Stimulant Medication For ADHD Research Articles

Finding the “Sweet Spot”: Sharing the decision-making in ADHD treatment selection

BackgroundStimulants are often prescribed as first-line therapy for attention-deficit/hyperactivity disorder. Currently, there are many therapeutic options available for clinicians and families to consider when making the decision to use a medication. In practice, selection of a stimulant medication for ADHD is highly personalized and can be narrowed down to two major factors: finding the optimal duration of the medication effect, and then estimating a starting dose and subsequently “fine-tuning” the medication to the optimal dosage of the medication. With the possibility of titrating to an optimal stimulant dosage within one prescription of a liquid stimulant, prescribers can recruit the parent/caregiver to actively participate in managing the transition to medication, allowing for greater ownership and a sense of shared control over the process.Case presentationThe short case series offers a communication method by which clinicians can apply the principles of shared decision-making in helping the parent or caregiver of a newly diagnosed patient with ADHD make informed decisions about medication selection, and to obtain a greater sense of comfort with the new medication regimen.ConclusionsMuch has been published on the importance of clinicians and their patients fostering an environment of clear and unrestricted information-sharing. This short case series illustrates the effectiveness of this approach. Once parents are comfortable with the decision to start drug treatment for ADHD, it is incumbent upon the healthcare provider to ensure that an open channel of communication is maintained, and that parent/caregivers are encouraged to raise concerns as soon as possible.

31.2 MINING THE MEANING OF THE MULTISITE MULTIMODAL TREATMENT STUDY OF ADHD (MTA) STUDY: NOVEL FINDINGS FROM QUALITATIVE STUDY METHODS

Most psychiatric research uses rigorously structured mental health interviews of DSM-based mental health disorders as well as paper-and-pencil questionnaires about study variables. Although these so-called “quantitative” study methods have generated important research findings, they have limitations. For example, although a given variable may be a causal factor for illness in some, the same variable can operate in the opposite manner in others; for example, taking a stimulant medication for ADHD might prevent substance abuse (SU) in some but precipitate it in others. Even diametrically opposed findings can be hidden in a study’s quantitative findings. In clinical practice, practitioners operate differently than quantitative researchers to understand illness. Like detectives who assemble clues after an event has occurred, clinicians seek to obtain a comprehensive history from various informants, gather clues regarding the patient’s beliefs and assumptions about the illness, and determine the most plausible explanation for the illness. Like clinical practitioners, qualitative researchers also use historical methods to understand patients’ beliefs and assumptions, in order to generate new hypotheses that can be verified by quantitative methods. We review a qualitative study of 183 patients’ interviews about their ADHD experiences via participation in the MTA and their beliefs and assumptions about ADHD, its causes, consequences, and optimal treatments. Despite over 150 quantitative research reports from the MTA study, questions persist. What explains the good vs poor outcomes of so many subjects? Why do some risk factors portend bad outcomes, but have no effect in others? How do “turning points” differentially affect the lives of youth, and how are these turning points linked to subsequent life decisions? Comparison of the MTA study’s quantitative vs qualitative findings reveals important new areas for study: some factors appear to convey “risk” in some but “benefit” in others. Some adults with ADHD cite the importance of turning points that led them to major life changes. For many, ADHD is seen as “no big deal,” and stimulants are seen as unnecessary. For some young adults, family factors are protective but are illness-producing for others.

HIGHER PERSISTENCE AND ADHERENCE WITH DR/ER-MPH OVER OTHER EXTENDED-RELEASE STIMULANTS FOR THE MANAGEMENT OF ADHD: REAL-WORLD EVIDENCE FROM A LARGE U.S. CLAIMS DATABASE ANALYSIS

The effectiveness of stimulant medication for ADHD is often reduced due to low medication adherence and discontinuation, resulting in less-than-desired improvements in patients’ symptoms and functional impairment. The evening-dosed, delayed-release and extended-release methylphenidate ([DR/ER-MPH]; JORNAY PM®; formerly HLD200) is released in the colon and provides a dose-dependent duration of effect for individuals with ADHD. Here, we report treatment persistence and adherence rates among individuals newly initiated on DR/ER-MPH and other stimulant options in a real-world setting over a 9-month period.

