 23952185 PMCID: PMC3749705 DOI: 10.1089/cap.2012.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to assess lisdexamfetamine dimesylate (LDX) treatment effects based on baseline emotional control dysfunction in children with attention-deficit/hyperactivity disorder (ADHD) categorized with or without impairments of executive function (EF) emotional control. METHODS Post-hoc analyses of a 7 week, open-label LDX study in children with ADHD (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision [DSM-IV-TR] defined) and impairments in EF control of emotional response. At baseline, participants were dichotomized by Behavior Rating Inventory of EF (BRIEF) emotional control domain T-scores of ≥65 (with impairment) or <65 (without impairment). ADHD Rating Scale-IV (ADHD-RS-IV), BRIEF Global Executive Composite and emotional control domain, Expression and Emotion Scale for Children (EESC) scores, Pearson correlations for BRIEF versus ADHD-RS-IV and EESC, and Clinical Global Impressions scores were assessed at baseline and end of study (week 7)/early termination (EOS/ET) by baseline category of BRIEF emotional control impairment. Safety assessments included treatment-emergent adverse events (TEAEs). RESULTS At baseline and EOS/ET, respectively, 53.0% and 20.7% met criteria for emotional control impairment. Participants with and without emotional control impairments had similar ADHD-RS-IV change scores. Mean (SD) change from baseline for those with and without emotional control impairments were -20.8 (12.89) and -14.6 (11.25) for BRIEF global scores and -16.0 (13.19) and -5.0 (9.48) for BRIEF emotional control domain scores. Participants with emotional control impairments had greater mean EESC total score changes. BRIEF emotional control domain and all ADHD-RS-IV scores indicated moderate correlations between change scores (all p<0.0001). Overall, 84.9% of participants had TEAEs (mostly mild-to-moderate in severity); 3.8% discontinued because of TEAEs. CONCLUSIONS The proportion of children with behavioral impairments in EF control of emotional response decreased during LDX treatment. ADHD symptoms improved in both groups. The moderate correlations between EF behaviors and ADHD symptoms suggest there may be utility in evaluating behavioral domains beyond core ADHD symptoms.
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Affiliation(s)
| | - Bryan Dirks
- Clinical Development and Innovation, Shire Development LLC, Wayne, Pennsylvania
| | - Thomas Babcock
- Global Medical Affairs, Shire Development, LLC, Wayne, Pennsylvania
| | - Brian Scheckner
- Global Medical Affairs, Shire Development, LLC, Wayne, Pennsylvania
| | - Ben Adeyi
- Biostatistics and Statistical Programming Department, Shire Development LLC, Wayne, Pennsylvania
| | - Cynthia Richards
- Clinical Development and Innovation, Shire Development LLC, Wayne, Pennsylvania
| | - Robert L. Findling
- Johns Hopkins Medicine and the Kennedy Krieger Institute, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland
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The Performance of College Students with and without ADHD: Neuropsychological, Academic, and Psychosocial Functioning. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9351-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Katic A, Ginsberg L, Jain R, Adeyi B, Dirks B, Babcock T, Scheckner B, Richards C, Lasser R, Turgay A, Findling RL. Clinically relevant changes in emotional expression in children with ADHD treated with lisdexamfetamine dimesylate. J Atten Disord 2012; 16:384-97. [PMID: 21173426 DOI: 10.1177/1087054710389990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe clinically relevant effects of lisdexamfetamine dimesylate (LDX) on emotional expression (EE) in children with ADHD. METHOD Children with ADHD participated in a 7-week, open-label, LDX dose-optimization study. Expression and Emotion Scale for Children (EESC) change scores were analyzed post hoc using two methods to determine proportion of participants with different categories of clinical response based on (a) clinically significant (movement >2 SD from baseline mean)/reliable change (not due to measurement error) and (b) standard error of measurement (SEM) as a measure of clinically meaningful change. RESULTS With LDX, no participants showed clinically significant/reliable improvement; 0.7% showed clinically significant/reliable deterioration of EE by reliable change index and movement from baseline mean. One third of participants had improved EE by SEM criteria; 9.2% had categorical worsening. CONCLUSION Using clinically meaningful change and clinically significant/reliable change categories derived from the EESC, most participants had no worsening of EE with LDX.
