Pharmacotherapy for Child and Adolescent Attention-deficit Hyperactivity Disorder

Department of Psychiatry, Hoboken University Medical Center, Hoboken, NJ 07030, USA.
Pediatric Clinics of North America (Impact Factor: 2.12). 02/2011; 58(1):99-120, xi. DOI: 10.1016/j.pcl.2010.10.009
Source: PubMed


Research in the past 2 decades showed that attention-deficit/hyperactivity disorder (ADHD) is a frequently occurring psychiatric disorder that causes considerable suffering to patients and their families. This article outlines current pharmacologic ADHD treatment options and focuses on their safety profile and efficacy. In addition, it addresses treatment selection, guidelines for monitoring treatment, and recent controversies in the field.

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    • "Atomoxetine is a norepinephrine reuptake transporter (NET) inhibitor (NRI) that is commonly used to treat attention deficit hyperactivity disorder (ADHD) in children and adolescents.10–11 Although there are no prior clinical trials of NRI in POTS, drugs that inhibit NET are sometimes prescribed by physicians seeking a clinically beneficial peripheral vasoconstriction for POTS patients.12–13 "
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    ABSTRACT: Postural tachycardia syndrome (POTS) is a disorder of chronic orthostatic intolerance accompanied by excessive orthostatic tachycardia. Patients with POTS commonly have comorbid conditions such as attention deficit hyperactivity disorder, depression, or fibromyalgia that are treated with medications that inhibit the norepinephrine reuptake transporter (NRI). NRI medications can increase sympathetic nervous system tone, which may increase heart rate (HR) and worsen symptoms in POTS patients. We sought to determine whether NRI with atomoxetine increases standing tachycardia or worsens the symptom burden in POTS patients. Patients with POTS (n=27) underwent an acute drug trial of atomoxetine 40 mg and placebo on separate mornings in a randomized, crossover design. Blood pressure (BP), HR, and symptoms were assessed while seated and after standing prior to and hourly for 4 hours following study drug administration. Atomoxetine significantly increased standing HR compared with placebo (121±17 beats per minute versus 105±15 beats per minute; P=0.001) in POTS patients, with a trend toward higher standing systolic BP (P=0.072). Symptom scores worsened with atomoxetine compared to placebo (+4.2 au versus -3.5 au; P=0.028) from baseline to 2 hours after study drug administration. Norepinephrine reuptake inhibition with atomoxetine acutely increased standing HR and symptom burden in patients with POTS. Unique identifier: NCT00262470.
    Full-text · Article · Aug 2013 · Journal of the American Heart Association
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    • "Risk for severe cardiovascular events such as sudden death has long been suspected to be influenced by treatment with psychostimulants; however, recently published data from a large population based study was reassuring and did not support this suspicion [12]. Nevertheless, the long-term impact of prolonged psychostimulant treatment beginning in early childhood on health in general and cardiovascular health in particular is not well defined [13]. "
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    ABSTRACT: Childhood hypertension's increasing prevalence has generally been linked to the obesity epidemic. We observed that a significant proportion of children referred to our pediatric center with documented office hypertension are nonobese and have a history of attention deficit hyperactivity disorder (ADHD). To define the extent of this anecdotal observation, we performed a retrospective analysis of ambulatory blood pressure monitoring (ABPM) tests which in our center are routinely performed in newly referred children suspected of hypertension. Twenty-one percent (48 of 227 new referrals) had a history of ADHD, and 81% of them were treated with psychostimulant medications at the time of their ABPM test. Children in this group had a significantly lower average BMI z-score compared with the rest of the children (0.18 versus 0.75) and were significantly more likely to have abnormally elevated wake systolic loads on ABPM (38% versus 4%). The overall proportion of children with any abnormality on ABPM was comparable in both groups (46% versus 40%). Conclusion. A significant proportion of children suspected of hypertension have ADHD which may be related to higher wake systolic BP values. The prevalence of hypertension among children with ADHD will have to be determined in prospective studies.
    Full-text · Article · Jul 2013 · International Journal of Hypertension
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    • "Med Hypotheses (2012), changes are small, in a sizeable minority of patients (5–15%), greater increases in BP and HR have been found [12] [13]. A recent large study found no significant association between ADHD drugs and serious cardiovascular events (sudden cardiac death, acute myocardial infarction, and stroke) [14]. "
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    ABSTRACT: a b s t r a c t Preliminary evidence suggests a possible association between Attention-Deficit/Hyperactivity Disorder and Restless Legs Syndrome with or without Periodic Limb Movements during Sleep. When comorbid, Restless Legs Syndrome/Periodic Limb Movements during Sleep might aggravate Attention-Deficit/ Hyperactivity Disorder symptoms. Pharmacological treatment of Attention-Deficit/Hyperactivity Disor-der may be associated, at least in some cases, with adverse cardiovascular events, including clinically sig-nificant elevation in heart rate and systemic blood pressure. However, the characteristics of patients with Attention-Deficit/Hyperactivity Disorder at risk for cardiovascular events during pharmacological treat-ment are poorly understood. Here, we hypothesize that Restless Legs Syndrome and/or Periodic Limb Movements during Sleep comorbid with Attention-Deficit/Hyperactivity Disorder increase cardiovascular risk via imbalance in activity of the autonomic nervous system. Such an imbalance of the could be related to alterations of sleep microarchitecture also detected by cyclic alternating pattern analysis. If empirical studies confirm our hypothesis, the clinician would be advised to systematically screen for and effectively treat Restless Legs Syndrome/Periodic Limb Movements during Sleep even before starting treatment with Attention-Deficit/Hyperactivity Disorder drugs. The management of Restless Legs Syndrome/Periodic Limb Movements during Sleep might reduce cardiovascular risk during pharmacological treatment of Attention-Deficit/Hyperactivity Disorder.
    Full-text · Article · Nov 2012 · Medical Hypotheses
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