HEREDITARY ANGIOEDEMA PRECIPITATED BY CONSTIPATION SECONDARY TO STIMULANT MEDICATION USE

Introduction Hereditary angioedema (HAE) is an inherited condition manifesting as recurrent episodes of swelling that commonly affects the skin and gastrointestinal tract (1,8). Various triggers can be the precipitating factors in an acute episode of HAE, however, sometimes the culprit cannot be determined. Case Description We present a patient with a diagnosis of hereditary angioedema, concomitant ADHD, with recurrent gastrointestinal exacerbations. Within 3 years, he had nine presentations to the emergency room, four related to abdominal pain, and the remainder for swelling alone. All presentations with abdominal pain had documentation indicating patient had not had a bowel movement for several days. He had abdominal ultrasounds showing thickened bowel loops and small amount of ascites, indicating likely hereditary angioedema attack with gastrointestinal involvement. HAE attacks became more frequent following initiation of stimulant medication for ADHD. It is hypothesized that these frequent attacks were exacerbated by constipation secondary to stimulant medication use, and upon discontinuation of medication, he has not presented to the ER with further abdominal crisis. Discussion HAE may present as recurrent episodes of swelling in one or more body parts, but should also be suspected when there are recurrent bouts of abdominal pain with or without emesis. Constipation, a common presenting pediatric complaint, can lead to stress on the body and result in an HAE acute attack (3,7). We are presenting this case for health care providers to consider stimulant medication as a cause of constipation in patients with HAE presenting with abdominal crisis. Hereditary angioedema (HAE) is an inherited condition manifesting as recurrent episodes of swelling that commonly affects the skin and gastrointestinal tract (1,8). Various triggers can be the precipitating factors in an acute episode of HAE, however, sometimes the culprit cannot be determined. We present a patient with a diagnosis of hereditary angioedema, concomitant ADHD, with recurrent gastrointestinal exacerbations. Within 3 years, he had nine presentations to the emergency room, four related to abdominal pain, and the remainder for swelling alone. All presentations with abdominal pain had documentation indicating patient had not had a bowel movement for several days. He had abdominal ultrasounds showing thickened bowel loops and small amount of ascites, indicating likely hereditary angioedema attack with gastrointestinal involvement. HAE attacks became more frequent following initiation of stimulant medication for ADHD. It is hypothesized that these frequent attacks were exacerbated by constipation secondary to stimulant medication use, and upon discontinuation of medication, he has not presented to the ER with further abdominal crisis. HAE may present as recurrent episodes of swelling in one or more body parts, but should also be suspected when there are recurrent bouts of abdominal pain with or without emesis. Constipation, a common presenting pediatric complaint, can lead to stress on the body and result in an HAE acute attack (3,7). We are presenting this case for health care providers to consider stimulant medication as a cause of constipation in patients with HAE presenting with abdominal crisis.

Lower risk of fractures under methylphenidate treatment for ADHD: A dose-response effect.

Methylphenidate (MP), a widely used and abused stimulant medication for ADHD, negatively affects bone mass. However, previous epidemiological studies demonstrated that MP is not associated with increased incidence of fractures in children, and may even have a protective effect due to behavior modification. This study aimed to investigate the association between MP and fracture risk in a retrospective cohort of healthy military recruits, aged 18-25, with at least 1 year of service between 2008 and 2017. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1-90, 91-180, or 181+ tablets during the study period. The primary outcome was at least one fracture diagnosis during the study. Among 682,110 subjects (409,175 men [60%]), 50,999 (7.5%) had fractures. MP was used by 1,681 (0.4%) men and 2.828 (1%) women. The fracture rates in the no ADHD, untreated ADHD, ADHD 0-90, ADHD 91-180, and ADHD 181+ groups were 10.4%, 16.4%, 8.7%, 4.8% and 5.8% in men, and 3.6%, 7.1%, 4.6%, 4.4% and 3% in women, respectively. Multivariate regression analysis confirmed an inverse dose-response association between MP and fractures in men (p < 0.001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). The study confirms previous literature and demonstrates an inverse dose-response association between MP and fracture risk in men. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3328-3333, 2018.