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Affiliation(s)
- Alain Katic
- Claghorn-Lesem Research Clinic, Bellaire, TX 77008, USA.
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Dupaul GJ, Weyandt LL, Rossi JS, Vilardo BA, O'Dell SM, Carson KM, Verdi G, Swentosky A. Double-blind, placebo-controlled, crossover study of the efficacy and safety of lisdexamfetamine dimesylate in college students with ADHD. J Atten Disord 2012; 16:202-20. [PMID: 22166471 DOI: 10.1177/1087054711427299] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate stimulant medication on symptoms and functioning for college students with ADHD using double-blind, placebo-controlled, crossover design. METHOD Participants included 24 college students with ADHD and 26 college students without psychopathology. Lisdexamfetamine dimesylate (LDX) was examined for ADHD participants over five weekly phases (no-drug baseline, placebo, 30-, 50-, and 70-mg LDX per day). Self-report rating scales of functioning and direct assessment of ADHD symptoms, verbal learning/memory, and adverse side effects were collected (baseline only for control students). RESULTS LDX was associated with large reductions in ADHD symptoms and improvement in executive functioning along with smaller effects for psychosocial functioning. Reduction in ADHD symptoms was found for 86.4% of participants; however, large differences in symptoms and executive functioning remained relative to controls. CONCLUSION LDX is a safe, efficacious treatment for symptom relief in college students with ADHD. Research documenting medication effects on academic functioning and evaluating psychosocial/educational interventions is needed.
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Childress AC, Sallee FR. The use of lisdexamfetamine dimesylate for the treatment of ADHD. Expert Rev Neurother 2012; 12:13-26. [PMID: 22243042 DOI: 10.1586/ern.11.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
ADHD is a common neurobehavioral disorder characterized by significant impairment in attention, hyperactivity and impulsivity. Symptoms begin in childhood and can persist into adulthood. Current data suggest that abnormal functioning of the prefrontal cortex, cortical and subcortical regions of the brain have roles in ADHD. All currently approved drugs used to treat ADHD enhance dopamine and norepinephrine signals in these regions. Lisdexamfetamine dimesylate (LDX) is a long-acting amphetamine prodrug indicated for the treatment of ADHD and has been shown to be effective in children, adolescents and adults. The prodrug properties of LDX make it a desirable treatment because of its long duration of effect, and low intrasubject and intersubject pharmacokinetic variability, and attenuated response on measures of abuse liability when compared with immediate-release amphetamine. However, LDX is still classified as a controlled substance. In this article, the pharmacokinetic parameters and efficacy and safety of LDX are reviewed.
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Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc., 7351 Prairie Falcon Road, Suite 160, Las Vegas, NV, USA.
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Findling RL, Brams M, Childress AC, López FA, Manos MJ, Jensen PS. Changes in emotions related to medication used to treat ADHD. Part II: clinical approaches. J Atten Disord 2011; 15:113-21. [PMID: 20858786 DOI: 10.1177/1087054710381232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ADHD is one of the most common neurobehavioral disorders of childhood, and FDA-approved medications offer an efficacious treatment option. However, case reports and anecdotal sources suggest that children can have emotional responses, both salutary and detrimental, to these agents. We have previously conducted a comprehensive literature review and found very few research studies systematically examining changes in emotional expression (EE) associated with ADHD medication use. In addition, no empirical data pertaining to the management of these responses could be found. Although few methodologically stringent data are available for changes in EE, such changes should be recognized and measured to determine appropriate responses by clinicians and to maximize treatment benefits and reduce side effects. In this companion report, we draw on available research evidence and clinical experience to explore typical clinical manifestations, differential diagnosis, scales for monitoring, and management approaches of EE observed with pharmacologic treatment of ADHD. In the future, controlled clinical trials of ADHD pharmacotherapy should employ standardized ratings of EE at baseline, during and after treatment. In addition, future research studies should examine various management approaches of these EE changes, to ensure maximal treatment benefits and minimal risks to patients with ADHD who are treated with medication.
