Stimulants For ADHD Research Articles

Use of stimulants for ADHD and subsequent substance abuse

Use of stimulants for ADHD and subsequent substance abuse

Central nervous system stimulants for secondary attention deficit-hyperactivity disorder after paediatric traumatic brain injury: a rationale and protocol for single patient (n-of-1) multiple cross-over trials

BackgroundIt is estimated that 22,800 children were living with an Acquired Brain Injury (ABI) (0.6% of children aged under 15 years) in Australia during 2003. Many children after a traumatic brain injury will experience difficulties with attention and concentration; a condition termed secondary Attention Deficit-Hyperactivity Disorder. There is conflicting evidence on whether treatment with stimulant therapy with medications such as methylphenidate or dexamphetamine will improve the attention and behavior of children with this condition.Methods/DesignSingle patient trials (n-of-1s or SPTs) evaluate the effect of titrated doses of psychostimulants methylphenidate or dexamphetamine compared to placebo on attention and behavior, in children with TBI and secondary ADHD. The aggregation of multiple SPTs will produce a population estimate of the benefit. Forty-two children will be registered into the trial through rehabilitation services at three large children’s hospitals in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 2 weeks long comprising seven days each of treatment and placebo, with the first two days of each cycle considered a washout period and the data not analysed. The order of treatment and placebo is randomly allocated for each cycle. The Conners’ Parent Rating Scales long forms will be employed to measure change in attention-deficit/hyperactivity and related problems of the child, and the primary outcome measure is the Conners’ Global Index Parent Version. Secondary outcomes include the teacher and child (if aged > 12 years) Conners’ Rating Scales, the Behaviour Rating Inventory of Executive Function among other measures. This study will provide high-level evidence using a novel methodological approach to inform clinicians about the most appropriate treatment for individual children. Through aggregation of individual trials, a population estimate of treatment effect will be provided to guide clinical practice in the treatment of children with secondary ADHD after a traumatic brain injury.DiscussionThis study employs an innovative methodological approach on the effectiveness of CNS stimulants for secondary ADHD from a brain injury. The findings will both guide clinicians on treatment recommendations, and inform the concept and acceptance of SPTs in paediatric research.Trial registrationAustralian New Zealand Clinical Trials Registry. ACTRN12609000873224

Elementary and Middle School Teacher Perceptions of Attention-Deficit/Hyperactivity Disorder Prevalence

Background Estimates of ADHD diagnosis and stimulant medication use vary across studies. Few studies ascertain the teacher perspective on these rates.

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AbstractAntipsychotics for Youth at Risk for Psychosis Not Supported as First OptionRelative Age in Class Affects ADHD Stimulant TreatmentSurvey Analysis Does Not Point to OvermedicationHyperprolactinemia Found in Risperidone‐Treated YouthFree the Future: Investment in MH Services Crucial Post‐NewtownPediatric Social Anxiety Disorder: Predictors of Response to Pharmacological TreatmentZiprasidone vs. Olanzapine for 1st‐Episode SchizophreniaUtilization and Cost of Antipsychotics in Stimulant‐Treated YouthAcute Myocardial Infarction in Teen Taking Adderall with AlcoholManaging Side Effects of ADHD MedicationsNew Requirements for Zolpidem Products

Nonmedical Use and Diversion of ADHD Stimulants Among U.S. Adults Ages 18-49

Objective: Evaluate nonmedical use (NMU) of ADHD prescription stimulants (Ritalin®, Adderall®, Adderall® XR, Concerta®, and Vyvanse®) in a U.S. adult general population sample. Method: In all, 10,000 adults (aged 18-49) from an online, opt-in panel, proximity matched to U.S. Census demographics, were surveyed to assess NMU prevalence, routes of administration (ROA), reasons for NMU, and diversion source. Results: Lifetime NMU of any prescription drug was 35.1%, pain medications (24.6%), sedatives/tranquilizers (15.6%), sleep medications (9.9%), and prescription stimulants (8.1%). Within the prescription stimulants, rates of NMU (per 100,000 prescriptions dispensed) were 1.62 for Ritalin and 1.61 for Adderall followed by Adderall XR (0.62), Concerta (0.19), and Vyvanse (0.13). Respondents used stimulants mostly for wakefulness and performance enhancement, obtained the drugs from family/friends, and used oral ROA. Conclusion: NMU of ADHD prescription stimulants were low compared with other prescription medications. While prevalence of NMU was higher for immediate-release than extended-release ADHD medications, absolute rates for prescription stimulants were low.

Do conduct problems and sensation seeking moderate the association between ADHD and three types of stimulant use in a college population?

