Use Of Stimulant Medication Research Articles

Academic Performance Enhancement: A Qualitative Study of the Perceptions and Habits of Prescription Stimulant–Using College Students

This study explores the developmental implications of cognitive enhancement among college students. Data comes from interviews with a purposive sample of licit and illicit users of stimulant medications at a highly selective West Coast University. A semistructured protocol revolved around students’ habits and perceptions relating to stimulant medication use. Key findings identify academic use justifications, diversion pathways, and frames use within a biopsychosocial development model that impacts perceived self-efficacy, suggesting that academic dependence may develop differently between licit/ illicit users.

New Study Answers Questions About Cardiac Risk of ADHD Drugs

New Study Answers Questions About Cardiac Risk of ADHD Drugs

Comparison of the Behavioral and Cardiovascular Effects of Intranasal and Orald-Amphetamine in Healthy Human Subjects

Recent reports indicate an increase in intranasal use of prescription oral stimulant medication. However, there do not appear to be any published clinical studies that have characterized the behavioral and cardiovascular effects of intranasally administered d-amphetamine, which is commonly prescribed for Attention Deficit Hyperactivity Disorder. In this study, a range of d-amphetamine doses (0, 16, 24, and 32 mg/70 kg) were administered as an intranasal solution delivered using a mucosal atomization device. Equal oral doses were included for comparison. Assessments were conducted before and at regular intervals for 3 hours following drug administration and included self-reported drug-effect questionnaires, cardiovascular indices, a performance task, and 2 measures of impulsivity. d-Amphetamine produced prototypical stimulant effects (eg, increased subject ratings of Stimulated and Like Drug, elevated heart rate and blood pressure, and improved rate and accuracy on the digit symbol substitution task) irrespective of dose, but the onset of these effects was generally earlier following intranasal administration, with significant effects emerging 15 to 30 minutes after intranasal dosing and 45 to 60 minutes after oral dosing. These results demonstrate that intranasal administration of d-amphetamine results in a more rapid onset compared to oral dosing, which could be associated with the popularity of intranasal prescription stimulant use and an enhanced potential for abuse.

Prototypes or Pragmatics? The Open Question of Public Attitudes Toward Enhancement

Banja (2011) nimbly analyzes how a particular strain of conceptual myopia corrodes the rigor of “moral conservative” arguments in bioethics, particularly on the topic of human enhancement. We find his prototypist angle meritorious, but demur on a key conclusion: that virtue essentialism’s “prospects for remaining popular, especially among nonbioethicists and the electorate, are exceedingly good.” Our primary concern is that this prediction, despite enjoying a priori appeal, lacks empirical support. Gathering data on ordinary citizens’ moral intuitions about enhancement not only will prove worthwhile for its predictive value, but also will lend a helpful measure of nuance to debates on an important normative question: how public opinion should factor into policy decisions on biopolitical issues. We heartily agree with the central philosophical thrust of the article, as the picture of category-mediated reasoning emerging from prototype theory poses a vexing and potentially insurmountable challenge to arguments from naturalness, dignity, giftedness, et cetera, all aimed at establishing prohibitions on the use of cognition-enhancing pharmaceuticals. Moreover, we do not dispute the premises that Banja recruitsinsupportofhisforecastregardingthepopularityof such arguments. He elaborates that to the folk, virtue essentialist arguments, being “dogmatic, certain, and absolute,” sound“justthewaymoralargumentissupposedtosound.” One could suggest that preliminary support for Banja’s thesis can be found in examples such the comment thread on the CBS News website in reaction to its 60 Minutes segment on the illicit use of prescription stimulant medications by university students (CBS News 2010). Even a cursory review of the comments reveals explosions of moral outrage. However, there is a danger in relying too heavily on public comments such as those just cited, for they draw not on public opinion writ large but rather on the sentiments of a particular public—those sufficiently motivated by the television program to vent their frustration. What is not known is whether the general public shares those sentiments (Nadler and Reiner 2010). It may in fact be the case that the anxieties of the general public over cognitive enhancement rest for the most part not on philosophical op

The Nonmedical Use of Prescription Stimulants Among Dental and Dental Hygiene Students

