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"ADHD therapy research publications are scanned daily from major neurology journals and updated here" Archive 12/2008 Hematologic and blood biochemistry monitoring during methylphenidate treatment in children with attention-deficit/hyperactivity disorder: 2-year, open-label study results. Related Articles
Hematologic and blood biochemistry monitoring during methylphenidate treatment in children with attention-deficit/hyperactivity disorder: 2-year, open-label study results.
Pediatrics. 2007 Jul;120(1):e120-8
Latest ADHD therapy research Authors: Wigal SB, Wilens TE, Wolraich M, Lerner M
OBJECTIVES: Patients receiving methylphenidate for the management of attention-deficit/hyperactivity disorder are recommended to receive periodic hematologic monitoring. The objective of this study was to evaluate the long-term effects of methylphenidate treatment on blood biochemistry and hematologic values. METHODS: This study involved a detailed analysis of changes in hematologic and blood biochemistry values over the course of a 2-year study of once-daily OROS methylphenidate in otherwise healthy children aged 6 to 13 years with attention-deficit/hyperactivity disorder. Routine hematologic and blood biochemistry assessments were performed at baseline, at 6 and 12 months during study treatment, and at the end of the study. RESULTS: Of the 407 subjects enrolled in the study, 289 completed year 1, and 229 completed 21 of 24 months. No subject was excluded from entry into the study or discontinued from the study because of abnormalities of any of the blood chemistries evaluated. There were no clinically significant changes from baseline in mean values for hematologic or blood biochemistry parameters. For most values, the mean change in value over the course of the study was <5%. CONCLUSIONS: These longer-term data suggest that chronic therapy with OROS methylphenidate has no clinically significant impact on laboratory values, challenging the necessity of routine hematologic monitoring in otherwise healthy children with attention-deficit/hyperactivity disorder who are treated with methylphenidate.
Latest ADHD therapy research PMID:17548486 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention deficit hyperactivity disorder across the lifespan: the child, adolescent, and adult. Related Articles
Attention deficit hyperactivity disorder across the lifespan: the child, adolescent, and adult.
Dis Mon. 2007 Feb;53(2):70-131
Latest ADHD therapy research Authors: Greydanus DE, Pratt HD, Patel DR
Management of a child, adolescent, college student, or adult with ADD/ADHD (ADHD) is reviewed with emphasis on pharmacologic approaches in the adult. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants (psychostimulants), antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Psychopharmacology approved and/or used in pediatric patients are also used in adults with ADHD, though most are not officially FDA-approved. It is emphasized that ADHD management should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient of any age, and judicious use of medications. Such an approach is recommended to benefit those with ADHD achieve their maximum potential across the human life span.
Latest ADHD therapy research PMID:17386306 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Stimulant-drug therapy for attention-deficit disorder (with or without hyperactivity) and sudden cardiac death. Related Articles ADHD therapy
Stimulant-drug therapy for attention-deficit disorder (with or without hyperactivity) and sudden cardiac death.
Pediatrics. 2007 Jan;119(1):154-5
Latest ADHD therapy research Authors: Knight M
Latest ADHD therapy research PMID:17200281 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Optimizing therapy of seizures in children and adolescents with ADHD. Related Articles
Optimizing therapy of seizures in children and adolescents with ADHD.
Neurology. 2006 Dec 26;67(12 Suppl 4):S49-51
Latest ADHD therapy research Authors: Aldenkamp AP, Arzimanoglou A, Reijs R, Van Mil S
Attention deficit hyperactivity disorder (ADHD) can coexist with epilepsy and the prevalence of ADHD in epilepsy is three to five times greater than normal. This may be an effect of the epilepsy (particularly as a secondary symptom of subtle seizures) or of the antiepileptic treatment. There is an ongoing debate about the nature of ADHD in epilepsy and especially whether successive comorbidity exists (i.e., the possibility that epilepsy lowers the threshold for developing ADHD). Treatment of comorbid ADHD may be difficult. Methylphenidate is still the treatment of choice for the condition and, although it has been shown that neither methylphenidate nor other psychostimulants provoke seizures, there is still a possibility that seizure frequency may increase in children with active epilepsy.
Latest ADHD therapy research PMID:17190923 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Seasonal affective disorder. Related Articles ADHD therapy
Seasonal affective disorder.
Am Fam Physician. 2006 Nov 1;74(9):1521-4
Latest ADHD therapy research Authors: Lurie SJ, Gawinski B, Pierce D, Rousseau SJ
Patients with seasonal affective disorder have episodes of major depression that tend to recur during specific times of the year, usually in winter. Like major depression, seasonal affective disorder probably is underdiagnosed in primary care settings. Although several screening instruments are available, such screening is unlikely to lead to improved outcomes without personalized and detailed attention to individual symptoms. Physicians should be aware of comorbid factors that could signal a need for further assessment. Specifically, some emerging evidence suggests that seasonal affective disorder may be associated with alcoholism and attention-deficit/hyperactivity disorder. Seasonal affective disorder often can be treated with light therapy, which appears to have a low risk of adverse effects. Light therapy is more effective if administered in the morning. It remains unclear whether light is equivalent to drug therapy, whether drug therapy can augment the effects of light therapy, or whether cognitive behavior therapy is a better treatment choice.
Latest ADHD therapy research PMID:17111890 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning. Related Articles
Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning.
Clin Pediatr (Phila). 2006 Nov;45(9):819-27
Latest ADHD therapy research Authors: Brown RT, Perwien A, Faries DE, Kratochvil CJ, Vaughan BS
The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder (ADHD) symptoms and functional impairments at school and at home. Participants were 153 children (age 8 to 12 years) diagnosed with attention-deficit hyperactivity disorder who were randomized to double-blind treatment with either atomoxetine (n = 101) or placebo (n = 52). Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy. Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents. No significant effects were revealed for the teacher ratings of academic productivity. Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD. The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest, albeit less compelling for this particular investigation, than for the effects on overt symptom display.
Latest ADHD therapy research PMID:17041169 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder. Related Articles
Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder.
Pediatrics. 2006 Sep;118(3):e704-10
Latest ADHD therapy research Authors: Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B
OBJECTIVE: Automobile accidents are the leading cause of death among adolescents, and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder. Studies have demonstrated that stimulants improve driving performance. This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations. METHODS: Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylphenidate, 30 mg of mixed amphetamine salts extended release, or placebo in a randomized, double-blind, placebo-controlled, crossover study design. During laboratory testing, adolescents drove a driving simulator at 5:00 pm, 8:00 pm, and 11:00 pm. Driving performance was rated by adolescents and investigators. RESULTS: The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder (19 boys/16 girls). The mean age was 17.8 years. The overall Impaired Driving Score demonstrated that OROS methylphenidate led to better driving performance compared with placebo and mixed amphetamine salts extended release, whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo. Specifically, relative to placebo, OROS methylphenidate resulted in less time driving off the road, fewer instances of speeding, less erratic speed control, more time executing left turns, and less inappropriate use of brakes. OROS methylphenidate and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder. CONCLUSIONS: This study validates the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder. In the study, OROS methylphenidate promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release.
Latest ADHD therapy research PMID:16950962 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]General anesthesia and chronic amphetamine use: should the drug be stopped preoperatively? Related Articles
General anesthesia and chronic amphetamine use: should the drug be stopped preoperatively?
Anesth Analg. 2006 Jul;103(1):203-6, table of contents
Latest ADHD therapy research Authors: Fischer SP, Schmiesing CA, Guta CG, Brock-Utne JG
Prescription amphetamines are being used more often for several medical conditions. Anesthesia concerns focus on the cardiovascular stability of patients who may be catecholamine-depleted and thus have a blunted response to intraoperative hypotension. Previously we reported one case of a patient receiving chronic amphetamine therapy who had a stable intraoperative course. We now report eight additional patients taking chronic prescription amphetamines who underwent a safe general anesthesia and outcome. Predominantly prescribed for narcolepsy and attention deficit hyperactivity disorder, amphetamine drugs had been given to these 8 patients for 2 to 10 yr. Ages ranged from 22 to 77 yr and genders were equally divided. All required general anesthesia for their surgical procedures and 6 of the 8 patients were tracheally intubated. Anesthesia operating room times ranged from 30 min to 4.25 h. The authors conclude that amphetamine use need not be stopped before surgery and anesthesia.
Latest ADHD therapy research PMID:16790654 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Continuity of methylphenidate treatment for attention-deficit/hyperactivity disorder. Related Articles
Continuity of methylphenidate treatment for attention-deficit/hyperactivity disorder.
