Practitioner Review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents
Open accessAbstract
Background: Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well‐tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence‐ and expert‐based guidance concerning the management of (AEs) with medications for ADHD. Methods: For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta‐analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence‐level of the management recommendations was based on the SIGN grading system. Results: The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms. Conclusion: Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.
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Stimulant medications, on average, increase heart rate and blood pressure to a mild and clinically insignificant degree.
“Stimulant medications, on average, increase patient heart rate (HR) and blood pressure (BP) to a mild and clinically insignificant degree (average increases: 1–2 beats per minute for HR and 1–4 mm Hg for systolic and diastolic BP).112”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [112]
Stimulants have been linked to more substantial increases in HR and BP in a subset of individuals (5%-15%).
“However, because stimulants have been linked to more substantial increases in HR and BP in a subset of individuals (5%–15%), clinicians are encouraged to monitor these vital signs in patients receiving stimulant treatment.112”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [112]
ADHD medications can impact on sleep.
“There are also indications that ADHD medications can impact on sleep (e.g. Cortese et al. 2013).”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Cortese et al. 2013
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Serra-Pinheiro, M. A., Coutinho, E. S. F., Souza, I. S., Pinna, C., Fortes, D., Araújo, C., Szobot, C. M., Rohde, L. A., & Mattos, P. (2013) · Journal of Attention Disorders · doi:10.1177/1087054711435362 · Cited by 43 · see citing works
Denchev, P., Kaltman, J. R., Schoenbaum, M., & Vitiello, B. (2010) · Circulation · doi:10.1161/circulationaha.109.901256 · Cited by 38 · see citing works
Critical Review of Data Supporting Affective Disorder Caused by Nonpsychotropic Medication
Long, T., & Kathol, R. G. (1993) · Annals of Clinical Psychiatry · doi:10.3109/10401239309148826 · Cited by 37 · see citing works
Common Comorbidities Seen in Adolescents With Attention-Deficit/Hyperactivity Disorder
Young, J. (2008) · AM:STARs: ADHD/Learning Disorders, Vol. 19, No. 2 · doi:10.1542/9781581104035-common · Cited by 36 · cited 1× · see citing works
“It should, however, not automatically be assumed that any suicidal ideation or attempt is an adverse effect of medication, since a systematic review has indicated that there is a relationship between the presence of ADHD itself and suicidal attempts (Young, 2008).”
BackgroundMcAfee, A. T., Holdridge, K. C., Johannes, C. B., Hornbuckle, K., & Walker, A. M. (2008) · Current Drug Safety · doi:10.2174/157488608784529233 · Cited by 25 · see citing works
Clonidine Abuse Among Opiate Addicts
Dennison, S. J. (2001) · Psychiatric Quarterly · doi:10.1023/a:1010375727768 · Cited by 21 · see citing works
Hamilton, R. M., Rosenthal, É., Hulpke‐Wette, M., Graham, J. G. I., & Sergeant, J. A. (2011) · Cardiology in the Young · doi:10.1017/s1047951111000928 · Cited by 21 · see citing works
Self-citationGuanfacine extended-release for attention-deficit/hyperactivity disorder (ADHD)
Sallee, F. R., & Eaton, K. (2010) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2010.517523 · Cited by 20 · see citing works
Clonidine Plus Haloperidol in the Treatment of Schizophrenia/Psychosis
Maas, J. W., Miller, A. L., Tekell, J. L., et al. (1995) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199510000-00009 · Cited by 17 · see citing works
Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians
Leslie, L. K., Rodday, A. M., Saunders, T. S., Cohen, J. T., Wong, J. B., & Parsons, S. K. (2012) · PEDIATRICS · doi:10.1542/peds.2011-1574 · Cited by 17 · see citing works
New-Onset Seizures: A Possible Association With Clonidine?
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HALLUCINATIONS ASSOCIATED WITH INITIATION OF GUANFACINE
Boreman, C. D., & Arnold, L. E. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200312000-00004 · Cited by 10 · see citing works
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First-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants
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Self-citationDoes Guanfacine Cause Hallucinations in Children?
