ADHD Medication Research Articles

The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid.

To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (p<0.01) and 7.74% (p<0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (p<0.01) in the prescribing rate and a 16.2% decrease (p<0.001) in the units per prescription. The main analysis was conducted using the Borusyak etal. (2023) Imputation Estimator with a robustness check using the Callaway and Sant'Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant'Anna's (2021) DD Estimator.

Longitudinal Associations Between Physical Health Conditions in Childhood and Attention-Deficit/Hyperactivity Disorder Symptoms at Age 17

ADHD is associated with lower birth weight, but also with obesity in childhood. Findings on the direction of this association are mixed. This study investigated the relationship between weight and ADHD from birth across development. We used data from the Millennium Cohort Study (MCS), collected at seven time points between 9 months and 17 years. ADHD diagnosis status and scores on the Strength and Difficulties Questionnaire (SDQ) were used to create an ADHD group and a control group. Random intercept cross-lagged panel models were conducted in females (N=4051) and males (N=3857) to examine bidirectional associations between BMI z-scores and SDQ scores between ages three and 17. Analyses were adjusted for common risk factors for ADHD and obesity, such as sex assigned at birth, multiple births, and ADHD medication status. Children in the ADHD group were significantly lighter at birth than the control group (t(5674)=2.65, 95% CI [0.02, 0.14] p=.008) and significantly more likely to have obesity at age five onwards (OR range 1.57-2.46, RR range 0.98-2.29). Path analyses conducted separately for males and females showed that higher ADHD symptoms in females at ages 7, 11 and 14 significantly predicted higher BMI z-score at ages 11, 14 and 17 respectively. In males, this association was only seen between age 11 and 14 (β= 0.07; 95% CI, 0.04-0.10, p < .001). Results suggest that interventions for children with ADHD, and their parents, should begin as soon as possible, prenatally if possible. Developmental sex differences should be considered.

Efficacy of pharmacological interventions for ADHD: protocol for an updated systematic review and dose–response network meta-analysis

BackgroundAttention-deficit/hyperactivity disorder (ADHD) affects approximately 5% of children globally, with symptoms often persisting into adulthood. While pharmacological interventions are commonly employed for management, understanding the optimal dosing for efficacy and tolerability remains crucial. This study aims to conduct a dose–response network meta-analysis to estimate the efficacy of pharmacological treatments across different doses, aiming to inform clinical decision-making and improve treatment outcomes.MethodsThis updated systematic review will include randomized controlled trials evaluating ADHD medication efficacy in children, adolescents, and adults. An updated search from a 2018 NMA will be conducted across multiple electronic databases with no language restrictions, using specific eligibility criteria focused on randomized controlled trials. The primary outcome will assess the severity of ADHD core symptoms, while secondary outcomes will consider treatment tolerability. A dose–response Bayesian hierarchical model will be used to estimate dose–response curves for each medication, identifying optimal dosing strategies.DiscussionWith this dose–response network meta-analysis, we aim to better understand the dose–response relationship of pharmacological treatment in ADHD, which could help clinician to the identification of optimal doses.Systematic review registrationOSF https://doi.org/10.17605/OSF.IO/3MY4A.

"Everything's a Challenge": An Interview Study of ADHD Individuals in the Midst of the Prescription Stimulant Shortage.

The shortage of prescription stimulants is an ongoing issue that is impacting the ability of individuals with ADHD to access their medication. Amidst concerns that this shortage may have a substantial impact on individuals' ability to manage their symptoms effectively, this research seeks to understand the experiences and consequences for those affected. In this study, we interviewed individuals with ADHD who have been directly impacted by the stimulant shortage. Thematic analysis focused on identifying common themes related to challenges with medication access and the resulting effects on daily living. The study uncovered significant difficulties in accessing ADHD medication due to current shortages, leading to disruptions in the management of ADHD symptoms and subsequent detriments to individuals' professional, educational, and personal lives. Systematic controls aimed at reducing non-medical use were found to exacerbate these access issues, inadvertently compounding the challenges faced by those using medication for legitimate medical needs. Individuals also described ways they coped with the shortage, with some seeking ADHD medication via unofficial channels. Our findings highlight the urgency of addressing stimulant shortages to safeguard the wellbeing of individuals with ADHD. This study also calls for a critical review of policy measures regulating stimulant medication access, and their effectiveness at reducing non-medical use given the unintended consequences these regulations appear to have on individuals prescribed these medications for therapeutic purposes.