Arch Pediatr Adolesc Med. 2005 Jun;159(6):572-8
Latest ADHD therapy research Authors: Marcus SC, Wan GJ, Kemner JE, Olfson M
OBJECTIVE: To compare the continuity of methylphenidate hydrochloride (MPH) therapy among youth Medicaid beneficiaries treated for attention-deficit/hyperactivity disorder with immediate-release (IR) or extended-release (ER) MPH formulations.Method An analysis was conducted of statewide California Medicaid claims (2000-2003) focusing on children and adolescents, ages 6 to 17 years, who started ER-MPH or IR-MPH treatment for attention-deficit/hyperactivity disorder. The study cohorts were limited to youth who had not filled a prescription for MPHs, amphetamines, pemoline, or atomoxetine for 6 months preceding the index prescription and remained eligible for Medicaid benefits for the following 12 months. The study groups were compared with respect to background demographic traits and clinical characteristics. Mean and median duration of MPH treatment episodes were defined to terminate if a gap of 30 or more days occurred from the end of the last prescription supply to the start of the next prescription. Survival time ratios were used to assess treatment duration controlling for group differences in background characteristics. RESULTS: As compared with patients initiating IR-MPH treatment, patients initiating ER-MPH treatment had a significantly longer mean estimated duration of treatment (ER-MPH, 140.3 days [95% confidence interval (CI), 136.3-144.4 days] vs IR-MPH, 103.4 days [95% CI, 101.3-103.4 days]). Similar results were found in analyses stratified by patient age, race/ethnicity, and sex. Controlling for group differences in age, sex, race/ethnicity, coprescribed psychotropic medications, other treated mental disorders, case management, managed care participation, and seasonal effects, ER-MPH treatment initiation was associated with an average 37% longer duration of treatment than IR-MPH treatment (survival time ratio, 1.37 [95% CI, 1.32-1.42]). Among patients treated with ER-MPH, treatment initiation with an osmotic release oral system MPH (Concerta) was associated with significantly longer mean duration (147.2 days [95% CI, 142.6-151.7 days]) than treatment initiation with Metadate CD (controlled delivery) (113.0 days [95% CI, 100.9-125.1 days]) or Ritalin LA (long acting) (101.1 days [95% CI, 91.2-111.0 days]), respectively. CONCLUSIONS: Extended-release MPH formulations were associated with greater continuity of MPH treatment than IR formulations in the study population. Initial selection of an ER formulation may help to prolong continuity of MPH therapy among youth Medicaid beneficiaries with attention-deficit/hyperactivity disorder.
Latest ADHD therapy research PMID:15939858 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Related Articles ADHD therapy
Treatment of attention-deficit/hyperactivity disorder: overview of the evidence.
Pediatrics. 2005 Jun;115(6):e749-57
Latest ADHD therapy research Authors: Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, Pierce K, Wolraich ML, ,
The American Academy of Pediatrics' Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder, reviewed and analyzed the current literature for the purpose of developing an evidence-based clinical practice guideline for the treatment of the school-aged child with attention-deficit/hyperactivity disorder (ADHD). This review included several key reports, including an evidence review from the McMaster Evidence-Based Practice Center (supported by the Agency for Healthcare Research and Quality), a report from the Canadian Coordinating Office for Health Technology Assessment, the Multimodal Treatment for ADHD comparative clinical trial (supported by the National Institute of Mental Health), and supplemental reviews conducted by the subcommittee. These reviews provided substantial information about different treatments for ADHD and their efficacy in improving certain characteristics or outcomes for children with ADHD as well as adverse effects and benefits of multiple modes of treatment compared with single modes (eg, medication or behavior therapies alone). The reviews also compared the effects of different medications. Other evidence documents the long-term nature of ADHD in children and its classification as a chronic condition, meriting the application of general concepts of chronic-condition management, including an individual treatment plan with a focus on ongoing parent and child education, management, and monitoring. The evidence strongly supports the use of stimulant medications for treating the core symptoms of children with ADHD and, to a lesser degree, for improving functioning. Behavior therapy alone has only limited effect on symptoms or functioning of children with ADHD, although combining behavior therapy with medication seems to improve functioning and may decrease the amount of (stimulant) medication needed. Comparison among stimulants (mainly methylphenidate and amphetamines) did not indicate that 1 class outperformed the other.
Latest ADHD therapy research PMID:15930203 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Incidence and prevalence of HIV encephalopathy in children with HIV infection receiving highly active anti-retroviral therapy (HAART). Related Articles ADHD therapy
Incidence and prevalence of HIV encephalopathy in children with HIV infection receiving highly active anti-retroviral therapy (HAART).
J Pediatr. 2005 Mar;146(3):402-7
Latest ADHD therapy research Authors: Chiriboga CA, Fleishman S, Champion S, Gaye-Robinson L, Abrams EJ
OBJECTIVE: To describe neurologic outcomes in children infected with HIV in the era of highly active anti-retroviral therapy (HAART), including rates of progressive HIV encephalopathy (PHE) and clinical sequelae among PHE survivors. STUDY DESIGN: Neurobehavior and school placement was assessed prospectively in the year 2000 in 126 children infected with HIV. PHE, developmental delay, and attention deficit disorder (ADHD) were the main outcome variables analyzed. Predictors of PHE were assessed in controlled analysis among age-matched controls. RESULTS: The rate of active PHE in 2000 was 1.6% (n = 2), and the prevalence of arrested PHE was 10% (n = 13). Residual motor and cognitive sequelae and need for special education was found in the majority of survivors. PHE relapse occurred in 3 (23%) children with previously arrested PHE. Viral load (VL) was the only significant factor associated with PHE. HIV or PHE was not associated with ADHD. Isolated developmental delay was not associated with HIV. CONCLUSIONS: PHE is an infrequent and reversible complication of HIV infection that responds to HAART and that may relapse if control of the virus is lost. Children with arrested PHE show higher rates of residual neurologic, cognitive, and scholastic impairments compared with children who never had PHE. Children with arrested PHE are the group of children with HIV infection most at risk for PHE, in the form of a relapse.
Latest ADHD therapy research PMID:15756229 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Managing attention deficit/hyperactivity disorder: unmet needs and future directions. Related Articles
Managing attention deficit/hyperactivity disorder: unmet needs and future directions.
Arch Dis Child. 2005 Feb;90 Suppl 1:i19-25
Latest ADHD therapy research Authors: Steer CR
The management of attention deficit/hyperactivity disorder (ADHD) requires a multimodal approach. Although shared-care protocols are suggested, uptake by general practice has been tentative. Behavioural management, both on its own and in combination with pharmacotherapy, reduces core symptoms and associated behaviours, such as oppositional defiant disorder (ODD). Links with education and social support are also important for helping children and their families. Psychostimulants have shown to be effective in the treatment of ADHD, however, their short duration of action highlights potential limitations. Other drugs used in the management of ADHD and comorbid disorders include antidepressants, clonidine and its analogues, newer atypical neuroleptics, and atomoxetine, a novel, non-stimulant therapy that has potential to fulfil some unmet treatment needs. Further research is needed in preschool children, girls, those with epilepsy, young adults, and in those with associated sleep disturbance. Selected rating scales and careful history taking, allied to close links with schools, are vital for the initial and ongoing assessment of ADHD and its comorbidities.
Latest ADHD therapy research PMID:15665152 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder. Related Articles
A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder.
Pediatrics. 2005 Jan;115(1):e97-104
Latest ADHD therapy research Authors: Foy JM, Earls MF
There remain large discrepancies between pediatricians' practice patterns and the American Academy of Pediatrics (AAP) guidelines for the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment. Publication of the AAP ADHD toolkit provides resources to assist with implementing the ADHD guidelines in clinical practice. These resources address a number of the barriers to office implementation, including unfamiliarity with Diagnostic and Statistical Manual of Mental Disorders criteria, difficulty identifying comorbidities, and inadequate knowledge of effective coding practices. Also crucial to the success of improved processes within clinical practice is community collaboration in care, particularly collaboration with the educational system. Such collaboration addresses other barriers to good care, such as pressures from parents and schools to prescribe stimulants, cultural biases that may prevent schools from assessing children for ADHD or may prevent families from seeking health care, and inconsistencies in recognition and referral among schools in the same system. Collaboration may also create efficiencies in collection of data and school-physician communications, thereby decreasing physicians' non-face-to-face (and thus nonreimbursable) elements of care. This article describes a process used in Guilford County, North Carolina, to develop a consensus among health care providers, educators, and child advocates regarding the assessment and treatment of children with symptoms of ADHD. The outcome, ie, a community protocol followed by school personnel and community physicians for >10 years, ensures communication and collaboration between educators and physicians in the assessment and treatment of children with symptoms of ADHD. This protocol has the potential to increase practice efficiency, improve practice standards for children with ADHD, and enhance identification of children in schools. Perhaps most importantly, the community process through which the protocol was developed and implemented has an educational component that increases the knowledge of school personnel about ADHD and its treatment, increasing the likelihood that referrals will be appropriate and increasing the likelihood that children will benefit from coordination of interventions among school personnel, physicians, and parents. The protocol reflects a consensus of school personnel and community health care providers regarding the following: (1) ideal ADHD assessment and management principles; (2) a common entry point (a team) at schools for children needing assessment because of inattention and classroom behavior problems, whether the problems present first to a medical provider, the behavioral health system, or the school; (3) a protocol followed by the school system, recognizing the schools' resource limitations but meeting the needs of community health care providers for classroom observations, psychoeducational testing, parent and teacher behavior rating scales, and functional assessment; (4) a packet of information about each child who is determined to need medical assessment; (5) a contact person or team at each physician's office to receive the packet from the school and direct it to the appropriate clinician; (6) an assessment process that investigates comorbidities and applies appropriate diagnostic criteria; (7) evidence-based interventions; (8) processes for follow-up monitoring of children after establishment of a treatment plan; (9) roles for central participants (school personnel, physicians, school nurses, and mental health professionals) in assessment, management, and follow-up monitoring of children with attention problems; (10) forms for collecting and exchanging information at every step; (11) processes and key contacts for flow of communication at every step; and (12) a plan for educating school and health care professionals about the new processes. A replication of the community process, initiated in Forsyth County, North Carolina, in 2001, offers insights into the role of the AAP ADHD guidelines in facilitating development of a community consensus protocol. This replication also draws attention to identification and referral barriers at the school level. The following recommendations, drawn from the 2 community processes, describe a role for physicians in the collaborative community care of children with symptoms of ADHD. (1) Achieve consensus with the school system regarding the role of school personnel in collecting data for children with learning and behavior problems; components to consider include (a) vision and hearing screening, (b) school/academic histories, (c) classroom observation by a counselor, (d) parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or Achenbach scales), (e) consideration of speech/language evaluation, (f) screening intelligence testing, (g) screening achievement testing, (h) full intelligence and achievement testing if discrepancies are apparent in abbreviated tests, and (i) trials of classroom interventions. (2) Use pediatric office visits to identify children with academic or behavior problems and symptoms of inattention (history or questionnaire). (3) Refer identified children to the contact person at each child's school, requesting information in accordance with community consensus. (4) Designate a contact person to receive school materials for the practice. (5) Review the packet from the school and incorporate school data into the clinical assessment. (6) Reinforce with the parents and the school the need for multimodal intervention, including academic and study strategies for the classroom and home, in-depth psychologic testing of children whose discrepancies between cognitive level and achievement suggest learning or language disabilities and the need for an individualized educational plan (special education), consideration of the "other health impaired" designation as an alternate route to an individualized educational plan or 504 plan (classroom accommodations), behavior-modification techniques for targeted behavior problems, and medication trials, as indicated. (7) Refer the patient to a mental health professional if the assessment suggests coexisting conditions. (8) Use communication forms to share diagnostic and medication information, recommended interventions, and follow-up plans with the school and the family. (9) Receive requested teacher and parent follow-up reports and make adjustments in therapy as indicated by the child's functioning in targeted areas. (10) Maintain communication with the school and the parents, especially at times of transition (eg, beginning and end of the school year, change of schools, times of family stress, times of change in management, adolescence, and entry into college or the workforce).