The purpose of this study was to determine the nonmedical use of prescription attention deficit disorder (ADD) stimulant medication among dental and dental hygiene students. A questionnaire was used to examine demographic information, student experiences, and perceptions of prescription stimulant medication and to determine if students used a prescription stimulant nonmedically. In 2008, 401 surveys were mailed to dental education institutions in the south-central region of the United States, and 243 surveys (61 percent) were returned. The survey found that 12.4 percent of these students used a prescription stimulant nonmedically and, of those, 70 percent took it to improve attention and/or concentration. The most commonly reported stimulant medication used nonmedically was Adderall (77 percent). The majority (87 percent) of the students obtained the medication through friends, and 90 percent began using the drug in college. Even though 74 percent of the students reported being stressed, chi-square analysis found no significant association between nonmedical use of ADD stimulant medication and stress level (p=0.585). Sixteen percent of the students surveyed felt it was easy to obtain stimulant medication for nonmedical use at their school, and 17 percent thought it was a problem within their institution. These results may help administrators and faculty members become aware of potential problems with the misuse of ADD stimulant medication.

Pharmacologic Treatment of Attention-Deficit/Hyperactivity Disorder in Children: Incidence, Prevalence, and Treatment Patterns in The Netherlands

Background The prevalence of attention-deficit/hyperactivity disorder (ADHD) and the associated use of stimulant medications may have increased in the Netherlands in recent years, but there is a lack of data to confirm this trend. This retrospective analysis examined the incidence, prevalence, and treatment pattern of ADHD among children from a large sample representation of the general population of the Netherlands and represents the first such analysis in a large cohort of European children. Objective The aim of this study was to estimate the incidence and prevalence of children receiving initial pharmacotherapy for ADHD between 2000 and 2007 in the Netherlands and to describe treatment patterns (including persistence and adherence to ADHD medications) in this pediatric population. Methods Prescription and hospitalization data from the PHARMO medical record linkage system database in the Netherlands (2003 to 2006) were analyzed for patients with newly prescribed ADHD medication who were aged 6 to 17 years and received follow-up for at least 12 months after treatment initiation with methylphenidate, dexamphetamine, atomoxetine, or combination therapy. The yearly incidence and prevalence of children receiving ADHD pharmacotherapy were estimated for the period 2000 to 2007. Demographic characteristics and baseline medication data at treatment initiation were collected along with data on hospitalizations and psychotropic treatments in the year before initiation of ADHD treatment. Results Of the 4909 patients in the study cohort, 82% were male and 46% were between 6 and 9 years of age. The yearly incidence of children receiving ADHD medication—extrapolated from the PHARMO database to the Netherlands population—increased from 30 per 10,000 in the year 2000 to 75 per 10,000 in the year 2007. Prevalence rates showed a similar trend, increasing from 110 per 10,000 in 2000 to 210 per 10,000 in 2007. Prevalence and incidence rates both were consistently higher among boys than girls, although the greatest increases over time were observed in female patients. Analysis of treatment patterns revealed that most children (98%) initiated treatment with methylphenidate. Of those, 89% received an immediate-release formulation, although increased use of long-acting amphetamine and atomoxetine was apparent over the study period. Persistence and adherence rates varied according to the medications used and the prescribing physician. Antipsychotic agents and melatonin were the most commonly used therapeutics in the year before ADHD treatment initiation (6% and 4% of patients, respectively). Conclusions The incidence and prevalence of children treated for ADHD increased from 2000 to 2007. Most children (98%) initiated treatment with immediate-release methylphenidate.

College students’ use of compliance-gaining strategies to obtain prescription stimulant medications for illicit use

Objective: To examine college students’ illicit use of prescription stimulant medications and compliance-gaining strategies that they would use to obtain a stimulant medication. Design: A questionnaire-based study. Setting: Seven hundred and twenty undergraduate college students at a large, northeastern university in the United States were surveyed. Method: The study received approval from the university’s Institutional Review Board (IRB). Students completed anonymous questionnaires outside of class time. Results: Respondents were more likely to use rationality and promise strategies to gain others’ compliance. No differences in strategy selection for close friends and acquaintances were reported. Illicit prescription stimulant users scored higher in sensation seeking than those who reported no prior illicit stimulant use. Conclusions: A compliance-gaining perspective provided a better understanding of the strategies college students are likely to use to obtain prescription stimulants from those with a legitimate prescription.