Cluster B personality disorders and psychotropic medications: a focused analysis of trends and patterns across sex and age groups.

This study investigated sex and age differences in patterns of psychotropic medication use before and after the initial diagnosis of Cluster B personality disorders (PDs) and analyzed trends over time. Analyzing data from the Quebec Integrated Chronic Disease Surveillance System for individuals newly diagnosed with Cluster B PD (≥ 14 years) between 2002 and 2018 and under the provincial public drug plan, we calculated yearly and monthly proportions of individuals exposed to psychotropic medications during the year before and after their diagnosis by sex and age. Robust Poisson regression models assessed the association between sex and exposure to psychotropic medications after the diagnosis of Cluster B PD. Among 87,778 individuals with a first Cluster B PD diagnosis (mean age: 44.5 years; 57.5% women), the proportion of users increased post-diagnosis. Notably, after diagnosis, females were more likely to receive psychiatric medications (between 78.9% and 83.7% during the study period vs. 72.8% and 76.8%). Males were less likely than females to receive antidepressants (adjusted prevalence ratio (aPR): 0.83; 99% confidence interval (CI): 0.82-0.85) and anxiolytics (aPR: 0.86; 99%CI: 0.84-0.88), whereas they had higher exposure to antipsychotics (aPR: 1.04; 99%CI: 1.02-1.06) and ADHD medications (aPR: 1.14; 99%CI: 1.07-1.2). Age-specific trends showed increased ADHD medication use among younger patients (14-24 years), and anxiolytic use predominated in those aged ≥ 65 years. Psychotropic medication use was high among Cluster B PD patients, with differences in medication classes according to age and sex. The marked sex and age differences in psychotropic medication use among Cluster B PD patients underscore the need for a sex-sensitive and age-specific approach in psychiatric care.

Risk of psychiatric neurodevelopmental disorders after meningitis in childhood: a nationwide, population-based cohort study.

Few studies have investigated the risk of psychiatric neurodevelopmental disorders (PNDD) after childhood meningitis. Nationwide population-based cohort study (Denmark, 1995-2021) of children with positive cerebrospinal fluid for bacteria or enterovirus, stratified on age as young infants (0 to <90 days, n = 637) or older children (≥90 days to <17 years, n = 1,218). We constructed a comparison cohort from the general population (n = 18,550), and cohorts of siblings of participants. As risk estimates of PNDD we calculated age- and sex-adjusted hazard ratios (aHRs) with 95% confidence intervals (95%CI). Children with bacterial meningitis had increased risks of PNDD, especially learning and intellectual developmental disorders (young infants: aHR 4.2, 95%CI: 2.4-7.1; older children: aHR 1.5, 95%CI: 1.0-2.3), attention deficit disorder (ADHD) (young infants: aHR 2.8, 95%CI: 1.5-5.2; older children: 1.4, 95%CI: 0.9-2.2) and redemption of ADHD medication (young infants: aHR 2.2, 95%CI: 1.0-4.7; older children: 1.5, 95%CI: 1.0-2.3). Young infants with bacterial meningitis additionally had increased risks of autism spectrum disorders (aHR 1.9, 95%CI: 0.9-4.1) and behavioural and emotional disorders (aHR 2.0, 95%CI: 1.0-3.9). In young infants, the excess risk of PNDD was especially observed in premature children. Siblings of older children with bacterial meningitis also had increased risks of PNDD. Children with enteroviral meningitis at any age did not have increased risks of PNDD or redemption of ADHD medication. Bacterial meningitis in childhood is associated with subsequent diagnosis of PNDD, while enteroviral meningitis is not. The association appears to be partly explained by prematurity and familial and socioeconomic factors.