Latest ADHD therapy research PMID:15629972 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Repetitive arm and hand movements (complex motor stereotypies) in children. Related Articles
Repetitive arm and hand movements (complex motor stereotypies) in children.
J Pediatr. 2004 Sep;145(3):391-5
Latest ADHD therapy research Authors: Mahone EM, Bridges D, Prahme C, Singer HS
OBJECTIVE: To characterize clinical features, associated problems, and outcomes for children with complex motor stereotypies who do not have mental retardation or pervasive developmental disorders. STUDY DESIGN: We performed a record review for 40 children (63% male) aged 9 months to 17 years with complex motor stereotypies between 1993 and 2003. RESULTS: Age at onset was at or before 3 years in 90% of the sample. Symptoms occurred at least once daily in 90%. Excitement was identified as a trigger in 70%. Movements stopped when cued in 98%, and none had stereotypies during sleep. A total of 25% had comorbid attention deficit hyperactivity disorder (ADHD), and 20% had a learning disability. Family history of stereotypies was identified in 25%, tics in 33%, ADHD in 10%, and mood-anxiety disorder in 38%. Pharmacotherapy to target associated conditions was used in 40%, and behavioral therapy was used in 23%. A total of 53% identified symptoms for more than 5 years. Movements resolved in 5% of the children, improved in 33%, were unchanged in 50%, and worsened in 13%. CONCLUSIONS: The clinical course of complex motor stereotypies appears chronic. Better understanding of the clinical features of complex stereotypies in primary care settings is essential for early diagnosis and management.
Latest ADHD therapy research PMID:15343197 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Related Articles
Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder.
Pediatrics. 2004 Jul;114(1):e23-8
Latest ADHD therapy research Authors: Rushton JL, Fant KE, Clark SJ
OBJECTIVES: Several guidelines have been published for the care of children with attention-deficit/hyperactivity disorder (ADHD); however, few data describe adoption of practice guidelines. Our study sought 1) to describe primary care diagnosis and management of ADHD, 2) to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and 3) to describe factors associated with guideline adherence. METHODS: We conducted a mail survey of 1374 primary care physicians in Michigan. Main outcome measures were reported adherence to practices specified in the AAP guidelines; ADHD practice patterns; and other measures, including attitudes about parent, teacher, and community influences on ADHD diagnosis and treatment. Bivariate and multivariate analyses were performed to assess patient and physician factors associated with adherence to guideline components. RESULTS: The overall response rate was 60%. The majority (77.4%) of primary care physicians were familiar with AAP guidelines on ADHD, and many (61.1%) reported incorporating the guidelines into their practice. Differences were apparent by specialty: 91.5% of pediatricians were familiar with the guidelines in contrast to 59.8% of family physicians. The majority of clinicians reported practices consistent with individual components of the diagnostic and treatment guidelines. However, when adherence to multiple components was analyzed together, only 25.8% of clinicians reported routine use of all 4 diagnostic components in the survey. In addition, some physicians continue to use diagnostic modalities that are currently not recommended for routine evaluation of school-aged children with ADHD--continuous performance testing, neuroimaging, and laboratory tests (eg, thyroid, lead, or iron testing). With regard to ADHD treatment, the majority (66.6%) of respondents reported routine recommendation of pharmacotherapy and titration of medications in the first month when prescribed (81.3%). However, just over half (53.1%) reported routine follow-up visits (3-4 times per year) for children who have ADHD and are taking medications. Most (53.4%) clinicians also recommended behavioral therapy for children who had a diagnosis of ADHD. Patterns of specialty differences were less consistent for treatment components: pediatricians were more likely to recommend medications, but family physicians reported more frequent follow-up evaluations for children who receive medications. There were no specialty differences in recommendations for behavioral therapy. In addition to physician specialty variations, differences in management were apparent by practice type and other demographic characteristics. There were few significant associations between adherence to guideline components and physician attitudes about parent, teacher, or community influences. However, these factors were noted by many respondents. Only 32.5% agreed that their community had adequate, accessible mental health resources. Half (50.1%) of the physicians reported that insurers limit coverage for assessment and treatment of ADHD. CONCLUSIONS: Primary care physicians generally report awareness of pediatric ADHD guidelines and follow these clinical practice recommendations. However, some physician variations are apparent, and areas for improvement are noted. Many primary care physicians report poor access to mental health services, limited insurance coverage, and other potential system barriers to the delivery of ADHD care. Additional study is needed to confirm provider-reported data; to determine what constitutes high-quality, long-term management of this chronic condition; and to confirm how reported practices associate with long-term outcomes for children with ADHD.
Latest ADHD therapy research PMID:15231969 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Related Articles
National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder.
Pediatrics. 2004 Apr;113(4):754-61
Latest ADHD therapy research Authors:
OBJECTIVE: In the Multimodal Treatment Study of ADHD (MTA), the effects of medication management (MedMgt) and behavior modification therapy (Beh) and their combination (Comb) and usual community comparison (CC) in the treatment of attention-deficit/hyperactivity disorder (ADHD) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy (Comb or MedMgt) over Beh and CC and modest additional benefits of Comb over MedMgt alone. Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention. METHODS: Of 579 children who entered the study, 540 (93%) participated in the first follow-up 10 months after the end of treatment. Mixed-effects regression models explored possible persisting effects of the MTA medication strategy, the incremental benefits of Comb over MedMgt alone, and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains. RESULTS: The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months, although not as great as at 14 months. Significant additional benefits of Comb over MedMgt and of Beh over CC were not found. The groups differed significantly in mean dose (methylphenidate equivalents 30.4, 37.5, 25.7, and 24.0 mg/day, respectively). Continuing medication use partly mediated the persisting superiority of Comb and MedMgt. CONCLUSION: The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time.
Latest ADHD therapy research PMID:15060224 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Obstructive sleep apnea in children. Related Articles
Obstructive sleep apnea in children.
Am Fam Physician. 2004 Mar 1;69(5):1147-54
Latest ADHD therapy research Authors: Chan J, Edman JC, Koltai PJ
Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenotonsillectomy is curative in most patients. Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.
Latest ADHD therapy research PMID:15023015 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum. Related Articles
Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum.
Pediatr Clin North Am. 2003 Oct;50(5):1049-92, vi
Latest ADHD therapy research Authors: Greydanus DE, Pratt HD, Sloane MA, Rappley MD
Management of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) is reviewed, including psychological and pharmacologic approaches. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, educator/teacher training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants, antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Management of ADHD should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient (child or adolescent), and judicious use of medications. Parents, school officials, and clinicians must work together to help all children and adolescents with ADHD achieve their maximum potential.
Latest ADHD therapy research PMID:14558681 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention deficit hyperactivity disorder in elementary school children in Rhode Island: associated psychosocial factors and medications used. Related Articles
Attention deficit hyperactivity disorder in elementary school children in Rhode Island: associated psychosocial factors and medications used.
Clin Pediatr (Phila). 2003 Jul-Aug;42(6):497-503
Latest ADHD therapy research Authors: Harel EH, Brown WD
This study was undertaken to explore psychosocial factors associated with referral for attention deficit hyperactivity disorder (ADHD) evaluation or ADHD diagnosis among elementary school children in Rhode Island, as well as to examine the extent of drug therapy among this population. A survey was distributed to parents/guardians of 2,800 3rd- to 5th-grade public school students in 4 Rhode Island school districts. The average age of the children was 9.0 +/- 1.0 years with 52% girls. Approximately 12% of the students had been referred for ADHD evaluation (RFE). Of these, 52% (6% of all children in the survey) were receiving psychoactive prescription medications daily. While the male:female ratio in the non-RFE group was almost 1:1, there were more boys than girls in the RFE group (male/female ratio of 3:1, p < 0.0001) and in the medicated group (male/female ratio 4:1, p < 0.0001). RFE children and medicated children were older than classroom peers (p < 0.0001), and had a greater degree of school misconduct (p < 0.0001). RFE children and medicated children were significantly less likely to have parents who completed college (p < 0.05), were significantly more likely to have stepparents (p < 0.05), and to be only children (p < 0.05) when compared with their peers. Amphetamine was the most commonly prescribed drug (used by 54% of the medicated children) followed by methylphenidate (43%). Nearly 18% of the medicated children were receiving 1 to 3 additional psychoactive prescription medications on a daily basis. In conclusion, RFE children and children medicated for ADHD were more likely to have a stepparent, have no siblings, and have parents that had not completed college. Amphetamine rather than methylphenidate accounted for the majority of medications used in this study, and simultaneous use of multiple psychoactive medications was reported in 18% of the medicated children.
