Article

Sequential pharmacotherapy for children with comorbid attention-deficit/hyperactivity and anxiety disorders.

New York University Child Study Center, New York, NY 10016, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 6.35). 06/2005; 44(5):418-27. DOI: 10.1097/01.chi.0000155320.52322.37
Source: PubMed

ABSTRACT Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children.
Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions-Improvement scores were also obtained.
Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global Impressions-Improvement-defined responder rate. Medications in both arms were well tolerated.
Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

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    • "MPH treatment in our study was well tolerated and safe; none of the participants reported intolerable side effects that would cause termination of the MPH treatment. These findings are consistent with previous studies that demonstrated the safety of stimulant treatment in ADHD pediatric patients with comorbid anxiety disorders (Diamond et al., 1999; Abikoff et al., 2005). "
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    ABSTRACT: The aim of this study was to assess the response of social phobia (SP) symptoms to methylphenidate (MPH) treatment in children with attention deficit hyperactivity disorder (ADHD). Twenty-one ADHD patients with SP, aged between 8 and 18 years, received 12 weeks of MPH treatment. The severity of SP symptoms were assessed by the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA), and the severity of ADHD symptoms was assessed by the ADHD Rating Scale at baseline and at endpoint. MPH treatment was associated with a significant decrease in the ADHD Rating Scale scores (P<0.0001) and in the total LSAS-CA scores (P=0.013), as well as the school-related items of LSAS-CA (P=0.011). A significant correlation was found between the reductions in ADHD score and total LSAS-CA score (P=0.038), especially in school-related SP. The improvement in ADHD symptoms because of MPH treatment correlates with a parallel improvement in SP. MPH treatment appears to be safe and effective in ADHD/SP children.
    International clinical psychopharmacology 01/2014; 29(4). DOI:10.1097/YIC.0000000000000029 · 3.10 Impact Factor
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    • "At the same time, current research has shown that stimulant treatment for children with ADHD and anxiety often results in improvements in ADHD but not changes in anxiety symptoms at the group level (Abikoff et al., 2005). At the individual level, though, Abikoff et al. (2005) did find some children who responded to stimulant medication for both ADHD and anxiety symptoms. Future stimulant medication studies might be able to offer unique examinations of the temporal relationships between ADHD and anxiety symptoms over the course of stimulant treatment, since symptom change might be more tightly coupled with stimulant medication treatment than behavioral treatment (i.e., the intervention is more closely related to symptoms than psychosocial treatment). "
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    • "ren with ADHD ) study . In this study , behavioral management had a place along with pharmacological methods to treat ADHD comorbid with anxiety ( Jensen et al . 2001 ; March et al . 2000 ) . A recent paper supports that children with both ADHD and anxiety disorders have a similar response rate to stimulants as children without anxiety disorders ( Abikoff et al . 2005 ) . Children with ADHD who remained anxious after the MTA trial ( N=25 ) were randomly assigned to 8 weeks of double - blind stimulant and fluvoxamine or stimulant and placebo ; intent - to - treat analyses showed no difference between the groups according to the PARS or CGI – I response criteria . Thus , the benefit of adding fluvoxami"
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