High prevalence of treatment with ADHD medicines indicates overdiagnosis of ADHD in Iceland

ADHD is a neurodevelopmental disorder characterized by hyperactivity, inattention and impulsivity. For many the core symptoms become less troubling in adulthood. Treatment with stimulants is considered the most efficacious treatment for ADHD. Large high-quality studies have estimated the prevalence of AHDH to be 3,4-7,2% for children and adolescents and 2,5-6,8% for young adults. The aim of this study was to estimate the proportion of Icelanders who have received an ADHD diagnosis based on ADHD-medication prescriptions since an ADHD diagnosis is a prerequisite for such prescriptions in Iceland. This population-based retrospective cohort study included all Icelanders 7-70 years old who received a prescription for an ADHD drug from 1.1.2004-31.12.2023. Every citizen receiving a prescription is included in the Icelandic Prescription Medicines Registry (IPMR). In 2023 14,7% of youth, 7-17 years of age, received a prescription for an ADHD medication, 17,7% of boys and 11,6% of girls. Among 12-17 years old youth the proportion was higher still, 17,6%, 20,1% for boys and 14,6% for girls. For 18-44 years old adults the proportion was 10,2%, 9,4% for males and 11,0% for females. From 2010-2023 the increase in prescriptions for 7-17 years old boys has been 93% but 224% for girls. For 18-44 years old males the increase has been 414% for males and 543% for females during this period. The incidence of new ADHD prescriptions for 7-17 years old boys from 2021-2023 was 10,9 and 13,5 for girls per 1000, respectively. For 18-44 years old the incidence in the years 2021-2023 was 18,7 for males and 19,2 for females per 1000, respectively. The prevalence of Icelanders who have received an ADHD diagnosis is double to treble that observed in the best available studies in other populations. We therefore call for an urgent review of how ADHD diagnoses are made in Iceland because it is obvious that the current system leads to overdiagnosis and inappropriate treatment.

Examining the Myth of Prescribed Stimulant Misuse among Individuals with Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

The literature emphasizes the importance of addressing the misuse of ADHD medications as a potential significant healthcare issue within the general population. Nevertheless, there are no systematic reviews that specifically examine whether the misuse of psychostimulant medication among clinical populations diagnosed with ADHD who are undergoing prescribed stimulant therapy is a rational concern or a false myth. This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. We searched PubMed databases for articles indexed up to 12th July 2023, without language restrictions. Our systematic search generated 996 unique articles. After a full-text revision, 13 studies met the eligibility criteria and were included in the systematic review. In the 50% of the study on the adult population, the reported prevalence of stimulant misuse was 0%. In other studies, the range of stimulant misuse rates varied from 2% to 29%, with no available data specifically focusing on the youth population. It has been noted that misuse of prescribed stimulant treatment is linked with particular subject characteristics, such as older age, prior or more frequent use of ADHD medication, use of short-acting medication, and a history of alcohol/substance misuse diagnosis. Despite certain limitations, our study highlights that while a significant proportion of individuals undergoing psychostimulant treatment for ADHD follow their prescribed medication regimens without resorting to misuse behaviors, there is variability in adherence, with occurrences of misuse behaviors. The misuse of prescribed ADHD treatment appears to be associated with distinct subject characteristics, underscoring the importance for tailored interventions addressing the specific requirements of these individuals to attain optimal treatment outcomes while mitigating misuse risks.

Need for further exploring at the intersection of ADHD medications and bipolar disorder.

Need for further exploring at the intersection of ADHD medications and bipolar disorder.

Attention-Deficit/Hyperactivity Disorder in Medication Treated Preschool-Age Children Without and With Autism Spectrum Disorder: A Developmental-Behavioral Research Network Study

Abstract: Objectives: The study objective was to compare preschool children with attention-deficit/hyperactivity disorder without autism spectrum disorder (ADHD − ASD) with those with ADHD and ASD (ADHD + ASD), treated with stimulant or alpha-2-agonist (A2A) medications. Methods: Retrospective electronic health record review of 497 children from 7 developmental behavioral pediatrics research network sites. Children were younger than 72 months when treated with medication for ADHD from January 1, 2013, to January 7, 2017. We analyzed differences in children with ADHD − ASD versus ADHD + ASD treated with stimulants or A2As, including demographics, coexisting conditions, medication effectiveness, medication, discontinuation factors, and adverse effects. Results: Of the 497 preschool-age children with ADHD, 389 had ADHD − ASD and 108 had ADHD + ASD. No statistically significant differences were found in demographics between the groups. At baseline, ADHD + ASD group reported more sleep problems. For the ADHD − ASD group, stimulant medication was significantly more effective than A2As; no significant differences were found in medication effectiveness of stimulants versus A2As for the ADHD + ASD group. Children with ADHD − ASD experienced more appetite suppression and stomachaches on stimulants. No associations were found between ASD status and rates of common adverse effects for children initiated on A2As. Conclusion: We found more similarities than differences when comparing ADHD − ASD preschool-age children with those with ADHD + ASD. For children with ADHD − ASD, stimulant medications were significantly more effective than A2As. Overall, there was notable overlap in presentation, response to medication, coexisting conditions, and effectiveness of medication classes.