Affordances of mHealth technology and the structuring of clinic communication

ABSTRACTCareful examination of communicative outcomes of mHealth technology is critical for understanding its capacity to shape the clinical interview and structure clinic communication. Drawing on a communicative affordances framework and adopting a video-based inductive analytic approach, we extend the concept of actualizations. We do so by examining the in situ communicative actions afforded by a mHealth web interface utilized during medication titration interviews with parents of children beginning stimulant medication for ADHD. We find that the web interface served five broad communicative functions that provided opportunities for improving information accuracy and for rendering clinical reasoning transparent, while jeopardizing opportunities for parents to narrativize medication experiences. We discuss clinical, theoretical, and methodological implications.

Long-Term Course After Adaptive Multimodal Treatment for Children With ADHD: An 8-Year Follow-Up

Objective: This study reassessed adolescents and young adults (15-22 years old) who received individually tailored multimodal treatment for ADHD (behavior therapy and/or stimulant medication) during childhood 6 to 12 years after treatment (M = 8.8 years, SD = 1.6). Method: All participants (N = 75) provided information about their social functioning. Most parents (83%) completed behavior rating scales. Results: Participants demonstrated significant improvement in behavior during the follow-up period with effect sizes on ADHD symptoms of d = 1.2 and 68% of the former patients in the normal range at follow-up. Participants reported elevated rates of grade retention (51%), school dropout (13%), special education service use (17%), school change (47%), and conviction (16%), but few were unemployed (4%). Conclusion: This study provides evidence that the effects of individually tailored multimodal treatment for ADHD in childhood are maintained into adolescence and young adulthood. No hints could be found that continued medication results in a more favorable long-term outcome.

Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in children with ADHD-only, ADHD and conduct problems, and controls.

This study compared the unique and combined effects of evidence-based treatments for ADHD-stimulant medication and behavior modification-on children's rates of reinforcement for deviant peer behavior (RDPB). Using a within-subjects design, 222 elementary school-age children attending a summer treatment program, including 151 children with ADHD (127 male), with and without comorbid conduct problems, and 71 control children (57 male), received varying combinations of behavior modification (no, low-intensity, and high-intensity) and methylphenidate (placebo, 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg). RDPB was measured through direct observation and compared across all behavior modification and medication conditions. Children with ADHD reinforced the deviant behavior of their peers at a significantly higher rate than control children in the absence of either intervention. However, that difference largely disappeared in the presence of both behavior modification and medication. Both low and high-intensity behavior modification, as well as medium (0.30 mg/kg) and high (0.60 mg/kg) doses of methylphenidate, significantly reduced the rate of ADHD children's RDPB to levels similar to the control group. Results indicate that although untreated children with ADHD do engage in RDPB at a greater rate than their non-ADHD peers, existing evidence-based interventions can substantially decrease the presence of RDPB, thereby limiting potential iatrogenic effects in group-based treatment settings.

Drug Utilization Pattern of Lisdexamfetamine Dimesylate in Germany.