Evidence suggests that ADHD symptoms predict increased risk for misusing stimulant medication, which may extend to misuse of over-the-counter (OTC) stimulants and illicit stimulants. Conduct-problem (CP) symptoms and sensation seeking (SS) also predict substance use and may enhance risk for stimulant use among college students with ADHD symptoms. Participants, who were undergraduate students aged 18 to 25 years (N = 660; average age = 20.23 years, SD = 1.40; 30% male; 49% non-European American), completed an online survey regarding ADHD symptoms, CP symptoms, SS, and stimulant use (i.e., OTC stimulants, misuse of stimulant medication, and illicit stimulants). Results of logistic regression indicated that SS moderated the association between ADHD symptoms and OTC stimulants. Also, CP moderated the relation between ADHD symptoms and misuse of stimulant medication. Disinhibition, a subscale of SS, also moderated the association between ADHD symptoms and misuse of stimulant medication. Only CP symptoms predicted illicit stimulants. These results suggest that college students with ADHD symptoms display risk for using OTC stimulants, and that disinhibition and CP symptoms increase their risk for misuse of stimulant medication. Implications of these findings are discussed.

Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults

Compared to children, adults with ADHD are at greater risk for developing adverse cardiovascular related outcomes and, if treated, may be likely to carry a greater burden of exposure to stimulant medications. The goal of this report is to critically review the available literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD (aADHD). Twenty potential clinical trials of a CNS stimulant for aADHD have been published between 1979 and 2012. Of these, ten presented sufficient data to estimate the relative change in various cardiovascular parameters associated with ADHD treatment modalities. These trials were predominantly focused on long-acting stimulant preparations for acute symptom reduction (median duration=6 weeks, range: 4-24 weeks) and enrolled relatively young subjects (median age=36 years, range: 22-40). Using random effects meta-analysis, we found that subjects randomized to CNS stimulant treatment demonstrated a statistically significant increased resting heart rate [+5.7bpm (3.6, 7.8), p<0.001] and systolic blood pressure findings [+2.0mmHg (0.8, 3.2), p=0.005] compared with subjects randomized to placebo. There was a statistically significant increased risk for a resting heart rate >90bpm [4.2% (n=50) vs. 1.7% (n=8), OR=2.75 (1.3, 6.7), p=0.006] associated with CNS stimulant treatment. In light of prognostic value of resting heart rate with regard to cardiovascular morbidity in epidemiological studies, future research of adults with ADHD should focus on the potential clinical impact of the increase in heart rate observed in this meta-analysis.

A cardiopulmonary study of lisdexamfetamine in adults with attention-deficit/hyperactivity disorder

Objectives. Due to concerns about the safety of stimulants for ADHD, novel assessments of the cardiopulmonary impact of these agents are needed. Methods. An open design of lisdexamfetamine (LDX) in 15 adults with DSM-IV ADHD. Following a psychiatric evaluation and medical history, subjects underwent echocardiography (TTE) and cardiopulmonary exercise testing (CPET). LDX was titrated to 70 mg daily over 6 weeks, followed by monthly visits to 6 months. Change in TTE and CPET measures were examined following up to 6 months of LDX. Results. At endpoint, there were no significant alterations in indices of cardiac systolic performance, or in metabolic and ventilatory variables at maximum exertion (P values >0.05). We found significant mean changes in resting LV systolic dimension and Doppler diastolic indices. Change in heart rate recovery at 1 min met statistical significance (P = 0.05). Conclusions. We did not detect clinically meaningful changes in cardiac structure and function or in metabolic and ventilatory variables at maximum exertion in ADHD adults receiving open LDX. The clinical significance of changes in resting LV dimension and indices of diastolic function are not in the direction of cardiomyopathy. Future large sample controlled study can examine these findings, as well as stimulants’ impact on heart rate recovery.

Cardiovascular Events and Stimulants for ADHD

Researchers from Vanderbilt University, TN; Kaiser Permanente, California; and other centers conducted a retrospective cohort study of serious cardiovascular events in 1,200,438 children and young adults, ages 2 to 24 years (mean 11.1 years), with ADHD.

Skin Reactions Linked to ADHD Stimulants

Skin Reactions Linked to ADHD Stimulants

ADHD Stimulants May Not Delay Male Puberty

ADHD Stimulants May Not Delay Male Puberty

Motor function and methylphenidate effect in children with attention deficit hyperactivity disorder

Hyperactivity, impulsivity and poor attention are the core problems of ADHD and central stimulant medication is the preferred treatment. Many children with ADHD also display motor problems. The present study investigated the presence of motor problems in subjects who showed positive response to central stimulants on ADHD symptoms, compared with non-responders. This is a retrospective study of 73 children diagnosed ADHD, aged 5-17 years, who had been assessed with parts of the 'Motor Function Neurological Assessment' (MFNU) and evaluated with regard to effect of central stimulant medication. The sample was divided into two subgroups based on the responses to methylphenidate: Medicine responders and Non medicine responders. Stimulant responders showed significantly more motor problems than the non-responders on all sub-tests and on the total problem score of the MFNU. Motor problems were present both in younger (age 5-10 years) and older (11-17 years) stimulant responders. There were no gender differences in motor performance. Our findings indicate that the probability of positive effect of central stimulants on core problems of ADHD is higher when motor problems are present in addition to ADHD symptoms, than when motor problems are absent.