Illicit ADHD Medication Use Associated With Alcohol and Caffeine Consumption

Illicit ADHD Medication Use Associated With Alcohol and Caffeine Consumption

Evaluation of Problematic Video Game Use in Adolescents with ADHD and without ADHD: New Evidence and Recommendations.

Video game addiction among adolescents, particularly those with ADHD, is a significant concern. To gather more insights into video game usage patterns in this population, we investigated levels of potentially problematic use, passion, motivations, and emotional/behavioral symptoms in adolescents with and without ADHD. Our cross-sectional, multicenter study involved 2513 subjects (Age M = 15.07; SD = 2.82) from 24 schools in Galicia (Spain), including 158 (6.3%) diagnosed with ADHD. We employed an ad hoc questionnaire covering sociodemographic data and ADHD diagnosis, the Questionnaire of Experiences Associated with Video Games (CERV), the scale of passion for video games, reasons for playing video games Questionaire (VMQ), and emotional/behavioral problems assessment (SDQ). Results indicated heightened vulnerability in adolescents with ADHD, manifesting in longer usage durations and higher problematic use scores. Interestingly, ADHD medication did not affect internet gaming disorder development. Motivations for gaming differed between groups, with the ADHD cohort showing distinctions in cognitive development, coping, and violent reward. Additionally, the ADHD group exhibited greater emotional/behavioral symptoms, hyperactivity, and reduced prosocial behavior.

Use of ADHD medications increased sharply during pandemic

Use of ADHD medications increased sharply during pandemic

Is ADHD Medication Monitoring Being Completed in CAMHS?

Is ADHD Medication Monitoring Being Completed in CAMHS?

Development of an Integrated Electronic Platform for ADHD Medication Initiation in Child and Adolescent Mental Health Services

Development of an Integrated Electronic Platform for ADHD Medication Initiation in Child and Adolescent Mental Health Services

A pre-visit video/question prompt list intervention to increase youth question-asking about attention deficit hyperactivity disorder during pediatric visits

ObjectiveTo conduct a pragmatic randomized controlled trial to test the effectiveness of an ADHD question prompt list with video intervention to increase youth question-asking and provider education about ADHD during visits. MethodsEnglish-speaking youth ages 11–17 with ADHD and their caregivers were enrolled from two pediatric clinics. Youth were randomized to intervention or usual care groups. Intervention group adolescents watched the video and then completed an ADHD question prompt list before their visits. Multivariable regression was used to analyze the data. ResultsTwenty-one providers and 102 of their patients participated. Intervention group youth were significantly more likely to ask one or more questions about ADHD and its treatment than usual care youth (odds ratio=5.4, 95 % Confidence Interval (CI)= 1.8, 15.9). Providers were significantly more likely to educate youth who asked one or more questions during visits about more ADHD medication areas (unstandardized beta=0.98, 95 % CI=0.31 to 1.64) and more non-medication strategies for ADHD (unstandardized beta=0.50, 95 % CI=0.13 to 0.88). ConclusionThe intervention increased youth question-asking about ADHD and its treatment. Providers provided more education to youth who asked one or more questions about ADHD and its treatment. Practice implicationsProviders and practices should consider having youth complete ADHD question prompt lists and watch the video before visits to increase youth question-asking during visits.

ADHD medications for cognitive impairment in bipolar disorders.

ADHD medications for cognitive impairment in bipolar disorders.