The need for a long-term perspective in child and adolescent psychiatry

When taking care of our patients and families in daily clinical practice, it is difficult to not solely be directed at acute, short-term improvements. Typically, patients are being referred to our clinical services at a time when symptoms of mental disorders have already led to significant impairments on important areas such as social, academic, and family functioning. Then, obviously, we try to put effective interventions in place that aim to decrease symptoms as well as reduce impairments. Indeed, we now have several treatments in the field of child and adolescent psychiatry with a solid evidence base [1]. Well-researched examples include the use of stimulant medications for attention-deficit/hyperactivity disorder (ADHD), risperidone [2] and aripiprazole [3] for irritability in autism spectrum disorders, and behavioral parent training [4] for children with disruptive behavior problems. Ideally, however, in addition to addressing the acute needs of our pediatric patients, our interventions should be truly aimed at preparing our children for a better life in the long run. Will the interventions we apply contribute to the better functioning of our patients as adults? The long-term results of the Multimodal Treatment study of ADHD (MTA) [5] have been complex, but clearly demonstrate that there is not a simple relationship between impressive acute treatment effects of well-monitored stimulant medication and effects over the long run. Fortunately, the Treatment for Adolescents with Depression Study (TADS) [6] that investigated the effectiveness of fluoxetine, cognitive-behavioral therapy, and their combination in adolescents with major depressive disorder was able to demonstrate persistent benefits of treatments over 1 year of naturalistic follow-up. This issue of European Child and Adolescent Psychiatry contains several articles that deal with the long-time perspective in our field. Gevensleben et al. [7] report on the long-term follow-up of their randomised controlled trial of neurofeedback versus a control treatment (a computerized attention skills training) in children with ADHD and demonstrated that behavioral improvements through neurofeedback were actually maintained at a 6-month follow-up. Longitudinal cohort studies are a classic way to investigate the long-term effects of important environmental factors for children’s development. Elberling et al. [8] longitudinally studied the influence of perinatal and socioeconomic data, and data on child mental illness diagnosed in preschool years on psychosocial function at 5–7-year follow-up, in the Copenhagen Child Cohort, which involves more than 6,000 children. Several markers of socioeconomic disadvantages were found to be associated with mental health problems at 5–7 years of age. In another large-scale longitudinal cohort study in Norway in this issue, Lien et al. [9] showed that internalizing mental health problems among adolescent girls were significantly associated with atopic conditions 3 years earlier, thus demonstrating that atopy may have long-lasting effects on mood and anxiety levels. Finally, a truly long-term perspective on our field is provided by a wonderful overview by the most eminent long-term leader and pioneer of child and adolescent psychiatry. Professor Sir Michael Rutter gives a unique perspective on the developments from the mid-twentieth century onwards, ending with a look ahead to the most important opportunities and challenges as well as the hazards that need to be avoided.

Factors Associated with Atomoxetine Efficacy for Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

The aims of this study were to determine if relationships exist between the efficacy of atomoxetine for treatment of attention-deficit/hyperactivity disorder (ADHD) and demographic characteristics, specific co-morbid diagnoses, subtype of ADHD, and/or additional use of a stimulant medication. A retrospective chart review was performed using data from an institutional electronic medical record system. Children aged 5-17 years who were diagnosed with ADHD and prescribed atomoxetine were included; 432 study subjects were categorized as treatment success (TS), treatment failure (TF), or undetermined. Co-morbid diagnoses, demographic factors, subtype of ADHD, and additional use of stimulant medications were examined for association with TS. A total of 88 children were categorized as TS, 197 as TF, and 147 as undetermined. More subjects in the TS group were receiving stimulant medication in addition to the atomoxetine than in the TF group (p = 0.0319; 95% Wald confidence interval [CI], 1.064-3.972). There was no significant difference between groups for any demographic characteristic, the presence of any co-morbid diagnosis, or type of ADHD. In particular, the presence of anxiety or depression was not associated with a response to atomoxetine. Children who were prescribed a stimulant medication in addition to atomoxetine had better outcomes in treating ADHD than those receiving only atomoxetine.