Latest ADHD therapy research PMID:12921450 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Related Articles
Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature.
Pediatrics. 2003 Jan;111(1):179-85
Latest ADHD therapy research Authors: Wilens TE, Faraone SV, Biederman J, Gunawardene S
OBJECTIVE:Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes. METHODS:A search of all available prospective and retrospective studies of children, adolescents, and adults with ADHD that had information relating childhood exposure to stimulant therapy and later SUD outcome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates. RESULTS: Six studies--2 with follow-up in adolescence and 4 in young adulthood--were included and comprised 674 medicated subjects and 360 unmedicated subjects who were followed at least 4 years. The pooled estimate of the odds ratio indicated a 1.9-fold reduction in risk for SUD in youths who were treated with stimulants compared with youths who did not receive pharmacotherapy for ADHD (z = 2.1; 95% confidence interval for odds ratio [OR]: 1.1-3.6). We found similar reductions in risk for later drug and alcohol use disorders (z = 1.1). Studies that reported follow-up into adolescence showed a greater protective effect on the development of SUD (OR: 5.8) than studies that followed subjects into adulthood (OR: 1.4). Additional analyses showed that the results could not be accounted for by any single study or by publication bias. CONCLUSION:Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.
Latest ADHD therapy research PMID:12509574 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Evaluation of clumsiness in children. Related Articles
Evaluation of clumsiness in children.
Am Fam Physician. 2002 Oct 15;66(8):1435-40, 1379
Latest ADHD therapy research Authors: Hamilton SS
Parents and physicians often dismiss seemingly minor motor difficulties in children. Approximately 6 percent of school-aged children have coordination problems serious enough to interfere with academic performance and social integration. These problems often arise during the early school years and manifest in difficulties with such simple motor tasks as running, buttoning, or using scissors. Increasing evidence shows that rather than improving over time, these motor difficulties remain stable throughout adolescence and adulthood. While these children are initially singled out for motor difficulties, their problems are rarely limited to poor motor coordination. Many of them have a range of associated deficits, such as attention-deficit/hyperactivity disorder, learning disabilities, poor handwriting and drawing skills, and emotional immaturity. Associated problems magnify with time, and as teenagers, these children have higher rates of educational, social, and emotional problems. Diagnosis is determined by taking a careful history that includes a review of fine motor, visual, adaptive, and gross motor milestones, and performing a physical examination. Formal standardized testing may be indicated. Referral to occupational therapy that is appropriately individualized to the needs of each child appears to be effective. To aid in management, the family physician must be aware of this condition, as well as the associated coexisting deficits.
Latest ADHD therapy research PMID:12408418 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Related Articles
Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs.
Pediatrics. 2002 Sep;110(3):e34
Latest ADHD therapy research Authors: Turgay A, Binder C, Snyder R, Fisman S
OBJECTIVE: The objective of this study was to investigate the long-term safety and efficacy of risperidone in disruptive behavior disorders in children with subaverage IQs. Disruptive behavior disorders were defined as oppositional defiant disorder, disruptive behavior disorder, and conduct disorder as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. METHODS: This was a 48-week open-label (OL) extension study of risperidone in 77 children diagnosed with a disruptive behavior disorder, and either borderline intellectual function or mild or moderate mental retardation who had participated in a previous 6-week, double-blind (DB) study and completed at least 2 weeks of DB therapy. Children, aged 5 to 12 years inclusive, who had: 1) a DSM-IV Axis I diagnosis of conduct disorder, oppositional defiant disorder, or disruptive behavior disorder- not otherwise specified; 2) a parent-assessed rating of > or =24 in the Conduct Problem Subscale of the Nisonger-Child Behavior Rating Form(28); 3) a DSM-IV Axis II diagnosis of mild or moderate mental retardation or borderline intellectual functioning with an IQ > or =36 and < or =84; and 4) a score of < or =84 on the Vineland Adaptive Behavior Scale. Participants received oral solution risperidone given at a once daily dose of between 0.02 and 0.06 mg/kg for a maximum of 48 weeks. Participants in the DB study who had been randomized would have had a maximum of 54 weeks of risperidone therapy. Study visits were scheduled at entry, weekly for the first month, and monthly for the remaining 11 months. RESULTS: Baseline scores on the conduct problem subscale at the start of the previous DB study were similar for both treatment groups: mean values of 33.5 and 33.3 were recorded for placebo- and risperidone-treated participants, respectively. At the time of the OL baseline visit, mean Conduct Problem Subscale scores were lower in those who had been treated with risperidone than in those who remained risperidone-naïve (17.5 and 26.1, respectively). Within 1 week of receiving daily risperidone therapy (mean daily dose: 1.38 mg), those participants who had been risperidone-naïve at OL entry showed a rapid improvement in the Conduct Problem Subscale score. At the week 1 assessment, the mean change from baseline for those who had been risperidone-naïve at OL entry was similar in magnitude to the change from DB baseline recorded for participants who had received risperidone in the DB study. This mean improvement was sustained in both groups throughout the remainder of the OL study. At study endpoint, those participants who had been risperidone-naïve at OL entry experienced a highly significant mean decrease from OL baseline in the mean Conduct Problem Subscale score of 10.6 +/- 2.18. The response to risperidone in the OL trial remained stable in those participants who had been treated with risperidone in the previous DB trial; in this group, the mean change at study endpoint from OL baseline was a nonsignificant decrease of 1.26 +/- 1.45. At DB baseline, 68% of participants had a Clinical Global Impression assessment rated as marked, severe, or extremely severe. By DB study endpoint, only 17% of participants (15% of whom had received placebo and 19% of whom had been treated with risperidone in the previous study) had this severe an assessment; 63% of participants had symptoms rated as either none, very mild, or mild. Similarly, highly significant decreases from baseline in the Vineland Adaptive Behavior Scale rating of the most troublesome symptom (often identified as either aggression (hitting, fighting, or temper tantrums) were observed by study endpoint after 48 weeks of risperidone therapy. For those participants who had received placebo in the previous study, a mean decrease of 47.1 +/- 4.87 mm from a DB baseline of 79.4 +/- 2.69 mm was observed. In those who had received risperidone, a mean decrease of 43.5 +/- 4.57 mm from a DB baseline of 79.3 +/- 3.66 mm was observed. Five subgroup analyses of the primary efficacy outcome were performed. These included analysis by diagnosis (conduct disorder, oppositional defiant disorder, and disruptive behavior disorder-not otherwise specified), degree of mental retardation (borderline, mild, moderate), and presence or absence of somnolence, attention-deficit/hyperactivity disorder, and psychostimulants. The results showed that the efficacy of risperidone was not affected by type of disorder, level of retardation, presence/absence of somnolence or attention-deficit/hyperactivity disorder, or use of psychostimulants. Adverse events were reported for 76 participants; none were serious and most were mild/moderate in severity. Somnolence (52%), headache (38%), and weight gain (36%) were the most common adverse events. The degree of sedation was mild and not associated with cognitive deterioration. In fact, for most parameters assessed on the modified California Verbal Learning Test (a test for verbal learning and memory), there were statistically significant improvements relative to both OL and DB baselines in the mean scores. In addition, statistically significant improvements over baseline were also seen for some Continuous Performance Task (which is a test for attention and impulsivity) parameters. Overall, no deterioration of cognitive function was observed while participants were treated with risperidone. Almost half of the 8.5 kg gained was attributable to normal growth. Asymptomatic peak prolactin levels were observed within 4 weeks of beginning risperidone treatment and declined over time to within normal range. At study endpoint, mean prolactin levels were statistically significantly greater than baseline only in male participants but still <20 ng/mL, which is within the normal range. Twenty participants experienced mild or moderate extrapyramidal symptoms, although none withdrew for this reason. CONCLUSIONS: Risperidone, administered as an oral solution at a mean dose of 1.38 mg/d (range: 0.02-0.06 mg/kg/d) for 1 year, was well tolerated, safe, and showed maintenance of effect in the treatment of disruptive behavior disorders in children aged 5 to 12 years with subaverage IQs.
Latest ADHD therapy research PMID:12205284 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention deficit hyperactivity disorder in adults: a guide for the primary care physician. Related Articles
Attention deficit hyperactivity disorder in adults: a guide for the primary care physician.
South Med J. 2002 Jul;95(7):736-42
Latest ADHD therapy research Authors: Elliott H
Attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to 60% of cases with childhood onset. A childhood history of ADHD is a prerequisite for making the ADHD diagnosis in an adult. The Utah, Copeland, and Brown self-rating scales are useful in helping the primary care physician confirm the diagnosis. A thorough developmental history, a substance abuse history, and a medical and neurologic examination should be obtained to rule out other causes of poor concentration and attention. Medication interventions can include the stimulants and/or noradrenergic and dopaminergic antidepressants. Nonmedication intervention should include education, referral to support groups, and referral for individual and/or couples therapy. If the diagnosis is unclear or if there is inadequate response to an intervention, referral to a psychiatrist or psychologist is indicated.
Latest ADHD therapy research PMID:12144080 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Treatment of ADHD in children with tics: a randomized controlled trial. Related Articles
Treatment of ADHD in children with tics: a randomized controlled trial.