Luthra, V., Markov, D., & Ambrosini, P. J. (1999) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.1999.9.313 · Cited by 4 · see citing works
Preliminary studies of clonidine in psychotic patients
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Johnson, M. R. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09091292 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000065 · Cited by 7,391 · see citing works
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000066 · Cited by 4,347 · see citing works
Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. O. Q. I. A. M. (2011) · Pediatrics · doi:10.1542/peds.2011-2654 · Cited by 2,185 · see citing works
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., et al. (2019) · Pediatrics · doi:10.1542/peds.2019-2528 · Cited by 1,410 · see citing works
Attention-deficit/hyperactivity disorder
Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J. S., Tannock, R., & Franke, B. (2015) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2015.20 · Cited by 1,479 · see citing works
Self-citationWhelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000596 · Cited by 1,127 · see citing works
Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W., Holtmann, M., Santosh, P., Stevenson, J., Stringaris, A., et al. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.12.010 · Cited by 627 · see citing works
Self-citationAssociations of sleep disturbance with ADHD: implications for treatment
Hvolby, A. (2015) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-014-0151-0 · Cited by 339 · see citing works
Pharmacologic Treatment of Attention Deficit–Hyperactivity Disorder
Cortese, S. (2020) · New England Journal of Medicine · doi:10.1056/nejmra1917069 · Cited by 342 · see citing works
Self-citationTarver, J., Daley, D., & Sayal, K. (2014) · Child: Care, Health and Development · doi:10.1111/cch.12139 · Cited by 234 · see citing works
ADHD management during the COVID-19 pandemic: guidance from the European ADHD guidelines group
Cortese, S., Asherson, P., Sonuga-Barke, E., Banaschewski, T., Brandeis, D., Buitelaar, J., Coghill, D., Daley, D., Danckaerts, M., Dittmann, R. W., et al. (2020) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(20)30110-3 · Cited by 225 · see citing works
Self-citationCoogan, A. N., & McGowan, N. M. (2017) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-016-0214-5 · Cited by 208 · see citing works
The Potential for Misuse and Abuse of Medications in ADHD: A Review
Clemow, D. B., & Walker, D. J. (2014) · Postgraduate Medicine · doi:10.3810/pgm.2014.09.2801 · Cited by 198 · see citing works
ADHD Medication and Substance-Related Problems
Quinn, P. D., Chang, Z., Hur, K., Gibbons, R. D., Lahey, B. B., Rickert, M. E., Sjölander, A., Lichtenstein, P., Larsson, H., & D’Onofrio, B. M. (2017) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2017.16060686 · Cited by 187 · see citing works
Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., Daley, D., Danckaerts, M., Dittmann, R. W., Doepfner, M., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01871-x · Cited by 180 · see citing works
Self-citationChang, Z., D’Onofrio, B. M., Quinn, P. D., Lichtenstein, P., & Larsson, H. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.02.018 · Cited by 154 · see citing works
Association of risk of suicide attempts with methylphenidate treatment
Man, K. K. C., Coghill, D., Chan, E. W., Lau, W. C. Y., Hollis, C., Liddle, E., Banaschewski, T., McCarthy, S., Neubert, A., Sayal, K., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2183 · Cited by 140 · see citing works
Self-citationLenzi, F., Cortese, S., Harris, J., & Masi, G. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.08.010 · Cited by 141 · see citing works
Self-citationHoltmann, M., Sonuga-Barke, E., Cortese, S., & Brandeis, D. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.006 · Cited by 128 · see citing works
Self-citationComputer-based Cognitive Training for ADHD
Sonuga-Barke, E., Brandeis, D., Holtmann, M., & Cortese, S. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.009 · Cited by 92 · see citing works
Self-citationDittmann, R. W., Cardo, E., Nagy, P., Anderson, C. S., Bloomfield, R., Caballero, B., Higgins, N., Hodgkins, P., Lyne, A., Civil, R., et al. (2013) · CNS Drugs · doi:10.1007/s40263-013-0104-8 · Cited by 88 · see citing works
Self-citationZhang, J., Díaz-Román, A., & Cortese, S. (2018) · Evidence Based Mental Health · doi:10.1136/ebmental-2018-300015 · Cited by 55 · see citing works
Self-citationRutter, L. A., Thompson, H. M., Howard, J., Riley, T. N., De Jesús-Romero, R., & Lorenzo-Luaces, L. (2021) · JMIR Mental Health · doi:10.2196/26134 · Cited by 51 · see citing works
McCarthy, S., Neubert, A., Man, K. K. C., Banaschewski, T., Buitelaar, J., Carucci, S., Coghill, D., Danckaerts, M., Falissard, B., Garas, P., et al. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1884-7 · Cited by 25 · see citing works
Self-citation
- Authors
- Cortese, S., Holtmann, M., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., Dittmann, R. W., Graham, J., Taylor, E., Sergeant, J., & on behalf of the European ADHD Guidelines Group
- Affiliations
- Université de Tours (FR)
- LWL-Universitätsklinik Hamm (DE)
- Heidelberg University (DE)
- Radboud University Nijmegen (NL)
- University of Dundee (GB)
- KU Leuven (BE)
- King's College London (GB)
- Vrije Universiteit Amsterdam (NL)
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2013-01-07
- Volume
- 54
- Issue
- 3
- Pages
- 227-246
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2108571276
- Semantic Scholar
- da03401dd4cf4328db4c44e33862d091c01ca3e8
- Cited by
- 336
- References
- 104
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 23 · 2023: 29 · 2022: 16 · 2021: 24 · 2020: 31 · 2019: 24 · 2018: 20 · 2017: 26 · 2016: 28 · 2015: 26 · 2014: 42 · 2013: 10 · 2012: 1
- FWCI
- 24.92
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- ADHD medication, adverse events, children and adolescents, appetite loss, growth delay, cardiovascular risk, sleep disorders, tics, substance abuse, seizures, suicidal ideation, psychotic symptoms, adverse event management, therapeutic drug monitoring
- MeSH terms
- Atomoxetine Hydrochloride, Lisdexamfetamine Dimesylate, Suicide Prevention, Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Blood Pressure, Cardiovascular Diseases, Child, Clonidine, Dextroamphetamine, Growth Disorders, Heart Rate, Humans, Methylphenidate, Propylamines, Psychoses, Substance-Induced, Seizures, Sleep Wake Disorders, Tic Disorders, Guanfacine, Treatment Outcome, Substance-Related Disorders, Body Size
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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