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Cited by 77Attention Deficit Hyperactivity DisorderNeuroethics, Human Enhancement, Biomedical InnovationsNeurotransmitter Receptor Influence on Behavior

Reviews : Pharmacotherapy of adolescent attention deficit hyperactivity disorder: challenges, choices and caveats

Garland, E. Jane·1998·Journal of Psychopharmacology
DOI 10.1177/026988119801200410
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Abstract

A recent increase in stimulant treatment of adolescents with attention deficit hyperactivity disorder (ADHD) has been documented. Challenges in treating adolescent ADHD with methylphenidate or dextroamphetamine include compliance with frequent dosing, abuse potential and wear-off or rebound effects. Co-morbid anxiety, occurring in at least 30 percent of ADHD youths, is associated with lower rate of response to stimulants. The effective alternatives, tricyclic antidepressants or pemoline, are each associated with rare but serious toxicity. Bupropion has recently proven effective in controlled trials. Other noradrenergic or dopamine-enhancing agents such as venlafaxine and nicotine show some benefit in open trials. The need for more options in pharmacotherapy of ADHD is evidenced by rapid adoption in clinical practice of alternative and adjunctive medication despite lack of controlled research on efficacy and safety. The indications for long-term stimulant treatment of ADHD present some controversy, and highlight a need for more research on safety and efficacy through the lifespan. Thresholds for diagnosis are much lower with DSM than with ICD, and thresholds for treatment are contentious, given the performance-enhancing effects of stimulants in normal students. The endpoint for treatment is unclear, as stimulants are also effective in adult ADHD. Based on short- and intermediate-term studies to date, stimulant medication is clearly more efficacious than cognitive and behavioral strategies for the symptoms of ADHD. Longer term research is needed to determine whether sustained stimulant therapy will reduce the adverse emotional, behavioral and academic consequences of inattention and impulsivity in adolescents and adults.

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Crossref · 10.1177/026988119801200410

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  • Compliance to frequent dosing regimens is poor in ADHD patients due to forgetfulness, inattentiveness and self-organisation problems, leading to daily instability by frequent rebound symptoms and ineffective treatment.

    “Compliance to such frequent dosing regimens is however poor in ADHD patients due to forgetfulness, inattentiveness and self-organisation problems, leading to daily instability by frequent rebound symptoms and ineffective treatment [148,289-291].”

    From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [290]

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Authors
Garland, E. J.
Affiliations
University of British Columbia (CA)
Corresponding author
Garland, E. Jane
ORCID
Garland, E. Jane
Venue
Journal of Psychopharmacology
Publisher
SAGE Publications
Published
1998-07
Volume
12
Issue
4
Pages
385-395
ISSN
  • 0269-8811 (ISSN-L)
  • 1461-7285
DOI
10.1177/026988119801200410
OpenAlex
W2131345109
Cited by
77
References
132
Citations by year
2025: 1 · 2023: 1 · 2020: 1 · 2019: 1 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 2
FWCI
0.93
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Psychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
stimulant pharmacotherapy, methylphenidate, d-amphetamine, anxiety comorbidity, tricyclic antidepressants, bupropion, venlafaxine, nicotine, adult ADHD, treatment efficacy and safety
MeSH terms
Adolescent, Adolescent Behavior, Central Nervous System Stimulants, Anticonvulsants, Antidepressive Agents, Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Humans, Dopamine Agents

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