Adolescent behavior and adult health status in childhood cancer survivors

This study examined the longitudinal association between adolescent psychological problems following cancer treatment and obesity, limited exercise, smoking, and excess sun exposure during adulthood in the Childhood Cancer Survivor Study cohort. Participants included 1,652 adolescent survivors of childhood cancer and 406 siblings of cancer survivors, initially evaluated at 12-17 years of age and > or = 5 years post-diagnosis. A follow-up survey of these participants was conducted roughly 7 years later and included assessment of health status and health behaviors. Logistic regression models were used to assess the association between adolescent psychological problems and adult health behavior outcomes. During adolescence, survivors demonstrated higher rates of attention deficits, emotional problems, externalizing behavior and social withdrawal compared to sibling controls. Social withdrawal was associated with adult obesity (OR = 1.5, 95% CI = 1.1-2.1) and physical inactivity (OR = 1.7, 1.1-2.5). Use of stimulant medication during adolescence was also associated with adult obesity (OR = 1.9, 1.1-3.2), while antidepressant use was associated with physical inactivity (OR = 3.2, 1.2-8.2). Adolescent survivors of childhood cancer display higher rates of psychological problems compared to siblings of cancer survivors. These psychological problems are associated with an increased risk for obesity and poor heath behavior in adulthood, which may increase future risk for chronic health conditions and secondary neoplasms. In order to decrease risk of future health problems, adolescent survivors of childhood cancer should be routinely screened and treated for psychological problems following cancer therapy.

Juan: A 9-Year-Old Latino Boy With ADHD

Juan, a 9-year-old Latino male, was referred to a community clinic by his third-grade teacher for evaluation of classroom behavior problems. He is an only child and lives with both parents. At home, Juan speaks Spanish with his parents although he occasionally speaks English with his father. His father came to the U.S. from Mexico as a small child and completed the 12 grade in the U.S. Juan's mother completed 8 grade in Mexico and immigrated to the U.S. as a teenager.Juan's mother reported that he has had no significant medical problems. Her report of his behavior included an inability to focus on tasks at hand and easy distractibility. She was concerned that the principal of the school mentioned that Juan may be asked to repeat the 3 grade or change schools. In the clinic, Juan sat quietly but appeared to be daydreaming and attentive to the conversation. The pediatrician called the principal who expressed frustration with Juan's behavior. In class, he was very fidgety, did not pay attention and usually did not answer questions. He also bothered other students when they were working. The principal explained that because Juan's school was a Spanish language immersion school, there were no special education services available. If a student at the school required special education services, he or she would be transferred to another school in the same school district. An evaluation for an Individualized Education Plan (IEP) indicated that Juan had above average cognitive ability (90 percentile), with superior ability to problem solve and process information simultaneously (99 percentile). The Woodcock Johnson III (Spanish version) indicated average achievement in academic skills, with low average in reading fluency, comprehension and spelling. On the Test of Auditory-Perceptual Skills, Juan tested generally low average in all domains, and was at the 14 percentile for both auditory number and auditory word memory. On the Test of Visual-Perceptual Skills, Juan scored above the 92 percentile. Juan did not qualify for special education services on the basis on the standardized tests. However, because of the individual attention required by Juan, a transfer to another school was considered inevitable if his classroom behaviors did not improve. Juan's mother and teacher filled-out the NICHQ Vanderbilt Assessment Scale. Their responses were consistent with the diagnosis of ADHD, inattentive type. In discussion of treatment options with the family, the possibility of stimulant medication use was raised. Juan's mother was opposed to the medication because of what she had heard from her friends-that these medications had bad side effects and did not work most of the time. Juan's father, however, was in favor of the medication because it might assist Juan to stay at the school. After several clinical visits that included further information about ADHD, behavioral treatment, and reviewing information from the school, Juan's parents agreed to a trial of medication. Juan was evaluated for a follow-up visit 2 weeks after starting fourth grade; he had been taking a stimulant medication for one month. He seemed much happier about school and was proud to report that he has completed all of his assignments in school as well as homework assignments, and he did well on a math quiz. Juan's mother was also pleased with his progress. The pediatrician called the principal, who reported that Juan was an entirely different student. He now sat at his desk and wrote down the assignments. He seemed eager to learn and able to be attentive in the classroom. The principal was amazed at the difference.