Bedtime Regularity and Sleep Sufficiency in Children With Tourette Syndrome

BackgroundDespite research demonstrating sleep disturbance in children with Tourette syndrome (TS), few studies have examined bedtime regularity and sleep sufficiency, two important sleep health dimensions. Therefore, this study examined bedtime regularity and sleep sufficiency in children with TS relative to matched healthy control subjects, and its associated demographic, clinical, and behavioral factors. MethodsParticipants were 384 parents or caregivers of children aged three to 17 years, including 192 with current TS and 192 matched healthy control subjects drawn from the 2020-2021 cycle of the National Survey of Children's Health. Parents completed questions assessing demographic (i.e., age, race, sex), clinical (i.e., attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, anxiety, depression, tic severity, behavioral or conduct problems, ADHD medication, health condition-related impairment), and behavioral (i.e., screen time) characteristics. Mann-Whitney U test and chi-square test of independence were performed to compare groups on bedtime regularity and sleep sufficiency, respectively. Ordinal regression and binary logistic regression without and with backward elimination were performed to evaluate indicators of bedtime regularity and sleep sufficiency, respectively, in children with TS. ResultsChildren with current TS had significantly poorer bedtime regularity, but not sleep sufficiency, relative to matched healthy control subjects. In children with TS, anxiety and two or more hours of daily screen time were associated with higher likelihood of poor bedtime regularity. Autism was associated with lower likelihood of insufficient sleep, and depression was associated with increased likelihood of insufficient sleep. ConclusionsFindings put forth screen time, anxiety, and depression as intervention targets to optimize sleep health in children with TS.

Associations between Illicit Drug Use, Academic Performance and Self Esteem Among College Students

Many college students place a high value on their grade-point average (GPA) as a representative of their academic performance. Due to this pressure to achieve, students often feel overwhelmed to the point where it starts affecting their mental wellbeing. Several students resort to study aids to enhance their GPA, while others rely on illicit drug use to cope with the stress. Reports have associated GPAs with a sense of self-worth, suggesting that students with low GPAs presumably have lower self-esteem. In addition, self-worth is closely associated with mental health and drug use. However, it is unknown how these factors interact. Thus, the purpose of the study is to assess the association between drug use, mental distress and GPA in relation to self-esteem. This study included 702 undergraduate college students from different universities across the United States. The anonymous survey, which was distributed online via Google Forms, assessed self-reported drug usage, and different aspects of mental distress were assessed by the Kessler Psychological Distress Scales (K10+) and the Perceived Stress Scale (PSS). The data were analyzed in SPSS, Version 28.0, using a Pearson’s correlation coeffcient. The results suggest that GPA is correlated with traits of self-esteem (p&lt;0.01), such as self-rated mental wellbeing, feelings of worthlessness, and hopelessness. Additionally, GPA is correlated with the belief that they are able to effectively cope with troubles in their lives (p&lt;0.01), and is negatively correlated with loss of control (p&lt;0.05). Feelings of distress and lack of control may cause students to turn to negative coping strategies such as abusing substances such as alcohol (p&lt;0.01), marijuana (p&lt;0.01), cocaine (p&lt;0.01), and illicit ADHD medication use (p&lt;0.05), all of which were found to be negatively correlated with GPA. Our results propose a possible cyclic relationship between illicit drug use as coping mechanisms, GPA, and not only low self-worth but different aspects of mental distress. This research received no specific grant from any funding agency, commercial or not-for-profit sectors. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm

To evaluate the effect of ADHD diagnosis by the age of 10 on the suicide/self-harm risk at age 14 and examine factors that may modify/mediate the association, a longitudinal study based on the nationwide survey consisting of 5,107 children in Australia was used. Self-harm and suicidal risks in children with ADHD at age 14 were the main outcomes; ADHD medication, history of bullied or depression, and other sociodemographic disadvantages, were treated as covariates. The diagnosis of ADHD at age 10 is associated with elevated risks of self-harm, suicidal thoughts, planning, or attempts by age 14, with greater susceptibility in males. The pathway from ADHD symptoms to suicide/self-harm could also be mediated by depression and exposure to bullying assessed at age 12. Note that depression and exposure to bullying might at best contribute to less than 10 % of the total effect of ADHD diagnosis on either the risk of suicide or self-harm. Early gender-tailored intervention and prevention strategies are crucial in clinical practice and health policy.