scholarly journals Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

CNS Spectrums ◽  
2020 ◽  
pp. 1-20 ◽  
Author(s):  
Greg W. Mattingly ◽  
Joshua Wilson ◽  
Leticia Ugarte ◽  
Paul Glaser
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Neurodevelopmental Disorder ◽  
Treatment Options ◽  
Hyperactivity Disorder ◽  
Psychosocial Therapy ◽  
Adhd Treatment ◽  
Disorder Treatment ◽  
Adhd Medications

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that manifests in childhood and can persist into adolescence and adulthood. Impairments associated with ADHD can impact quality of life, social interactions, and increase the risk of morbidity and mortality; however, for many patients, effective treatment can lessen these effects. Pharmacotherapy with stimulants or nonstimulants is recommended in conjunction with psychosocial therapy for most patients. Determining the optimal pharmacotherapy can be complex, and the clinician needs to consider many factors such as the patient’s age, comorbidities, and lifestyle. Furthermore, the needs of the patient with ADHD will change over time, with specific challenges to consider at each stage of life. A variety of Food and Drug Administration (FDA)-approved stimulant and nonstimulant formulations are available with different modes of delivery and durations of effect. This armamentarium of ADHD medications can be used to individualize ADHD treatment for each patient’s needs. This article combines current information from the literature and the first-hand experience of the authors to provide guidance on ADHD treatment options for patients of different ages and for some of the more common comorbidities.

scholarly journals Viloxazine in the Treatment of Attention Deficit Hyperactivity Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Amber N. Edinoff ◽  
Haseeb A. Akuly ◽  
John H. Wagner ◽  
Megan A. Boudreaux ◽  
Leah A. Kaplan ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Neurodevelopmental Disorder ◽  
Treatment Options ◽  
Early Response ◽  
Clinical Effects ◽  
Phase 3 ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Serotonergic Activity

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children. Over the past twenty years, research on the disease and its characteristics and treatment options has grown exponentially. The first-line pharmacologic treatment of ADHD is stimulants, which have a response rate of ~70%. With the support of four phase 3 studies involving more than 1,000 pediatric patients 6–17 years old, the FDA has approved the non-stimulant, serotonin-norepinephrine modulating agent (SNMA) viloxazine in an extended-release capsule (viloxazine ER) for treatment of ADHD in children aged 6–17. Viloxazine modulates serotonergic activity as a selective 5-HT22B receptor antagonist and 5-HT2C receptor agonist and moderately inhibits norepinephrine transporter (NET), thus blocking the reuptake of norepinephrine. A phase 2 study by Johnson et al. found that once-daily dosing of viloxazine ER in 200, 300, or 400 mg dosages in children with ADHD for eight weeks resulted in a statistically significant reduction of ADHD-RS-IV total score. A post hoc analysis of data from four phase 3, randomized, placebo-controlled, double-blind, three-arm, clinical trials by Faraone et al. found that early response to viloxazine treatment, defined as a change in ADHD-RS-5 total score at week 2, best predicted the treatment response at week 6 [75% positive predictive power (PPP), 75% sensitivity]. Proper treatment of the symptoms and comorbidities associated with ADHD is crucial in improving a patient's quality of life, cognitive function, and overall therapeutic outcomes. Viloxazine's mechanism of action, clinical effects, and limited side effect profile point toward the drug's relevance in the treatment of ADHD.

scholarly journals Druggable genome in attention deficit/hyperactivity disorder and its co-morbid conditions. New avenues for treatment

2019 ◽  
Author(s):  
Tor-Arne Hegvik ◽  
Kai Waløen ◽  
Sunil K. Pandey ◽  
Stephen V. Faraone ◽  
Jan Haavik ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Drug Targets ◽  
Neurodevelopmental Disorder ◽  
Hyperactivity Disorder ◽  
Starting Point ◽  
Adhd Treatment ◽  
Gwa Studies ◽  
Druggable Genome ◽  
Morbid Conditions

Abstract Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder with only symptomatic care available. Genome-wide association (GWA) studies can provide a starting point in the search for novel drug targets and possibilities of drug repurposing. Here, we explored the druggable genome in ADHD by utilising GWA studies on ADHD and its co-morbid conditions. First, we explored whether the genes targeted by current ADHD drugs show association with the disorder and/or its co-morbidities. Second, we aimed to identify genes and pathways involved in the biological processes underlying ADHD that can be targeted by pharmacological agents. These ADHD-associated druggable genes and pathways were also examined in co-morbidities of ADHD, as commonalities in their aetiology and management may lead to novel pharmacological insights. Strikingly, none of the genes encoding targets of first-line pharmacotherapeutics for ADHD were significantly associated with the disorder, suggesting that FDA-approved ADHD drugs may act through different mechanisms than those underlying ADHD. In the examined druggable genome, three loci on chromosomes 1, 4 and 12 revealed significant association with ADHD and contained nine druggable genes, five of which encode established drug targets for malignancies, autoimmune and neurodevelopmental disorders. To conclude, we present a framework to assess the druggable genome in a disorder, exemplified by ADHD. We highlight signal transduction and cell adhesion as potential novel avenues for ADHD treatment. Our findings add to knowledge on known ADHD drugs and present the exploration of druggable genome associated with ADHD, which may offer interventions at the aetiological level of the disorder.