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Manos MJ, Brams M, Childress AC, Findling RL, López FA, Jensen PS. Changes in emotions related to medication used to treat ADHD. Part I: literature review. J Atten Disord 2011; 15:101-12. [PMID: 20876887 DOI: 10.1177/1087054710381230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To summarize the literature investigating changes in emotional expression (EE) as a function of pharmacotherapy in the treatment of ADHD and to differentiate emotional effects related to ADHD pharmacotherapy from emotional effects related to ADHD as a disorder. METHOD English language articles published from January 1, 1988, through August 31, 2008 were identified through a PubMed literature search using the search terms attention, ADHD, hyperactive, hyperkinesis, and ADD cross-referenced with medication terms amphetamine, lisdexamfetamine, methylphenidate , guanfacine, atomoxetine, and clonidine. The search was limited to randomized, controlled trials. Abstracts from all identified articles were selected for further review if they met criteria including (a) presence of a placebo arm, (b) children ≤ 18 years of age, (c) ≥ 20 participants, and (b) study design elements that would allow reviewers to determine whether EE phenomena were specifically attributable to medication effects versus alternative explanations (e.g., time, maturation, baseline comorbidity, selection artifacts, or treatments other than the medication-placebo contrast). Qualifying full-text articles were reviewed for prespecified EE terms. RESULTS Of 148 articles that met selection criteria, 47 reported varying types of EE. Eight of these included two active treatment arms. Hence, 55 data sets were identified. Patterns of change in EE in studies meeting search criteria are discussed. Data sets that reported accounts of EE by the percentage of patients were compiled and further analyzed for specific medication classes. The changes in EE are further discussed as (a) salutary or detrimental, (b) associated with time of day or circumscribed, and (c) presumed to be caused by pharmacological effects. CONCLUSIONS Definitive methodologies for assessing the presence of changes in EE in clinical trials and guidelines for the evaluation of EE in clinical practice are yet to be established and are needed. Such guidelines could be used by clinicians to monitor positive and negative changes in emotion when patients are taking medications for their ADHD.
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Turgay A, Ginsberg L, Sarkis E, Jain R, Adeyi B, Gao J, Dirks B, Babcock T, Scheckner B, Richards C, Lasser R, Findling RL. Executive function deficits in children with attention-deficit/hyperactivity disorder and improvement with lisdexamfetamine dimesylate in an open-label study. J Child Adolesc Psychopharmacol 2010; 20:503-11. [PMID: 21186969 PMCID: PMC3005278 DOI: 10.1089/cap.2009.0110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the effects of lisdexamfetamine dimesylate (LDX) on executive function (EF) behaviors in children with attention-deficit/hyperactivity disorder (ADHD). METHODS This observational, open-label, 7-week, dose-optimization study of LDX (20-70 mg/day) in children with ADHD evaluated efficacy with the ADHD Rating Scale IV; safety measures included adverse events (AEs). EF was assessed with the Behavior Rating Inventory of Executive Function (BRIEF). Post hoc analyses examined BRIEF scores by sex, ADHD subtype, comorbid psychiatric symptoms, and common treatment-emergent AEs (TEAEs). ADHD Rating Scale IV scores were assessed in subjects categorized by baseline BRIEF global executive composite T scores with clinically significant (≥65) or not clinically significant (<65) impairment in EF. RESULTS Mean (standard deviation) change from baseline to endpoint for BRIEF of -17.9 (12.5) for Global Executive Composite, -15.4 (12.6) for Behavioral Regulation Index, and -17.6 (12.3) for Metacognition Index demonstrated improvement with LDX (pooled doses; p < 0.0001 for all). Improvements in BRIEF scores were seen regardless of sex, ADHD subtype, comorbid psychiatric symptoms, common TEAEs, or baseline EF impairment category. TEAEs included decreased appetite, decreased weight, irritability, insomnia, headache, upper abdominal pain, and initial insomnia. CONCLUSIONS Improvements were demonstrated in EF behaviors and ADHD symptoms with LDX. LDX safety profile was consistent with long-acting stimulant use.