Neurology. 2002 Feb 26;58(4):527-36
Latest ADHD therapy research Authors:
BACKGROUND: The treatment of children with attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS) has been problematic because methylphenidate (MPH)--the most commonly used drug to treat ADHD--has been reported to worsen tics and because clonidine (CLON)--the most commonly prescribed alternative--has unproven efficacy. METHODS: The authors conducted a multicenter, randomized, double-blind clinical trial in which 136 children with ADHD and a chronic tic disorder were randomly administered CLON alone, MPH alone, combined CLON + MPH, or placebo (2 x 2 factorial design). Each subject participated for 16 weeks (weeks 1-4 CLON/placebo dose titration, weeks 5-8 added MPH/placebo dose titration, weeks 9-16 maintenance therapy). RESULTS: Thirty-seven children were administered MPH alone, 34 were administered CLON alone, 33 were administered CLON + MPH, and 32 were administered placebo. For our primary outcome measure of ADHD (Conners Abbreviated Symptom Questionnaire--Teacher), significant improvement occurred for subjects assigned to CLON (p < 0.002) and those assigned to MPH (p < 0.003). Compared with placebo, the greatest benefit occurred with combined CLON + MPH (p < 0.0001). CLON appeared to be most helpful for impulsivity and hyperactivity; MPH appeared to be most helpful for inattention. The proportion of individual subjects reporting a worsening of tics as an adverse effect was no higher in those treated with MPH (20%) than those being administered CLON alone (26%) or placebo (22%). Compared with placebo, measured tic severity lessened in all active treatment groups in the following order: CLON + MPH, CLON alone, MPH alone. Sedation was common with CLON treatment (28% reported moderate or severe sedation), but otherwise the drugs were tolerated well, including absence of any evident cardiac toxicity. CONCLUSIONS: Methylphenidate and clonidine (particularly in combination) are effective for ADHD in children with comorbid tics. Prior recommendations to avoid methylphenidate in these children because of concerns of worsening tics are unsupported by this trial.
Latest ADHD therapy research PMID:11865128 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]The behavioral impact of growth hormone treatment for children and adolescents with Prader-Willi syndrome: a 2-year, controlled study. Related Articles
The behavioral impact of growth hormone treatment for children and adolescents with Prader-Willi syndrome: a 2-year, controlled study.
Pediatrics. 2002 Feb;109(2):E35
Latest ADHD therapy research Authors: Whitman BY, Myers S, Carrel A, Allen D
INTRODUCTION: Prader-Willi syndrome (PWS) is characterized by obesity, hypotonia, hypogonadism, hyperphagia, short stature, and a neurobehavioral profile that includes cognitive deficits, learning problems, and behavioral difficulties that increase in both quantity and severity over time. PWS results from an alteration in the molecular composition of a critical region of C#15q. Morbid obesity resulting from hyperphagia is amplified by decreased energy expenditure and reduced physical activity. The hyperphagia has proven refractory to all psychopharmocologic intervention; the behavioral components are equally resistant to psychotropic intervention. PWS patients' body composition resembles that of individuals with growth hormone (GH) deficiency, including short stature and reduced lean body mass with concomitant increased fat mass. We hypothesized that GH administration to children with PWS, in addition to stimulating linear growth, would improve body composition, increase energy expenditure and fat utilization, and improve muscle strength, physical agility, and pulmonary function. Two recent reports from this study document significant positive effects of GH treatment on these children's physical parameters measured in a 2-year, controlled study. However, the behavioral impact of GH treatment in this population remains incompletely described. A psychosocial burden, including emotional, behavioral, and cognitive disturbances associated with short stature, has been previously described in a non-PWS population with GH deficiency and idiopathic short stature. An impaired quality of life and psychosocial status is also documented in otherwise normal adults with GH deficiency. In both populations, growth hormone replacement therapy (GHRT) is reported to improve alertness, activity level, endurance, irritability, tendency to worry, and extroversion resulting in better personal relationships with fewer conflicts. This report focuses on that portion of the study investigating the behavioral and psychosocial outcomes accompanying increased stature and improved physical status for persons with PWS treated with GHRT. We hypothesized that, as in other populations, GHRT for persons with PWS would have a significant positive effect on their psychosocial status as well as an improvement in their growth parameters. METHODS: A 2-year, controlled study with control group crossover in the second year was used. Fifty-four consecutive children with genetically confirmed PWS were enrolled. Patients were 4 to 16 years of age at time of enrollment, had skeletal maturation <13 for girls and <15 for boys; all but 3 participants remained prepubertal (Tanner stage 1) throughout the study. Children who had previous therapy with GH were excluded, as were children with a scoliosis >20 degrees. After a 6-month growth assessment were randomized into a 60:40 treatment:control ratio. Treatment consisted of Nutropin (Genentech), 1 mg/m2/day. A modified Offord Survey Diagnostic Instrument (SDI) was used to monitor behavior at 6-month intervals. The SDI is a 165-item behavioral checklist with items rated on a scale of 0 = Never or Not True, 1 = Sometimes or Somewhat True, and 2 = Often or Very True. The items are balanced between positively and negatively scored items. The present instrument was designed to derive diagnoses for the following Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition categories: Depression, Obsessive-Compulsive Disorder, Anxiety Disorder, Somatization Disorder, Conduct Disorder, and Attention-Deficit/Hyperactivity Disorder. The SDI was modified to include 10 items specifically inquiring about PWS (eg, denies having PWS, picks excessively at skin, nose, or other body parts). Because diagnoses are not mutually exclusive, an individual can meet criteria for 1 or more diagnostic categories. The SDI contains a second section measuring behavior functioning in the school environment, in the family, and in personal and social relationships. A wider scoring range is used and is question-specific. Parallel forms of this measure are available for parents, teachers, and the child him/herself. We gathered data from both parents and teachers at 6-month intervals. No questionnaire was scored until the completion of the entire study to avoid any possibility of an inadvertent "feedback" or "self-fulfilling prophecy" effect. All questionnaires were scored by a Bachelor's level research assistant blind to study assignment. Family stress was monitored with the Family Inventory of Life Events. At study completion, the impact of GH was measured with a 13-item summary interview adapted from Wiren et al. After completion of all final study visits, a single research assistant blind to treatment assignment interviewed all families by phone. This method was chosen to minimize any positively biased demand characteristics. RESULTS: Both between-group and within-group contrasts were computed for baseline, 12 (time 1) and 24 month (time 2) measures. Because behavioral deterioration, as well as improvement, was a possibility, a 2-tailed hypothesis test was used for all comparisons. No differences were found between treatment and control groups, nor within groups across measurement points for attentional symptoms, anxiety, obsessive-compulsive complex, violence, or psychotic symptoms. Similarly, no differences were noted between groups on depressive symptoms; however, a significant positive effect (reduction of depressive symptoms) was noted for the treatment group from baseline to time 1, and was retained at time 2. The group was divided by age, with those 11.0 years and younger comprising one group and those older the second group. This analysis indicated that the major reduction in depressive symptoms occurred in those over 11 years old. When divided by age, a second unexpected finding emerged. There was a significant increase in attention-deficit/hyperactivity disorder symptoms from baseline to 24 months in those children 11 and under, independent of treatment status. The groups were subsequently further broken down by sex and by genetic status (deletion versus disomy) with no significant findings. At no time was the expected behavioral deterioration reported. We conclude that in addition to the previously detailed improvements in physical parameters for these children, behavioral improvement, including a lack of predictable behavioral deterioration during the treatment period, is a strong argument for the use of GHRT for this difficult syndrome.
Latest ADHD therapy research PMID:11826245 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention-deficit/hyperactivity disorder: management. Related Articles
Attention-deficit/hyperactivity disorder: management.
Am Fam Physician. 2001 Oct 15;64(8):1355-62
Latest ADHD therapy research Authors: Szymanski ML, Zolotor A
Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood and often persists into adulthood. ADHD is a neurophysiologic disorder defined in behavioral terms and associated with significant morbidity in the realms of social and academic success, and self-esteem. ADHD is often associated with comorbid psychiatric disorders and learning disabilities, which further impede the successful development of these persons. It is essential that family physicians be knowledgeable about the presentation and diagnosis of ADHD. Stimulant medications continue to be the mainstay of treatment, although many other medications (such as antidepressants and alpha blockers) are helpful adjuvants to therapy. Current recommendations for treatment include an individualized, multimodal approach involving parents, teachers, counselors and the school system. Treatment follow-up includes monitoring response to medications in various settings, as well as side effects. With time and interest, the family physician can develop the skills needed to treat this disorder.
Latest ADHD therapy research PMID:11681777 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. Related Articles
A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder.
J Pediatr. 2001 Aug;139(2):189-96
Latest ADHD therapy research Authors: Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird WC
OBJECTIVE: To determine whether docosahexaenoic acid (DHA) supplementation for 4 months decreases the symptoms of attention-deficit/hyperactivity disorder (ADHD). STUDY DESIGN: Sixty-three 6- to-12-year-old children with ADHD, all receiving effective maintenance therapy with stimulant medication, were assigned randomly, in a double-blind fashion, to receive DHA supplementation (345 mg/d) or placebo for 4 months. Outcome variables included plasma phospholipid fatty acid patterns, scores on laboratory measures of inattention and impulsivity (Test of Variables of Attention, Children's Color Trails test) while not taking stimulant medication, and scores on parental behavioral rating scales (Child Behavior Checklist, Conners' Rating Scale). Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance, controlling for age, baseline value of each outcome variable, ethnicity, and ADHD subtype. RESULTS: Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group (4.85 +/- 1.35 vs 1.86 +/- 0.87 mol % of total fatty acids; P <.001). Despite this, there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms. CONCLUSION: A 4-month period of DHA supplementation (345 mg/d) does not decrease symptoms of ADHD.