Development of the Stimulant Medication Outcome Expectancies Questionnaire for College Students

Non-prescribed use of stimulant medication among college students has become a public health concern. Although it has been well-established that outcome expectancies play a prominent role in initiation and maintenance of drinking behaviors it is unknown if and how outcome expectancies influence non-prescribed use of stimulant medication among college students. The aim of this study was to develop a valid and reliable scale that assesses outcome expectancies of non-prescribed use of stimulant medication. A 16-item Stimulant Medication Outcome Expectancy Questionnaire (SMOEQ) was created using qualitative information given by introductory psychology students regarding their expectancies about misusing stimulant medication. An exploratory factor analysis (EFA) identified a three-factor solution: the Academic factor, Recreational factor, and Negative Physiological Effects factor, respectively. A confirmatory factor analysis (CFA) validated the factor structure identified in the EFA and indicated a modest fit of the hypothesized factor structure to the data. Correlation analyses provided support for the internal consistency and construct validity of the SMOEQ.

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Substance use disorders in Belgium: the need to study rarely investigated high impact disorders

Stimulant medication use among Flemish students: results from an exploring secondary data analysis1965-2005

Background/AimRecent media coverage in the Flemish media in Belgium reinforced the general public opinion on medication use among students, suggesting an alarming magnitude and a rising trend, with the use of stimulants as a specific element for enhancing study performances. These assumptions needed scientific verification, which we intended to do with this study.MethodSecondary data analysis was conducted on four Belgian studies on medication use among students from 1965, 1969, 1993 and 2005. The 2005 survey data are also used to give an insight in prevalence and frequency of use during exams and in other periods and to widen the scope to poly-substance use.Main FindingsAll studies show prevalence figures for stimulant medication use under 10%. Prevalence and frequency of use is highest during exam periods. No gender differences were found for stimulant medication use. Living status on the other hand is an influential factor: students living away from the parental home report higher prevalence rates than students still living in their parents' house. Prescription regulations seem to have a declining impact on the most popular products.Conclusions/DiscussionStudents' medication use, more particularly during exam periods, appears to be an all-time reality in Flanders. No indications for a rising trend were found. Although the extent of stimulant medication use is relatively limited, a small minority shows more risky consumption patterns: daily use of stimulant medication (incl. risky side effects) during exam periods and higher prevalence of poly-substance use. More research is needed, particularly on the most consumed products (e.g. methylphenidates) and on the supplying sources of this medication.

Dr. Gould Replies

Dr. Gould Replies

Stimulant Medication Use and Sudden Death in Youths: Considering Unmeasured Covariates

Stimulant Medication Use and Sudden Death in Youths: Considering Unmeasured Covariates

Evidence-based treatments in child and adolescent psychiatry: an inventory.

To provide a list of evidence-based psychopharmacology and psychotherapy treatments for child psychiatry. Published reviews and Medline searches were examined to generate a list of treatments supported by randomized controlled trials. For psychopharmacology, the best evidence to date supports the use of stimulant medications for attention-deficit/hyperactivity disorder and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder. There is also reasonable evidence addressing SSRIs for anxiety disorders and moderate to severe major depressive disorder, and risperidone for autism. The psychosocial interventions best supported by well-designed studies are cognitive-behavioral and behavioral interventions, especially for mood, anxiety, and behavioral disorders. Family-based and systems of care interventions also have been found effective. Although the number of evidence-based treatments for child psychiatry is growing, much of clinical practice remains based on the adult literature and traditional models of care. Challenges toward adopting evidence-based practices are discussed.

Cardiac risk assessment before the use of stimulant medications in children and youth

Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and paediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac sub-specialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.

Cardiac risk assessment before the use of stimulant medications in children and youth: A joint position statement by the Canadian Paediatric Society, the Canadian Cardiovascular Society, and the Canadian Academy of Child and Adolescent Psychiatry

Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and pediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac subspecialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.

Survey of Expert Treatment Approaches for Children with Bipolar Disorder-Not Otherwise Specified and Bipolar-I Presentations

The intrinsic difficulties in studying and treating children younger than 10 years who have bipolar affective disorders were highlighted in the article by Post (see page 879). Currently, there are virtually no Food and Drug Administration (FDA)-approved medications for children with pediatric onset bipolar disorder (PBD) who are younger than 10 years. This is in contrast to the nearly 20 FDA-approved medications for the treatment of attention-deficit/hyperactivity disorder (ADHD), an illness with onset before 7 years. Existing guidelines for PBD suggest that mood stabilization with lithium, anticonvulsants, or second-generation antipsychotics (SGA) in PBD is the first step in treating mania prior to the use of adjuvant stimulant medications to treat comorbid ADHD.