- The objective of the study was to provide utilization data in Germany for the ADHD stimulant medication lisdexamfetamine dimesylate (LDX) in the first six months following its launch in June 2013. - This drug utilization study (DUS) analysed a longitudinal electronic medical record database (IMS Disease Analyzer - Germany), and was part of a larger DUS providing data for 8 European countries for up to 5 years. The study included records of all patients who had been prescribed LDX from June 2013 to December 2013 in the paediatrician panel (PP) or neurologist/psychiatrist panel (NPP) of the German database. - The analysis included 123 patients (348 prescriptions) from the PP and 296 patients (710 prescriptions) from the NPP. In both panels, 91% of patients had a documented diagnosis of ADHD. When initiated on LDX treatment, most patients (PP, 98%; NPP, 91%) were between 6 and 18 years of age; up to 1% of patients in both panels were below 6 years of age and 2% and 8% of patients in the PP and NPP, respectively, were above 18 years of age. The majority of patients in both panels were male (PP, 77%; NPP, 79%). The average prescribed daily dose of LDX was within the recommended range (30–70 mg) for all patients in the NPP and for 98.4% in the PP, with a mean daily dose across patients of 42 mg in both panels. - The findings of this analysis of electronic medical records indicate that, during the first six months after launch, LDX was mainly prescribed in Germany within the EMA-approved Summary of Product Characteristics (SmPC) with regard to the indicated patients, age group and dose regimen.

Review: no evidence that stimulant medication for ADHD influences lifetime risk of substance use or dependence

Review: no evidence that stimulant medication for ADHD influences lifetime risk of substance use or dependence

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.

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.

Children's Self-Reports on Perceived Effects on Taking Stimulant Medication for ADHD

Objective: This study investigates children's views on positive and negative effects of stimulant medication for ADHD and the children's willingness to stop taking medication. Method: Questionnaire data were collected from 79 children with ADHD and one of each child's parents. Results/Conclusion: Swedish children treated with stimulants generally experienced positive treatment effects in many areas, especially in the school setting, and a majority wished to continue taking their medication. There was, however, a small group of children who reported a relatively large number of negative effects. Few differences between parents and children were found for positive effects, although parents reported higher levels of negative effects. Results also indicate that the child's knowledge of why he or she is on stimulant medication and the parent's views of medication are important factors to take into consideration as they influence the child's willingness to continue his or her medication. (J. of Att. Dis. 2009; 12(5) 460-468)

Kansas school nurses' knowledge and opinions about ADHD stimulant medication therapy.

Kansas school nurses' knowledge and opinions about ADHD stimulant medication therapy.

Use of stimulant medication for treatment of attention‐deficit/hyperactivity disorder: A survey of middle and high school students' attitudes

Six hundred fifty-one students (ages 11–18) completed a questionnaire that asked if they were taking stimulant medication for ADHD. Those who responded positively were then asked to answer a section of the questionnaire that asked them about their experiences and attitudes related to their treatment with the medication. If they responded that they were not diagnosed with ADHD and not receiving treatment with stimulant medication, they answered a section of the questionnaire that inquired about their perceptions of students who did take medication. Fifty students completed the taking-medication portion of the questionnaire. Although the students reported that the medication helped them somewhat in the areas of behavior, social ability with friends, parents, and teachers, and attention, they reported that the medication did not help them in the area of academic achievement. The majority of the students reported some side effects from their medication. Thirty-four percent of students taking ADHD medication reported being approached to sell or trade their medication, and 53% of students not taking ADHD medication reported that some students taking ADHD medication gave away or sold their medication. © 2001 John Wiley & Sons, Inc.

Use of stimulant medication for treatment of attention‐deficit/hyperactivity disorder: A survey of middle and high school students' attitudes

AbstractSix hundred fifty‐one students (ages 11–18) completed a questionnaire that asked if they were taking stimulant medication for ADHD. Those who responded positively were then asked to answer a section of the questionnaire that asked them about their experiences and attitudes related to their treatment with the medication. If they responded that they were not diagnosed with ADHD and not receiving treatment with stimulant medication, they answered a section of the questionnaire that inquired about their perceptions of students who did take medication. Fifty students completed the taking‐medication portion of the questionnaire. Although the students reported that the medication helped them somewhat in the areas of behavior, social ability with friends, parents, and teachers, and attention, they reported that the medication did not help them in the area of academic achievement. The majority of the students reported some side effects from their medication. Thirty‐four percent of students taking ADHD medication reported being approached to sell or trade their medication, and 53% of students not taking ADHD medication reported that some students taking ADHD medication gave away or sold their medication. © 2001 John Wiley &amp; Sons, Inc.