Latest ADHD therapy research PMID:11487742 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]General anesthesia in a patient on long-term amphetamine therapy: is there cause for concern? Related Articles
General anesthesia in a patient on long-term amphetamine therapy: is there cause for concern?
Anesth Analg. 2000 Sep;91(3):758-9
Latest ADHD therapy research Authors: Fischer SP, Healzer JM, Brook MW, Brock-Utne JG
IMPLICATIONS: Amphetamines are powerful, sympathomimetic amines that, when used chronically, can profoundly effect a patient's cardiovascular stability during anesthesia and surgery. Amphetamines are the third most widely abused class of drugs in the United States. They also have legitimate medical use for attention deficit disorder with hyperactivity, exogenous obesity, and narcolepsy. We report a case of a patient with a 40-yr history of chronic amphetamine use having undergone two general anesthesias without complication.
Latest ADHD therapy research PMID:10960415 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Double-blind methylphenidate trials: practical, useful, and highly endorsed by families. Related Articles
Double-blind methylphenidate trials: practical, useful, and highly endorsed by families.
Arch Pediatr Adolesc Med. 1999 Dec;153(12):1292-6
Latest ADHD therapy research Authors: Kent MA, Camfield CS, Camfield PR
OBJECTIVE: To evaluate a 3-week, randomized, double-blind, methylphenidate placebo-controlled trial (MPT) in routine practice for children with attention-deficit disorder. PATIENTS AND METHODS: School-aged children with attention-deficit/hyperactivity disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) who enrolled an "N of 1" trial at a pediatric tertiary care center were eligible. Families (n = 50) with a child eligible for the MPT were given 3 bottles of identical capsules. The capsules contained, in random order: placebo of the prescribed dose of methylphenidate (Ritalin) hydrochloride (0.3 mg/kg or 0.6 mg/kg). Families gave the child 1 capsule at 8 AM and 1 capsule at noon. The family, teacher, and physician were blinded for the order of medication. Conners questionnaires (Conners Parent Questionnaire and Conners Teacher Questionnaire) and written comments were completed by parents and teachers at baseline and at the end of each week. Once MPT results were known and following discussion with the physician, families decided whether to continue methylphenidate therapy. Families were interviewed by telephone 14 to 21 months after the MPT. RESULTS: Forty-three (86%) of the 50 eligible children (mean age, 129 months) were contacted. No family found the MPT difficult, but 6 trials were incomplete, usually because of side effects. All families used the MPT to decide if methylphenidate was the correct treatment choice for their child and 68% (34 of 50 families) used the results exclusively. The remaining 16 families believed the MPT was helpful. Overall, 31 (72%) of the 43 children had a good response to methylphenidate treatment--20 (47%) continued to use it for longer than 12 months and 8 (26%) for 2 to 12 months; 3 responders chose not to use it after the MPT. Nine of the 43 families chose not to use methylphenidate treatment; however, all indicated that participating in the MPT helped them to make that decision. In follow-up interviews, the same proportion of methylphenidate users and nonusers reported improvement in many areas of function including significantly less time spent doing homework. Users reported reduced aggression (P<.001) and fewer discipline problems (P<.01) compared with nonusers. CONCLUSIONS: An "N of 1" MPT was easily performed and permitted families to decide whether to use methylphenidate for long-term treatment of attention-deficit disorder or attention-deficit/hyperactivity disorder. Regardless of methylphenidate use or lack of use, the condition of all of these children was improved at follow-up.
Latest ADHD therapy research PMID:10591309 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Related Articles
Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder.
Arch Pediatr Adolesc Med. 1999 Dec;153(12):1257-63
Latest ADHD therapy research Authors: Zito JM, Safer DJ, dosReis S, Magder LS, Gardner JF, Zarin DA
OBJECTIVES: (1) To describe temporal patterns of office visits for attention-deficit/hyperactivity disorder (ADHD) and stimulant treatment for 5- to 14-year-old US youths; (2) to compare youth visits for ADHD with and without melication according to patient demographics, physician specialty, reimbursement source, and comorbid diagnoses; and (3) to compare office visits for youths with ADHD in relation to common medication patterns (stimulants alone, stimulants with other psychotherapeutic medication, and nonstimulant psychotherapeutic medications alone). DESIGN: Survey based on a national probability sample of office-based physicians in the United States. SETTING: Physician offices. PARTICIPANTS: A systematically sampled group of office-based physicians. MAIN OUTCOME MEASURES: National estimates of office visits for ADHD and psychotherapeutic drug visits for ADHD for each year and for a combined 8-year period. RESULTS: Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy within ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996. While the majority of non-ADHD youth visits were conducted by primary care physicians, one third of ADHD youth visits were managed by psychiatry and neurology specialists. Health maintenance organization insurance was the reimbursement source for 17.9% of non-ADHD youth visits but only 11.7% of ADHD youth visits. Complex medication therapy was more likely to be prescribed by psychiatrists and less likely to be related to visits with health maintenance organization reimbursement. CONCLUSIONS: National survey estimates in the 1990s confirm the substantial increase in visits for youths diagnosed as having ADHD, with more than three quarters of these visits associated with psychotherapeutic medication treatment. Physician specialty and reimbursement source variables identify distinct patient populations with a gradient in psychotherapeutic medication patterns from single-drug standard (stimulant) therapy to complex multidrug treatment regimens for which evidence-based scientific information is lacking.
Latest ADHD therapy research PMID:10591302 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Related Articles
A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD.
Arch Gen Psychiatry. 1999 Dec;56(12):1073-86
Latest ADHD therapy research Authors:
BACKGROUND: Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder (ADHD), but no longer-term (i.e., >4 months) investigations have compared these 2 treatments or their combination. METHODS: A group of 579 children with ADHD Combined Type, aged 7 to 9.9 years, were assigned to 14 months of medication management (titration followed by monthly visits); intensive behavioral treatment (parent, school, and child components, with therapist involvement gradually reduced over time); the two combined; or standard community care (treatments by community providers). Outcomes were assessed in multiple domains before and during treatment and at treatment end point (with the combined treatment and medication management groups continuing medication at all assessment points). Data were analyzed through intent-to-treat random-effects regression procedures. RESULTS: All 4 groups showed sizable reductions in symptoms over time, with significant differences among them in degrees of change. For most ADHD symptoms, children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care. Combined and medication management treatments did not differ significantly on any direct comparisons, but in several instances (oppositional/aggressive symptoms, internalizing symptoms, teacher-rated social skills, parent-child relations, and reading achievement) combined treatment proved superior to intensive behavioral treatment and/or community care while medication management did not. Study medication strategies were superior to community care treatments, despite the fact that two thirds of community-treated subjects received medication during the study period. CONCLUSIONS: For ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes.
Latest ADHD therapy research PMID:10591283 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Alternative and controversial treatments for attention-deficit/hyperactivity disorder. Related Articles
Alternative and controversial treatments for attention-deficit/hyperactivity disorder.
Pediatr Clin North Am. 1999 Oct;46(5):977-92
Latest ADHD therapy research Authors: Baumgaertel A
ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi. Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter the core symptoms of ADHD but may be helpful in controlling secondary symptoms. These methods are unique in ADHD treatment because children can become active agents of their own coping strategies. There is no scientific evidence to support the validity of vision therapy, oculovestibular treatment, or sound training (Tomatis method) as treatment modalities for ADHD. However, auditory stimulation with individualized music may help to improve situational performance in cognitive tasks. Regardless of the treatment approach, the diagnosis of ADHD and other comorbidities first must be established through a standard medical evaluation. The standard treatment options always should be presented and discussed carefully. If alternative approaches are sought, the merits of available options should be reiterated. If the primary care provider is not comfortable or knowledgeable about an acceptable method, referral to capable and responsible practitioners in the community who are experienced in these areas should be considered. The primary care provider, the alternative "specialist," and the family all should be willing to engage in "collaborative research," applying the same standards for treatment evaluation that one would apply in mainstream methods. Communication among all parties involved in a treatment strategy is the key to demystifying alternative approaches, creating strong therapeutic relationships, and optimizing management.
Latest ADHD therapy research PMID:10570700 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Management of stimulant medications in children with attention-deficit/hyperactivity disorder. Related Articles
Management of stimulant medications in children with attention-deficit/hyperactivity disorder.
Pediatr Clin North Am. 1999 Oct;46(5):945-63, vii-viii
Latest ADHD therapy research Authors: Adesman AR, Morgan AM
In the United States, considerable media attention has been given to the growing number of youth diagnosed with ADHD and treated with psychotropic medications. The efficacy of stimulant medications long has been recognized clinically and is well documented in research. Studies suggest that treatment with stimulant therapy, when properly done, is more effective than psychosocial interventions that did not yield any significant benefits on a range of behavioral, emotional, psychosocial, and academic measures. The purpose of this article is to provide clinicians with everything they need to know but were afraid to ask about stimulant therapy for children and adolescents with ADHD.
Latest ADHD therapy research PMID:10570698 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools. Related Articles
The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools.