Speeding through the Frat House: A Qualitative Exploration of Nonmedical Adhd Stimulant Use in Fraternities

Qualitative methods were used to investigate the use of nonmedical Attention Deficit Hyperactivity Disorder (ADHD) stimulants by fraternity members. The primary goal of the study was to determine students' levels of understanding and motivations for use of these Schedule II controlled substances. Seventy-nine in-depth interviews were conducted. Key findings highlighted how: a) easy it was for subjects to obtain stimulants; b) little health information nonmedical users have about stimulants; c) academic stress created a fertile context for stimulant use; and d) a small number of prescribed users supply the vast majority of nonmedical users with their stimulants. Most nonmedical users claimed to primarily use ADHD stimulants in periods of high academic stress and believed that they not only reduced fatigue, but also increased reading comprehension, interest, cognition, and memory. These qualitative data have supplied a rich and complex understanding behind nonmedical ADHD stimulant use among fraternity members.

Teen Abuse of ADHD Stimulants Climbed 76%

Teen Abuse of ADHD Stimulants Climbed 76%

Medicating children: ADHD and pediatric mental health

* Acknowledgments * Introduction * An Introduction to ADHD * A Survey of the Evolution of ADHD and Pediatric Stimulant Use, 1900--1980 * The Transformation of Mental Disorders in the 1980s: The DSM-III, Managed Care, and Cosmetic Psychopharmacology * ADHD and the Politics of Children's Disability Policy * The Backlash against ADHD and Stimulants * Current Questions about Stimulant Treatment for ADHD * Conclusion * Notes * Selected Bibliography * Index

Reduction of Drug Abuse in Adolescents Previously Treated with Stimulants for ADHD

The effects of early stimulant medication on subsequent risk for cigarette smoking and substance use disorders (SUDs) were evaluated in a 5-year, case-controlled, follow-up study of adolescent girls with ADHD at the Pediatric Psychopharmacology Program, Masachusetts General Hospital, Boston, MA, and Department of Psychiatry, New York State University, Syracuse, NY.

Cardiovascular Risk Screening before Starting Stimulants for ADHD in Canadian Practice

Health Canada released a statement advising against stimulants in ADHD patients with cardiac disease in May 2006, after isolated reports of sudden death The impact of this advisory on 1) physicians’ cardiovascular assessment of all children with ADHD before starting stimulant medications, and 2) on the treatment of children with potential or real cardiac disease was assessed by questionnaires mailed to noncardiologists and pediatric cardiologists in Canada from the Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.

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AbstractAnalysis of Children in Foster Care Finds High Prescribing of Psychotropic MedsFluoxetine Continuation Treatment Effective for Depression Relapse PreventionHigher Incidence of Early‐Onset Bipolar Disorder in the USA than in EuropeAtomoxetine and Suicidal Ideation in Pediatric ADHD PatientsStudy Design and MethodologyEfficacy of Modafinil in ADHD Patients with Inattentive and Combined SubtypesNew Measure for Assessing Emotional Expression in Children Taking ADHD MedicationRisperidone‐Induced Hyper‐Prolactinemia in Adolescents May be Dose‐DependentNo Effect of ADHD Stimulant Treatment on Future Substance AbusePsychotropic Drug Use Common in Medicaid‐Enrolled Children with AutismParents are Target of ONDCP Anti‐Prescription Drug CampaignNo Increase in Suicidal Behavior in the UK Following Reduced SSRI PrescribingCardiovascular Monitoring During ADHD Treatment with SimulantsApproval: Aripiprazole for Bipolar I Mixed/Manic EpisodesApproval: Fluvoxamine CR for SAD and OCD

Injury Among Stimulant-Treated Youth With ADHD

Objective: To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. Method: An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and multivariate analyses were performed to examine associations of demographic and clinical characteristics with injury. Results: In a Cox proportional hazard model that controlled for background patient characteristics, patients ages 13 to 17 years, male gender, prescription of anxiolytic/hypnotic medications, and diagnosis of a mood disorder were each independently associated with increased risk of injury, whereas African American ancestry and other minority racial/ethnic ancestry were associated with lower risk. Youth with high stimulant medication possession ratios (MPR) had a nonsignificantly lower risk of injury as compared to those with a low stimulant MPR. Conclusion: These findings reveal several patient characteristics that may be associated with increased risk of injury among children and adolescents treated for ADHD. (J. of Att. Dis. 2008; 12(1) 64-69)

Stimulants for ADHD Equal; Tx by Gender Is Not

Stimulants for ADHD Equal; Tx by Gender Is Not