ADHD Medication and Substance-Related Problems

AbstractSTARS-Adjunct was a multicenter, open-label effectiveness study of AKL-T01, an app and video-game-based treatment for inattention, as an adjunct to pharmacotherapy in 8–14-year-old children with attention-deficit/hyperactivity disorder (ADHD) on stimulant medication (n = 130) or not on any ADHD medication (n = 76). Children used AKL-T01 for 4 weeks, followed by a 4-week pause and another 4-week treatment. The primary outcome was change in ADHD-related impairment (Impairment Rating Scale (IRS)) after 4 weeks. Secondary outcomes included changes in IRS, ADHD Rating Scale (ADHD-RS). and Clinical Global Impressions Scale—Improvement (CGI-I) on days 28, 56, and 84. IRS significantly improved in both cohorts (On Stimulants: −0.7, p < 0.001; No Stimulants: −0.5, p < 0.001) after 4 weeks. IRS, ADHD-RS, and CGI-I remained stable during the pause and improved with a second treatment period. The treatment was well-tolerated with no serious adverse events. STARS-Adjunct extends AKL-T01’s body of evidence to a medication-treated pediatric ADHD population, and suggests additional treatment benefit.

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Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

Journal of Neurodevelopmental Disorders ◽

10.1186/s11689-020-09352-z ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Viktoria Johansson ◽

Sven Sandin ◽

Zheng Chang ◽

Mark J. Taylor ◽

Paul Lichtenstein ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Clinical Studies ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Prescribing Patterns ◽

Adhd Medication ◽

Hyperactivity Disorder ◽

Drug Register

Abstract Background Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. Methods Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. Results Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. Conclusions The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

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Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: a randomised controlled trial

Psychological Medicine ◽

10.1017/s0033291718004063 ◽

2019 ◽

Vol 50 (2) ◽

pp. 210-219 ◽

Cited By ~ 7

Author(s):

E. Sciberras ◽

M. Mulraney ◽

F. Mensah ◽

F. Oberklaid ◽

D. Efron ◽

...

Keyword(s):

Usual Care ◽

Sleep Problem ◽

Controlled Trial ◽

Parent Report ◽

Daily Functioning ◽

Adhd Medication ◽

Randomised Controlled ◽

Severe Sleep Problem ◽

Over Time

AbstractBackgroundWe aim to (1) determine whether a behavioural sleep intervention for children with attention-deficit/hyperactivity disorder (ADHD) leads to sustained benefits; and (2) examine the factors associated with treatment response.MethodsThis study was a randomised controlled trial of 244 children (5–13 years) with ADHD from Victoria, Australia. All participants had a moderate/severe sleep problem that met American Academy of Sleep Medicine criteria for an eligible sleep disorder by parent report. The two-session intervention covered sleep hygiene and standardised behavioural strategies. The control group received usual care. Parent- and teacher-reported outcomes at 12 months included sleep, ADHD severity, quality of life, daily functioning, behaviour, and parent mental health. Adjusted mixed effects regression analyses examined 12 month outcomes. Interaction analyses were used to determine moderators of intervention outcomes over time. The trial was registered with ISRCTN, http://www.controlled-trials.com (ISRCTN68819261).ResultsIntervention children were less likely to have a moderate/severe sleep problem by parent report at 12 months compared to usual care children (28.4% v. 46.5%, p = 0.03). Children in the intervention group fared better than the usual care group in terms of parent-reported ADHD symptoms (Cohen's d: −0.3, p < 0.001), quality of life (d: 0.4, p < 0.001), daily functioning (d: −0.5, p < 0.001), and behaviour (d: −0.3, p = 0.005) 12 months later. The benefits of the intervention over time in terms of sleep were less for children not taking ADHD medication and children with parents experiencing depression.ConclusionsA behavioural sleep intervention for ADHD is associated with small sustained improvements in child wellbeing. Children who are not taking ADHD medication or have parents with depression may require follow-up booster sleep sessions.

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Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based longitudinal study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.141952 ◽

2014 ◽

Vol 205 (4) ◽

pp. 291-297 ◽

Cited By ~ 18

Author(s):

Cédric Galéra ◽

Jean-Baptiste Pingault ◽

Grégory Michel ◽

Manuel-Pierre Bouvard ◽

Maria Melchior ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Psychiatric Comorbidity ◽

Medication Use ◽

Population Based ◽

Social Characteristics ◽

Adhd Medication ◽

Social Variables ◽

Hyperactivity Disorder ◽

The Impact

BackgroundThe impact of longitudinal psychiatric comorbidity, parenting and social characteristics on attention-deficit hyperactivity disorder (ADHD) medication use is still poorly understood.AimsTo assess the baseline and longitudinal influences of behavioural and environmental factors on ADHD medication use.MethodSurvival regressions with time-dependent covariates were used to model data from a population-based longitudinal birth cohort. The sample (n = 1920) was assessed from age 5 months to 10 years. Measures of children's psychiatric symptoms, parenting practices and social characteristics available at baseline and during follow-up were used to identify individual and family-level features associated with subsequent use of ADHD medication.ResultsUse of ADHD medication ranged from 0.2 to 8.6% between ages 3.5 to 10 years. Hyperactivity–inattention was the strongest predictor of medication use (hazard ratio (HR) = 2.75, 95% CI 2.35–3.22). Among all social variables examined, low maternal education increased the likelihood of medication use (HR = 2.09, 95% CI 1.38–3.18) whereas immigrant status lowered this likelihood (HR = 0.40, 95% CI 0.17–0.92).ConclusionsBeyond ADHD symptoms, the likelihood of receiving ADHD medication is predicted by social variables and not by psychiatric comorbidity or by parenting. This emphasises the need to improve global interventions by offering the same therapeutic opportunities (including medication) as those received by the rest of the population to some subgroups (i.e. immigrants) and by diminishing possible unnecessary prescriptions.

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