Am J Public Health. 1999 Sep;89(9):1359-64
Latest ADHD therapy research Authors: LeFever GB, Dawson KV, Morrow AL
OBJECTIVES: The purpose of this study was to determine the extent of medication use for attention deficit-hyperactivity disorder (ADHD) in southeastern Virginia. METHODS: Students enrolled in grades 2 through 5 in school districts in city A (n = 5767 students) and city B (n = 23,967 students) were included. Nurses recorded students who received ADHD medication in school. RESULTS: The proportion of students receiving ADHD medication was similar in both cities (8% and 10%) and was 2 to 3 times as high as the expected rate of ADHD. Receipt of drug therapy was associated with social and educational characteristics. Medication was used by 3 times as many boys as girls and by twice as many Whites as Blacks. Medication use increased with years in school, and by fifth grade 18% to 20% of White boys were receiving ADHD medication. Being young for one's grade was positively associated with medication use (P < .01). The prevalence of ADHD was 12% in district A, 63% in district B. CONCLUSIONS: These findings suggest that criteria for diagnosis of ADHD vary substantially across US populations, with potential overdiagnosis and overtreatment of ADHD in some groups of children.
Latest ADHD therapy research PMID:10474553 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Related Articles
Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder.
Arch Gen Psychiatry. 1999 Apr;56(4):330-6
Latest ADHD therapy research Authors: Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S
BACKGROUND: This study examined changes in attention-deficit hyperactivity (ADHD) behaviors and motor and vocal tics during long-term treatment with methylphenidate. METHODS: Thirty-four prepubertal children with ADHD and chronic multiple tic disorder (who had participated in an 8-week, double-blind, placebo-controlled methylphenidate evaluation) were evaluated at 6-month intervals for 2 years as part of a prospective, nonblind, follow-up study. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and behavior rating scales completed by parents and physician. Videotapes of the simulated classroom were scored by coders who were blind to treatment status. RESULTS: There was no evidence (group data) that motor tics or vocal tics changed in frequency or severity during maintenance therapy compared with diagnostic or initial double-blind placebo evaluations. Behavioral improvements demonstrated during the acute drug trial were maintained during follow-up. There was no evidence (group data) of clinically significant adverse drug effects on cardiovascular function or growth at the end of 2 years of treatment. CONCLUSIONS: Long-term treatment with methylphenidate seems to be safe and effective for the management of ADHD behaviors in many (but not necessarily all) children with mild to moderate tic disorder. Nevertheless, careful clinical monitoring is mandatory to rule out the possibility of drug-induced tic exacerbation in individual patients.
Latest ADHD therapy research PMID:10197827 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Stimulant medication withdrawal during long-term therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Related Articles
Stimulant medication withdrawal during long-term therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder.
Pediatrics. 1999 Apr;103(4 Pt 1):730-7
Latest ADHD therapy research Authors: Nolan EE, Gadow KD, Sprafkin J
OBJECTIVES: In this study we examined changes in attention-deficit hyperactivity disorder behaviors and motor and vocal tics during withdrawal from long-term maintenance therapy with stimulant medication. METHODS: Subjects were 19 children with attention-deficit hyperactivity disorder and chronic tic disorder who had received methylphenidate (n = 17) or dextroamphetamine (n = 2) for a minimum of 1 year. Children were switched to placebo under double-blind conditions. Treatment effects were assessed by using direct observations of child behavior in a simulated (clinic-based) classroom and behavior rating scales completed by parents and clinician. RESULTS: There was no change (group data) in the frequency or severity of motor tics or vocal tics during the placebo condition compared with maintenance dose of stimulant medication (ie, no evidence of tic exacerbation while receiving medication or of a withdrawal reaction). There was no evidence of tic exacerbation in the evening as a rebound effect. Treatment with the maintenance dose was also associated with behavioral improvement in attention-deficit hyperactivity disorder behaviors, indicating continued efficacy. CONCLUSIONS: Abrupt withdrawal of stimulant medication in children receiving long-term maintenance therapy does not appear to result in worsening of tic frequency or severity. Nevertheless, these findings do not preclude the possibility of drug withdrawal reactions in susceptible individuals.
Latest ADHD therapy research PMID:10103294 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Response to growth hormone in attention deficit hyperactivity disorder: effects of methylphenidate and pemoline therapy. Related Articles
Response to growth hormone in attention deficit hyperactivity disorder: effects of methylphenidate and pemoline therapy.
Pediatrics. 1998 Aug;102(2 Pt 3):497-500
Latest ADHD therapy research Authors: Rao JK, Julius JR, Breen TJ, Blethen SL
OBJECTIVE: To determine whether treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate hydrochloride or pemoline diminishes the response to growth hormone (GH) therapy in patients with idiopathic GH deficiency (IGHD) or idiopathic short stature (ISS). METHODS: The National Cooperative Growth Study database was used to identify patients between 3 and 20 years of age with IGHD or ISS and those within these groups who were treated with methylphenidate or pemoline for ADHD. Their growth in response to GH treatment (change in height standard deviation score [SDS]) was compared with that of patients with IGHD or ISS who were not treated for ADHD, by using a stepwise multiple regression analysis. RESULTS: In the IGHD cohort, there were 184 patients who were being treated for ADHD and 2313 who were not. In the ISS cohort there were 117 patients who were being treated for ADHD and 1283 who were not. There was a higher percentage of males being treated for ADHD in both cohorts. In the IGHD cohort, the change in height SDS was positively associated with the number of years of GH treatment, parents' heights, body mass index, and GH injection schedule, and was negatively associated with height SDS at the initiation of GH therapy, age, and maximum stimulated GH level. The use of methylphenidate or pemoline had a negative effect on the change in height SDS, but the magnitude of the effect was small. Similar effects were noted in the ISS cohort, but body mass index and the use of methylphenidate or pemoline had no effect on the change in height SDS. CONCLUSIONS: Concurrent ADHD therapy is associated with a slight decrease in the change in height SDS during GH treatment in patients with IGHD but not in those with ISS. Even in IGHD, the magnitude of the effect is small and should not deter the use of such concurrent therapy.
Latest ADHD therapy research PMID:9685452 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention-deficit hyperactivity disorder. Pharmacotherapy and beyond. Related Articles
Attention-deficit hyperactivity disorder. Pharmacotherapy and beyond.
Postgrad Med. 1997 May;101(5):201-4, 213-4, 216 passim
Latest ADHD therapy research Authors: Tan G, Schneider SC
Management of ADHD is a challenge that requires time, commitment, and great sensitivity on the part of the physician. Use of stimulant medications is often successful at improving symptoms, but it has become the knee-jerk treatment response for many. Given the wide-ranging effects of ADHD on aspects of patients' lives and the availability of various treatment alternatives, a multimodal approach is considered optimal. As more studies evaluate nonpharmacologic approaches such as behavior therapy, parent education, and neurofeedback and more physicians implement multimodal treatment, outcomes for patients with ADHD are expected to be even more positive.
Latest ADHD therapy research PMID:9158615 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective? Related Articles
Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective?
J Pediatr. 1997 Apr;130(4):670-4
Latest ADHD therapy research Authors: Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS
OBJECTIVE: To study the safety and efficacy of methylphenidate in children with the dual diagnosis of epilepsy and attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: Thirty children, aged 6.4 to 16.4 years, with epilepsy and ADHD were studied during a 4-month period. During the initial 2 months of the study, the children were treated with antiepileptic drugs (AEDs) only, and for the remaining 2 months, methylphenidate was added at a morning dose of 0.3 mg/kg. They underwent neurologic assessment, brain computed tomography, IQ testing, and assessment with the Childhood Behavior Checklist at baseline before methylphenidate therapy. Electroencephalography, AED determinations, and the continuous-performance task (CPT) test were done at baseline and after 2 months of methylphenidate therapy. A double-blind, crossover design was used to compare the effects of methylphenidate versus placebo on an electroencephalogram, AED levels, and the CPT. On the 2 days of testing, the child received AEDs and a capsule containing either placebo or methylphenidate. RESULTS: None of the 25 children of this sample who were seizure free had attacks while taking methylphenidate. Of the 5 children with seizures, 3 had an increase in attacks, whereas the other 2 showed no change or a reduction. There were no significant changes in AED levels or electroencephalographic findings. Methylphenidate benefited 70% of children according to parental report; methylphenidate also enhanced performance on the CPT. Side effects of methylphenidate were mild and transient. CONCLUSION: Methylphenidate is effective in treating children with epilepsy and ADHD and safe in children who are seizure free. Caution is warranted for those still having seizures while receiving AED therapy.
Latest ADHD therapy research PMID:9432523 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Optimizing ADHD therapy with sustained-release methylphenidate. Related Articles
Optimizing ADHD therapy with sustained-release methylphenidate.
Am Fam Physician. 1997 Apr;55(5):1705-9, 1711-2
Latest ADHD therapy research Authors: Lawrence JD, Lawrence DB, Carson DS
Rapid-release psychostimulants are commonly used to treat attention-deficit hyperactivity disorder (ADHD), but midday dosing requirements and poor compliance rates have prompted the development of sustained-release formulations. Sustained-release methylphenidate has been shown to have efficacy equal to that of the regular-release formulation and may be preferable when it is difficult or impossible to provide midday doses. Proper management of ADHD includes choosing the proper medication dosage, minimizing side effects of medications and periodically reevaluating the patient's progress.
Latest ADHD therapy research PMID:9105199 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Evaluation and management of attention-deficit hyperactivity disorder. Related Articles
Evaluation and management of attention-deficit hyperactivity disorder.
Am Fam Physician. 1997 Feb 15;55(3):887-94, 897, 901 passim
Latest ADHD therapy research Authors: Taylor MA
Attention-deficit hyperactivity disorder is the most common pediatric psychiatric disorder, involving one of every 20 children. It is often a disabling condition and is frequently accompanied by high levels of frustration and comorbidity. Diagnosis of attention-deficit hyperactivity disorder requires a detailed history from the family and use of rating scales to collect observations from two or more settings. Effective treatment, including behavior management, appropriate educational placement and stimulant medication, will improve academic performance and behavior in most patients. Armed with an organized approach and a broad general knowledge of stimulant therapy, the family physician can effectively evaluate and coordinate the initial therapy for many of these troubled children within the office setting. Children in whom initial management fails or for whom the diagnosis is unclear or complicated should be referred to appropriate mental health professionals.
