Advances in understanding and treating ADHD

In the paper

“Comorbidity rates in adult ADHD do not differ as a function of gender [18].”

What the sources say

• Not checked yetcites [18] Lahey BB, Applegate B, McBurnett K, Biederman J, Greenhill L, Hynd GW, Barkley RA, Newcorn J, Jensen P, Richters J, et al: DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. Am J Psychiatry. 1994, 151 (11): 1673-1685. source

In the paper

“some data suggest that 'uncomplicated' ADHD exists in about 20 to 25% of adults with ADHD [13].”

What the sources say

• Not checked yetcites [13] Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, Mick E, Lehman BK, Doyle A: Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry. 1993, 150 (12): 1792-1798. source

In the paper

“Research has continued to suggest that osmotic-release oral system (OROS) methylphenidate lessens ADHD symptoms throughout the day and has greater adherence, thought to be associated with the convenience of once-daily dosing [39-41].”

What the sources say

• Not checked yetcites [39] Kim Y, Shin MS, Kim JW, Yoo HJ, Cho SC, Kim BN: Neurocognitive effects of switching from methylphenidate-IR to OROS-methylphenidate in children with ADHD. Hum Psychopharmacol. 2009, 24 (2): 95-102. 10.1002/hup.1010. source
• Not checked yetcites [40] Chou WJ, Chou MC, Tzang RF, Hsu YC, Gau SS, Chen SJ, Wu YY, Huang YF, Liang HY, Cheng H: Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes. Psychiatry Clin Neurosci. 2009, 63 (2): 167-175. 10.1111/j.1440-1819.2009.01937.x. source
• Not checked yetcites [41] Abikoff H, Nissley-Tsiopinis J, Gallagher R, Zambenedetti M, Seyffert M, Boorady R, McCarthy J: Effects of MPH-OROS on the organizational, time management, and planning behaviors of children with ADHD. J Am Acad Child Adolesc Psychiatry. 2009, 48 (2): 166-175. 10.1097/CHI.0b013e3181930626. source

In the paper

“Transdermal methylphenidate bypasses the oral route entirely, and in short-term studies is associated with efficacy throughout the day, with improved family quality of life, and when carefully titrated, little effect on sleep [44-46].”

What the sources say

• Not checked yetcites [44] Faraone SV, Glatt SJ, Bukstein OG, Lopez FA, Arnold LE, Findling RL: Effects of once-daily oral and transdermal methylphenidate on sleep behavior of children with ADHD. J Atten Disord. 2009, 12 (4): 308-315. source
• Not checked yetcites [45] Wilens TE, Hammerness P, Martelon M, Brodziak K, Utzinger L, Wong P: A controlled trial of the methylphenidate transdermal system on before-school functioning in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 71 (5): 548-556. source
• Not checked yetcites [46] Manos M, Frazier TW, Landgraf JM, Weiss M, Hodgkins P: HRQL and medication satisfaction in children with ADHD treated with the methylphenidate transdermal system. Curr Med Res Opin. 2009, 25 (12): 3001-3010. 10.1185/03007990903388797. source

In the paper

“Long-acting stimulants are less prone to diversion, probably because extraction of active drug is more difficult, and for some, the delivery of drug to the brain is slower.”

In the paper

“LDX requires gut metabolism to reach its active form, and hence lessens the likelihood of abuse and overdose.”

In the paper

“The general consensus on cardiovascular side-effects at this point is that the short/medium term side-effects are usually of no clinical significance, but the long-term potential side-effects are less certain [63].”

What the sources say

• Not checked yetcites [63] Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Dopfner M, Hamilton R, Hollis C, Holtmann M, et al: European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry. 2011, 20 (1): 17-37. 10.1007/s00787-010-0140-6. source

In the paper

“However, a recent review article has shown that treatment with stimulants in childhood modestly reduced expected height and weight [62]. These effects were dose-dependent and attenuated over time.”

What the sources say

• Not checked yetcites [62] Faraone SV, Biederman J, Morley CP, Spencer TJ: Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry. 2008, 47 (9): 994-1009.

