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.

1 Follower
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Approximately 30%-40% of children with attention-deficit/hyperactivity disorder (ADHD) meet criteria for a comorbid anxiety disorder in clinical samples (Tannock, 2009), but little is known about treatment response for this subgroup. The current study evaluated processes of change in a psychosocial treatment designed for children with ADHD and anxiety (Jarrett & Ollendick, 2012). Processes included the slope of symptom change during treatment, the temporal relations between ADHD and anxiety symptoms during treatment, and changes in neurocognitive functioning, parent-child relationships, and family functioning. Treatment involved a combination of parent management training for ADHD and family based cognitive-behavioral therapy for anxiety. Sessions lasted approximately 90 min, and the treatment consisted of 10 weekly sessions. Eight children ages 8-12 with ADHD, combined type (ADHD-C), and at least 1 of 3 anxiety disorders (separation anxiety disorder, generalized anxiety disorder, social phobia) were selected for the study. The study utilized a single-case design with weekly measures of ADHD and anxiety symptoms along with pretreatment, midtreatment, and 1-week posttreatment assessments. Slopes of symptom change and temporal relationships among symptom domains were examined using simulation modeling analysis (Borckardt et al., 2008), while other analyses involved standard comparisons across time points. Results generally supported declining slopes for ADHD and anxiety and greater concurrent change between anxiety and hyperactivity/impulsivity than anxiety and inattention. Few changes were found for neurocognitive functioning, but some changes were found for parent-child relationships and family functioning. Future studies are needed to better understand the treatment of ADHD and comorbid anxiety. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Assessment 02/2013; 25(2). DOI:10.1037/a0031749 · 2.99 Impact Factor
  • Source
    • "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"
    [Show abstract] [Hide abstract]
    ABSTRACT: Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and increasing empirical evidence helps guide current clinical practice. To review studies which examine the pharmacological treatment of pediatric anxiety disorders, including obsessive-compulsive disorder and to summarize treatment implications. All relevant studies were searched using MEDLINE and PsycINFO search engines, supplemented by a manual bibliographical search; studies published between 1985 and 2006 that met inclusion criteria were examined. This article provides a systematic review of the psychopharmacological treatment of pediatric anxiety disorders based on available empirical evidence, with a focus on randomized controlled trials. General treatment principles and pharmacological management of specific pediatric anxiety disorders are also reviewed. There is good evidence to support the efficacy of several pharmacological agents including the selective serotonin reuptake inhibitors to treat pediatric anxiety and obsessive-compulsive disorder, although there are still many unanswered questions.
    Psychopharmacology 04/2007; 191(1):67-86. DOI:10.1007/s00213-006-0644-4 · 3.99 Impact Factor
Show more