Latest ADHD therapy research PMID:9048509 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Pemoline induced acute choreoathetosis: case report and review of the literature. Related Articles
Pemoline induced acute choreoathetosis: case report and review of the literature.
J Toxicol Clin Toxicol. 1997;35(1):105-8
Latest ADHD therapy research Authors: Stork CM, Cantor R
BACKGROUND: Pemoline is an oxazolidine derivative that is structurally different from amphetamines and used in the treatment of attention deficit disorder. Pemoline has not been commonly associated in the literature as a cause of acute movement disorders. The following case describes two children acutely poisoned with pemoline who experienced profound choreoathetosis. CASE REPORT: Two, 3-year-old male, identical twin siblings presented to the emergency department after found playing with a an empty bottle of pemoline originally containing 59 tablets. The children had a medical history significant for attention deficit disorder previously treated with methylphenidate without success. This was their first day of pemoline therapy. The choreoathetoid movements began 45 min to 1 h after ingestion. The children gave no history of prior movement disorders and there was no family history of movement disorders. The children received gastrointestinal decontamination and high doses of intravenous benzodiazepines in an attempt to control the choreoathetoid movements. Despite treatment, the children continued to have choreoathetosis for approximately 24 hours. Forty-eight hours after admission, the children appeared to be at their baseline and were discharged home. CONCLUSION: Pemoline associated movement disorder has been rarely reported in the acute toxicology literature. The possibility of choreoathetoid movements should be considered in patients presenting after pemoline overdose.
Latest ADHD therapy research PMID:9022662 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective?
Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective?
J Pediatr. 1997 Jan;130(1):40-4
Latest ADHD therapy research Authors: Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS
OBJECTIVE: To study the safety and efficacy of methylphenidate in children with the dual diagnosis of epilepsy and attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: Thirty children, aged 6.4 to 16.4 years, with epilepsy and ADHD were studied during a 4-month period. During the initial 2 months of the study, the children were treated with antiepileptic drugs (AEDs) only, and for the remaining 2 months, methylphenidate was added at a morning dose of 0.3 mg/kg. They underwent neurologic assessment, brain computed tomography, IQ testing, and assessment with the Childhood Behavior Checklist at baseline before methylphenidate therapy. Electroencephalography, AED determinations, and the continuous-performance task (CPT) test were done at baseline and after 2 months of methylphenidate therapy. A double-blind, crossover design was used to compare the effects of methylphenidate versus placebo on an electroencephalogram, AED levels, and the CPT. On the 2 days of testing, the child received AEDs and a capsule containing either placebo or methylphenidate. RESULTS: None of the 25 children of this sample who were seizure free had attacks while taking methylphenidate. Of the 5 children with seizures, 3 had an increase in attacks, whereas the other 2 showed no change or a reduction. There were no significant changes in AED levels or electroencephalographic findings. Methylphenidate benefited 70% of children according to parental report; methylphenidate also enhanced performance on the CPT. Side effects of methylphenidate were mild and transient. CONCLUSION: Methylphenidate is effective in treating children with epilepsy and ADHD and safe in children who are seizure free. Caution is warranted for those still having seizures while receiving AED therapy.
Latest ADHD therapy research PMID:9003849 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Persistent school dysfunction: unrecognized comorbidity and suboptimal therapy. Related Articles
Persistent school dysfunction: unrecognized comorbidity and suboptimal therapy.
Clin Pediatr (Phila). 1996 Nov;35(11):571-6
Latest ADHD therapy research Authors: Kube DA, Shapiro BK
To determine reasons for continued school dysfunction in children previously diagnosed as having attention deficit hyperactivity disorder (ADHD) or enrolled in a special education program (spec. ed.), a retrospective chart review of patients referred for interdisciplinary evaluations at a tertiary center for hyperactivity and learning problems was completed. Interdisciplinary clinical recommendations were used to define reasons for treatment failure in 116 children with prior diagnosis of ADHD or spec. ed. placement. Results showed 45% of children enrolled in spec. ed. had previously undiagnosed ADHD. Thirty-one percent of those with ADHD, 55% of those in spec. ed., and 55% of those diagnosed with ADHD and in spec. ed. (Both) received a new educationally handicapping diagnosis. Psychiatric comorbidity was present in 28% of those with ADHD, 18% of those in spec. ed., and 23% of Both subjects. Thirteen percent of those in spec. ed. had significant coexisting medical conditions. Special education services were insufficient in 55% of children in spec. ed. and 55% of Both subjects. A significant difference (P < 0.01) in medication use was noted between the groups with 56% of the ADHD group, 55% of the Both group, and none of the spec. ed. group treated with medication. Of all subjects with ADHD, 76% were receiving insufficient or no medication. This review suggests the following: (1) Comorbidity in children with school dysfunction is frequently not recognized. (2) Educational therapy alone may not be sufficient treatment for school dysfunction, and in cases where the treatment program is failing, the appropriateness of the program should be reviewed. (3) ADHD is commonly seen in conjunction with other educationally handicapping conditions. Therefore, in cases of continuing school dysfunction, children previously diagnosed has having ADHD should be assessed for other educationally handicapping conditions; those previously diagnosed as educationally handicapped should be assessed for ADHD. (4) Suboptimal medication use may be associated with treatment failure.
Latest ADHD therapy research PMID:8953132 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention-deficit hyperactivity disorder in adults. Related Articles
Attention-deficit hyperactivity disorder in adults.
Postgrad Med. 1996 Sep;100(3):207-11, 215-8
Latest ADHD therapy research Authors: Feifel D
Attention-deficit hyperactivity disorder (ADHD) may affect up to 3% of the adult population. Knowledge of its cardinal features and diagnostic criteria allows physicians to identify unrecognized cases and rule out incorrect self-diagnosis. Inattention and distractibility, impulsivity, and hyperactivity are the classic symptom triad of ADHD, but adults often lack the full symptom complex, especially hyperactivity. Mood-associated symptoms (eg, low frustration tolerance, irritability) are often present. Since the diagnosis is a clinical one, a comprehensive interview is the most important diagnostic procedure. Rating scales, collateral reports, and neuropsychological testing can be useful and should be part of any rigorous assessment for the disorder. When a definitive diagnosis is not possible, a trial of pharmacologic therapy may be appropriate.
Latest ADHD therapy research PMID:8795655 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Drug therapy in attention-deficit hyperactivity disorder. Related Articles
Drug therapy in attention-deficit hyperactivity disorder.
South Med J. 1996 Jan;89(1):33-8
Latest ADHD therapy research Authors: Kessler S
Of 292 patients (210 males and 82 females) receiving medication for attention-deficit hyperactivity disorder (ADHD), 272 (93%) responded well to sustained-release dextroamphetamine (D-Amp) and 21 patients (7%) to sustained-release methylphenidate (MPD). The dose of D-Amp ranged from 0.2 to 3.6 mg/kg/day and the dose of MPD from 1.4 to 7.7 mg/kg/day, without side effects requiring cessation of therapy. This suggests that the clinical improvement rate can be increased to nearly 100% in appropriate situations.
Latest ADHD therapy research PMID:8545689 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Clonidine therapy for comorbid attention deficit hyperactivity disorder and conduct disorder: preliminary findings in a children's inpatient unit. Related Articles
Clonidine therapy for comorbid attention deficit hyperactivity disorder and conduct disorder: preliminary findings in a children's inpatient unit.
South Med J. 1994 Jul;87(7):692-5
Latest ADHD therapy research Authors: Schvehla TJ, Mandoki MW, Sumner GS
This retrospective study examined the clinical course of 18 prepubertal boys (aged 6 to 12) who had dual diagnoses of attention deficit hyperactivity disorder and conduct disorder and who received clonidine on an inpatient basis after failed trials of conventional drug therapy, consisting predominantly of psychostimulants. The effects of clonidine were assessed during inpatient treatment and after discharge at intervals of 1 to 2 months. Eleven (61%) of the children had marked improvement as measured by clinical impression. Transient sedation lasting 2 to 3 days occurred after initial administration or dosage increase; otherwise, clonidine was well tolerated. Our findings suggest that clonidine may prove to be an alternative treatment of comorbid attention deficit hyperactivity disorder and conduct disorder.
Latest ADHD therapy research PMID:8023201 [PubMed - indexed for Related articles ( ADHD therapy ) ( ADHD therapy )]Attention-deficit hyperactivity disorder. Getting control of impulsive behavior. Related Articles
Attention-deficit hyperactivity disorder. Getting control of impulsive behavior.
Postgrad Med. 1994 Feb 1;95(2):153-60
Latest ADHD therapy research Authors: Leung AK, Robson WL, Fagan JE, Lim SH
A sizable number of school-aged children, more often boys, may have attention-deficit hyperactivity disorder (ADHD). Its cause is unknown. Some investigators implicate food additives or lead poisoning. These theories are not supported by study results, however. Physicians are dependent on reports of parents and teachers to diagnose ADHD, since the children may not show signs at an office visit. The presence of criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, third revised edition, and descriptions by parents and teachers of significant and pervasive impairment at home or school are diagnostic. Treatment is essential to minimize the academic failure, rejection, and loss of self-esteem that can result from the behaviors that typify ADHD. Use of stimulant medication is the most effective intervention and should be continued as long as it provides benefits without adverse effects. Concomitant behavioral therapy may be useful, and the entire family may benefit from psychotherapy.
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