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Affiliation(s)
| | | | | | - Rakesh Jain
- R/D Clinical Research, Inc., Lake Jackson, Texas
| | - Ben Adeyi
- Shire Development Inc., Wayne, Pennsylvania
| | - Joseph Gao
- Shire Development Inc., Wayne, Pennsylvania
| | | | | | | | | | | | - Robert L. Findling
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly genetic neuropsychiatric disorder that can cause impairment at school, work, home, and in social relationships. Once considered a childhood disorder, as many as 65% of children with ADHD continue to exhibit symptoms into adulthood. While a mainstay of ADHD patient care, immediate-release stimulant use has been constrained by concerns about safety, tolerability, and issues related to nonmedical use and abuse. These concerns have prompted interest in developing modified versions or new delivery systems for stimulants. Prodrugs have been used in pharmaceutical development to optimize delivery of an active drug or to minimize toxicity. Prodrugs are pharmacologically inactive compounds that require in vivo conversion to release therapeutically active medications. Lisdexamfetamine dimesylate (LDX) is an inactive, water-soluble prodrug in which d-amphetamine is bonded to l-lysine, a naturally occurring amino acid. After oral ingestion, LDX is metabolized into l-lysine and active d-amphetamine. This review of LDX presents the efficacy, safety, and pharmacokinetic profile of this novel stimulant medication, and is intended to help clinicians understand its role in treating children and adults with ADHD.
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Findling RL, Ginsberg LD, Jain R, Gao J. Effectiveness, safety, and tolerability of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: an open-label, dose-optimization study. J Child Adolesc Psychopharmacol 2009; 19:649-62. [PMID: 20035583 DOI: 10.1089/cap.2008.0165] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness and safety of lisdexamfetamine dimesylate (LDX) in children with attention-deficit/hyperactivity disorder (ADHD). METHOD This was a 7-week, open-label study evaluating 20, 30, 40, 50, 60, or 70 mg/day LDX in 318 children aged 6-12 years with ADHD. The ADHD Rating Scale IV (ADHD-RS-IV) was the primary efficacy assessment. Secondary measures included the Clinical Global Impressions-Improvement (CGI-I), Expression and Emotion Scale for Children (EESC), and Behavior Rating Inventory of Executive Function (BRIEF). Safety assessments included treatment-emergent adverse events (TEAEs), vital signs, and electrocardiograms. RESULTS At end point, mean (standard deviation [SD]) improvement from baseline in ADHD-RS-IV total score was 28.6 (10.9) (p < 0.0001). Most subjects (89.9%) were rated "improved" (i.e., CGI-I 1 or 2). Improvements from baseline were observed in the EESC total and subscale scores (p < or = 0.0002). LDX treatment resulted in significant improvement on the Global Executive Composite, Behavioral Regulation, and Metacognition indices of the BRIEF (p < 0.0001). TEAEs (incidences > or =10%) were decreased appetite, decreased weight, irritability, insomnia, headache, upper abdominal pain, and initial insomnia. CONCLUSIONS LDX was effective and generally well tolerated with a safety profile consistent with long-acting stimulant use. There was overall improvement in ADHD symptoms and executive function measures and no worsening of emotional expression measures. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00500071.
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Affiliation(s)
- Robert L Findling
- University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
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