In the paper

“The efficacy and side-effects of LDX are similar to the other long-acting stimulant preparations [68-72].”

What the sources say

• Not checked yetcites [68] Najib J: The efficacy and safety profile of lisdexamfetamine dimesylate, a prodrug of d-amphetamine, for the treatment of attention-deficit/hyperactivity disorder in children and adults. Clin Ther. 2009, 31 (1): 142-176. 10.1016/j.clinthera.2009.01.015. source
• Not checked yetcites [69] Antonucci D, Kunins C, Manos M, Lopez FA, Kerney DL: Assessing effects of treatment with lisdexamfetamine dimesylate for pediatric ADHD using a parental survey. CNS Spectr. 2010, 15 (4): 248-256. source
• Not checked yetcites [70] Findling RL, Ginsberg LD, Jain R, Gao J: Effectiveness, safety, and tolerability of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: an open-label, dose-optimization study. J Child Adolesc Psychopharmacol. 2009, 19 (6): 649-662. 10.1089/cap.2008.0165. source
• Not checked yetcites [71] Faraone SV, Spencer TJ, Kollins SH, Glatt SJ: Effects of lisdexamfetamine dimesylate treatment for ADHD on growth. J Am Acad Child Adolesc Psychiatry. 49 (1): 24-32. source
• Not checked yetcites [72] Boellner SW, Stark JG, Krishnan S, Zhang Y: Pharmacokinetics of lisdexamfetamine dimesylate and its active metabolite, d-amphetamine, with increasing oral doses of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: a single-dose, randomized, open-label, crossover study. Clin Ther. 32 (2): 252-264. source

In the paper

“Because atomoxetine has been rarely associated with acute suicidality [86], it has been given a 'black box' warning.”

What the sources say

• Not checked yetcites [86] Paxton GA, Cranswick NE: Acute suicidality after commencing atomoxetine. J Paediatr Child Health. 2008, 44 (10): 596-598. 10.1111/j.1440-1754.2008.01389.x. source

In the paper

“When atomoxetine is administered once daily, some evidence suggests that morning dosing may be more efficacious, but evening dosing may be more tolerable [84].”

What the sources say

• Not checked yetcites [84] Block SL, Kelsey D, Coury D, Lewis D, Quintana H, Sutton V, Schuh K, Allen AJ, Sumner C: Once-daily atomoxetine for treating pediatric attention-deficit/hyperactivity disorder: comparison of morning and evening dosing. Clin Pediatr (Phila). 2009, 48 (7): 723-733. 10.1177/0009922809335321. source

In the paper

“Modafinil [73] and reboxetine [74,75] have both shown some promise in the treatment of ADHD.”

What the sources say

• Not checked yetcites [73] Kahbazi M, Ghoreishi A, Rahiminejad F, Mohammadi MR, Kamalipour A, Akhondzadeh S: A randomized, double-blind and placebo-controlled trial of modafinil in children and adolescents with attention deficit and hyperactivity disorder. Psychiatry Res. 2009, 168 (3): 234-237. 10.1016/j.psychres.2008.06.024. source
• Not checked yetcites [74] Arabgol F, Panaghi L, Hebrani P: Reboxetine versus methylphenidate in treatment of children and adolescents with attention deficit-hyperactivity disorder. Eur Child Adolesc Psychiatry. 2009, 18 (1): 53-59. 10.1007/s00787-008-0705-9. source
• Not checked yetcites [75] Cohen-Yavin I, Yoran-Hegesh R, Strous RD, Kotler M, Weizman A, Spivak B: Efficacy of reboxetine in the treatment of attention-deficit/hyperactivity disorder in boys with intolerance to methylphenidate: an open-label, 8-week, methylphenidate-controlled trial. Clin Neuropharmacol. 2009, 32 (4): 179-182. 10.1097/WNF.0b013e318183796d. source

In the paper

“Recent studies have shown that adding clonidine to methylphenidate [95], extended-release guanfacine to stimulants [96], or OROS methylphenidate to atomoxetine [97] improved residual ADHD symptoms and was well tolerated.”