Quality Assessment of Treatment of Children and Adolescents with Developmental Disorders – A Feasibility Study Using the Example of Attention Deficit Hyperactivity Disorder

2017 ◽  
Vol 79 (10) ◽  
pp. e78-e84 ◽  
Author(s):  
Marta Ulusoy ◽  
Peter Borusiak ◽  
Karin Hameister ◽  
Max Geraedts
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Quality Indicators ◽  
Attention Deficit ◽  
Developmental Disorders ◽  
Treatment Quality ◽  
Tertiary Referral ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
High Degree

AbstractThe question of a possible presence of attention deficit/hyperactivity disorder (ADHD) is raised with increasing frequency in pediatric practice. There are guidelines and expert recommendations for diagnostic approaches. But there are no instruments available to evaluate the structural, process and outcome quality. In this pilot study, a set of quality indicators on the treatment quality of ADHD was analyzed in terms of their feasibility in tertiary referral centers.A set of 39 quality indicators (QI) on ADHD developed in advance in a multistage procedure was assessed at 9 tertiary referral centers, with a focus on process verifiability and feasibility. QI values were calculated as ratios for individual centers as well as across centers, followed by an explorative analysis to assess feasibility under due consideration of possible influencing factors.QI assessment is possible but highly complex and expensive in practice. Calculated QI values showed a high degree of heterogeneity between facilities as well as between institutions, which was mainly due to a lack of standardization in the documentation of required data.Basically, it is possible to assess the quality of ADHD treatment via QIs. The approach described here in assessing QIs may be also applied to other types of developmental disorders.

scholarly journals ADHD: Reviewing the Causes and Evaluating Solutions

2021 ◽  
Vol 11 (3) ◽  
pp. 166
Author(s):  
Luis Núñez-Jaramillo ◽  
Andrea Herrera-Solís ◽  
Wendy Verónica Herrera-Morales
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Side Effects ◽  
Environmental Factors ◽  
Attention Deficit ◽  
Associated Factors ◽  
Neurodevelopmental Disorder ◽  
Pharmacological Therapy ◽  
Pharmacological Treatments ◽  
Hyperactivity Disorder ◽  
Adhd Treatment

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.

scholarly journals Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective

2017 ◽  
Vol 23 (9-10) ◽  
pp. 916-929 ◽  
Author(s):  
E. Mark Mahone ◽  
Martha B. Denckla
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Diffusion Tensor ◽  
Neurodevelopmental Disorder ◽  
Diagnostic Methods ◽  
Behavioral Disorder ◽  
Public Health Issue ◽  
Hyperactivity Disorder ◽  
The Past ◽  
Adhd Treatment

AbstractThe behavior patterns of hyperactivity, impulsivity and inattention that would ultimately become recognized as Attention-Deficit Hyperactivity Disorder (ADHD) have been described for centuries. Nevertheless, in the past 35 years, advances in diagnostic methods, identification of biomarkers, and treatments have advanced at an exponential rate. ADHD is now recognized as the most common behavioral disorder of childhood, with risks extending well into adulthood for both males and females, leading to its identification as a significant public health issue. This historical neuropsychological review of ADHD emphasizes scientific highlights in the past 35 years related to ADHD, including the evolution of the diagnosis (from Hyperkinetic Reaction of Childhood to ADHD), influential theories (executive functions, cognitive-energetic, delay aversion), landmark treatment studies (Multimodal Treatment of ADHD [MTA] and Preschool ADHD Treatment Study [PATS]), and advances in brain mapping techniques (anatomic, functional, and resting state magnetic resonance imaging, diffusion tensor imaging). The review concludes by highlighting the challenges of studying and treating a heterogeneous neurodevelopmental disorder like ADHD, with emphasis on associated disorders and conditions (learning disabilities, sluggish cognitive tempo), special populations (girls, preschoolers, adults), and recommendations for scientific inquiry in the next 35 years. Neuropsychologists are well positioned to address the clinical and research challenges of the next generation of studies, especially involving advances in understanding the sexual dimor.phism, full developmental course, and dynamic risks associated with ADHD. (JINS, 2017, 23, 916–929)

Attention deficit hyperactivity disorder (ADHD): perspective of the general adult psychiatrist

2018 ◽  
Vol 35 (3) ◽  
pp. 247-249
Author(s):  
D. Murray ◽  
P. Devitt
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Ad Hoc ◽  
Neurodevelopmental Disorder ◽  
Psychiatric Services ◽  
Hyperactivity Disorder ◽  
Adhd Treatment

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset in childhood. In Ireland adult ADHD treatment is drifting in an ad hoc manner into general adult psychiatric services. We propose this process should be halted in favour of a delivering a carefully planned adult ADHD service.

scholarly journals How common is attention deficit hyperactivity disorder in a cohort of children with functional constipation, and does ADHD treatment improves functional constipation?