What the sources say

• Not checked yetcites [95] Cannon M, Pelham WH, Sallee FR, Palumbo DR, Bukstein O, Daviss WB: Effects of clonidine and methylphenidate on family quality of life in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (5): 511-517. 10.1089/cap.2009.0008. source
• Not checked yetcites [96] Spencer TJ, Greenbaum M, Ginsberg LD, Murphy WR: Safety and effectiveness of coadministration of guanfacine extended release and psychostimulants in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (5): 501-510. 10.1089/cap.2008.0152. source
• Not checked yetcites [97] Wilens TE, Hammerness P, Utzinger L, Schillinger M, Georgiopoulous A, Doyle RL, Martelon M, Brodziak K: An open study of adjunct OROS-methylphenidate in children and adolescents who are atomoxetine partial responders: I. Effectiveness. J Child Adolesc Psychopharmacol. 2009, 19 (5): 485-492. 10.1089/cap.2008.0125. source

In the paper

“studies in populations around the world have continued to confirm its efficacy [78-81], including for children with oppositional defiant disorder [82] or those who have received previous stimulant therapy [83].”

What the sources say

• Not checked yetcites [78] Svanborg P, Thernlund G, Gustafsson PA, Hagglof B, Poole L, Kadesjo B: Efficacy and safety of atomoxetine as add-on to psychoeducation in the treatment of attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in stimulant-naive Swedish children and adolescents. Eur Child Adolesc Psychiatry. 2009, 18 (4): 240-249. 10.1007/s00787-008-0725-5. source
• Not checked yetcites [79] Martenyi F, Zavadenko NN, Jarkova NB, Yarosh AA, Soldatenkova VO, Bardenstein LM, Kozlova IA, Neznanov NG, Maslova OI, Petrukhin AS, et al: Atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: a 6-week, randomized, placebo-controlled, double-blind trial in Russia. Eur Child Adolesc Psychiatry. 2010, 19 (1): 57-66. 10.1007/s00787-009-0042-7. source
• Not checked yetcites [80] Takahashi M, Takita Y, Yamazaki K, Hayashi T, Ichikawa H, Kambayashi Y, Koeda T, Oki J, Saito K, Takeshita K, et al: A randomized, double-blind, placebo-controlled study of atomoxetine in Japanese children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (4): 341-350. 10.1089/cap.2008.0154. source
• Not checked yetcites [81] Durell TM, Pumariega AJ, Rothe EM, Tamayo JM, Baron D, Williams D: Effects of open-label atomoxetine on African-American and Caucasian pediatric outpatients with attention-deficit/hyperactivity disorder. Ann Clin Psychiatry. 2009, 21 (1): 26-37.
• Not checked yetcites [82] Dell'Agnello G, Maschietto D, Bravaccio C, Calamoneri F, Masi G, Curatolo P, Besana D, Mancini F, Rossi A, Poole L, et al: Atomoxetine hydrochloride in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder: A placebo-controlled Italian study. Eur Neuropsychopharmacol. 2009, 19 (11): 822-834. 10.1016/j.euroneuro.2009.07.008. source
• Not checked yetcites [83] Hammerness P, Doyle R, Kotarski M, Georgiopoulos A, Joshi G, Zeitlin S, Biederman J: Atomoxetine in children with attention-deficit hyperactivity disorder with prior stimulant therapy: a prospective open-label study. Eur Child Adolesc Psychiatry. 2009, 18 (8): 493-498. 10.1007/s00787-009-0017-8. source

In the paper

“Recently, once-daily extended-release guanfacine has proven effective in both short-term [90,91] and long-term studies [92,93].”