2021 ◽  
Author(s):  
Hassan Bazmamoun ◽  
Alireza Momeni ◽  
Leila Jahangard ◽  
Farzaneh Asnaashari ◽  
Nasrollah Pezeshki
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Neurodevelopmental Disorders ◽  
Functional Constipation ◽  
Well Being ◽  
Response To Treatment ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Randomization Method

IntroductionAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Functional constipation is common in children and has a significant impact on the quality of their life, affecting both physical and emotional well-being. The aim of this study was to evaluate the frequency of ADHD in functional constipation patients and its treatment effect on constipation.Material and methodsIn this clinical trial study, 80 children with simultaneous ADHD and functional constipation were allocated to two equal groups by block randomization method. One group was treated only with ADHD drugs and the second group was treated for ADHD and functional constipation. Subsequently, the treatment outcome was evaluated in both groups.ResultsThe frequency of ADHD in functional constipation patients was 13.87%. The frequency of functional constipation recovery in the first and second group was respectively 2 (5%) and 39 (97.5%) (p <0.001). ADHD treatment has no significant effect on the recovery of constipation. There was no statistically significant relationship between the response to treatment with age, sex and duration of having ADHD and constipation.ConclusionsIn patients with simultaneous ADHD and functional constipation, ADHD treatment alone did not influence on the recovery of functional constipation and vice versa.

scholarly journals Insomnia Disorder in Adult Attention-Deficit/Hyperactivity Disorder Patients: Clinical, Comorbidity, and Treatment Correlates

2021 ◽  
Vol 12 ◽  
Author(s):  
Christian Fadeuilhe ◽  
Constanza Daigre ◽  
Vanesa Richarte ◽  
Lara Grau-López ◽  
Raul F. Palma-Álvarez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Rating Scales ◽  
Clinical Severity ◽  
Hyperactivity Disorder ◽  
Insomnia Disorder ◽  
Adhd Treatment

Introduction: Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). However, the relationship between insomnia disorder and adult ADHD has been neglected in research. The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life.Material and Methods: Two hundred and fifty-two adult patients with ADHD (mean age 37.60 ± 13.22 years; ADHD presentations—combined: 56.7%, inattentive: 39.7%, hyperactive/impulsive: 3.6%) were evaluated with an exhaustive clinical and psychological evaluation protocol including semistructured interviews (for comorbidities and ADHD assessment) and symptom rating scales for ADHD. The diagnosis of ADHD and insomnia disorder was made according to DSM-5 criteria. Furthermore, the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale were administered.Results: Insomnia disorder was found in 44.4% of adult ADHD patients and was more common in combined presentation (64.3%) and in patients with more ADHD severity. Comorbidities (both medical and psychiatric), especially mood disorders (42%), anxiety disorder (26.8%), personality disorder (39.3%), and any substance use disorder (11.6%), were associated with a higher insomnia disorder prevalence. ADHD stimulant treatment was related to lower insomnia disorder compared to patients without medication, as well as ADHD stable treatment. Additionally, worse health-related quality of life was associated with insomnia disorder.Conclusion: Insomnia disorder is highly prevalent in adult ADHD and is related to higher ADHD severity and more psychiatric and medical comorbidities. Some stimulants and stable pharmacological ADHD treatment are associated with better outcomes of insomnia disorder.

scholarly journals Effects of Caffeine Consumption on Attention Deficit Hyperactivity Disorder (ADHD) Treatment: A Systematic Review of Animal Studies

2021 ◽  
Author(s):  
Javier C. Vázquez ◽  
Ona Martin de la Torre ◽  
Júdit López Palomé ◽  
Diego Redolar-Ripoll
Keyword(s):  
Systematic Review ◽  
Attention Deficit Hyperactivity Disorder ◽  
Animal Models ◽  
Attention Deficit ◽  
Animal Studies ◽  
Neurodevelopmental Disorder ◽  
Caffeine Consumption ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Persistent Pattern

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. Neurobiologically, ADHD impairments arise from abnormalities in different circuits involving the prefrontal cortex. In face of high rates of diagnosis, alternative/complementary pharmacological therapeutic approaches for ADHD are needed. Although the number of publications that study the potential effects of caf-feine consumption on ADHD treatment have been accumulating over the last years, and caffeine has recently been used in ADHD research in the context of animal models, an updated evi-dence-based systematic review on the effects of caffeine on ADHD-like symptoms in animal stud-ies is missing. To provide insight and value at the preclinical level, a systematic review based on PRISMA guidelines was performed for all publications available up to September 1, 2021. Caffeine treatment increases attention, improves learning, memory and olfactory discrimination, without altering blood pressure and body weight. These results are supported at the neuronal level. Nonetheless, the implication of caffeine in modulating ADHD-like symptoms of hyperactivity and impulsivity is contradictory, raising discrepancies that require further clarification. Our results strengthen the hypothesis that caffeine cognitive effects found in animal models could be trans-lated to human ADHD, particularly during adolescence.

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