What the sources say

• Not checked yetcites [90] Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J: Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009, 48 (2): 155-165. 10.1097/CHI.0b013e318191769e. source
• Not checked yetcites [91] Biederman J, Melmed RD, Patel A, McBurnett K, Konow J, Lyne A, Scherer N: A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics. 2008, 121 (1): e73-84. 10.1542/peds.2006-3695. source
• Not checked yetcites [92] Sallee FR, Lyne A, Wigal T, McGough JJ: Long-term safety and efficacy of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (3): 215-226. 10.1089/cap.2008.0080. source
• Not checked yetcites [93] Biederman J, Melmed RD, Patel A, McBurnett K, Donahue J, Lyne A: Long-term, open-label extension study of guanfacine extended release in children and adolescents with ADHD. CNS Spectr. 2008, 13 (12): 1047-1055. source

In the paper

“As with stimulant treatment, atomoxetine rarely completely normalizes behavior [87], but symptom improvement is often reflected in gains in social and behavioral function [88].”

What the sources say

• Not checked yetcites [87] Whalen CK, Henker B, Ishikawa SS, Emmerson NA, Swindle R, Johnston JA: Atomoxetine versus stimulants in the community treatment of children with ADHD: an electronic diary study. J Atten Disord. 2010, 13 (4): 391-400. 10.1177/1087054708325118. source
• Not checked yetcites [88] Buitelaar JK, Wilens TE, Zhang S, Ning Y, Feldman PD: Comparison of symptomatic versus functional changes in children and adolescents with ADHD during randomized, double-blind treatment with psychostimulants, atomoxetine, or placebo. J Child Psychol Psychiatry. 2009, 50 (3): 335-342. 10.1111/j.1469-7610.2008.01960.x. source

In the paper

“Sedation is a common side-effect, which diminishes over time [94].”

What the sources say

• Not checked yetcites [94] Faraone SV, Glatt SJ: Effects of extended-release guanfacine on ADHD symptoms and sedation-related adverse events in children with ADHD. J Atten Disord. 2010, 13 (5): 532-538. 10.1177/1087054709332472. source

In the paper

“Stimulant misuse seems to be more common in those with comorbid alcohol-, drug- and cigarette-related problems, and those with higher levels of ADHD symptoms [115].”

What the sources say

• Not checked yetcites [115] Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, Utzinger L, Fusillo S: Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008, 47 (1): 21-31. 10.1097/chi.0b013e31815a56f1. source

In the paper

“A recently published study suggests that, when compared with adults with ADHD who received relaxation training and educational support, adults with ADHD who received 12 sessions of CBT had lower self-reported ADHD symptoms and greater functional improvements as rated by a blinded assessor [119].”

What the sources say

• Not checked yetcites [119] Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW: Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. Jama. 2010, 304 (8): 875-880. 10.1001/jama.2010.1192. source

In the paper

“At this point, the consensus for most alternative and complementary therapies is that these therapies are best used as a complement to ongoing pharmacotherapy rather than as an alternative.”

In the paper

“However, the only non-stimulant with FDA approval for adults with ADHD is atomoxetine.”

In the paper

“The potential for diversion and misuse may be greater in adults than in children, as parents might control the medications for the latter.”

In the paper

“Short-chain fatty acids [108] and omega-3/omega-6 fatty acids [109] have not been found to be efficacious.”

What the sources say

• Not checked yetcites [108] Raz R, Carasso RL, Yehuda S: The influence of short-chain essential fatty acids on children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study. J Child Adolesc Psychopharmacol. 2009, 19 (2): 167-177. 10.1089/cap.2008.070. source
• Not checked yetcites [109] Johnson M, Ostlund S, Fransson G, Kadesjo B, Gillberg C: Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents. J Atten Disord. 2009, 12 (5): 394-401. 10.1177/1087054708316261. source

In the paper

“Although most people with ADHD will respond favorably to pharmacological interventions [126], optimal functioning may not be attained.”

What the sources say

• Not checked yetcites [126] Elia J, Borcherding BG, Rapoport JL, Keysor CS: Methylphenidate and dextroamphetamine treatments of hyperactivity: are there true nonresponders?. Psychiatry Res. 1991, 36 (2): 141-155. 10.1016/0165-1781(91)90126-A. source

In the paper

“Furthermore, both groups reported less depression and anxiety. Both groups also had improved self-esteem at the end of the study, but the intervention group reported a greater improvement in self-esteem [120].”

What the sources say

• Not checked yetcites [120] Bramham J, Young S, Bickerdike A, Spain D, McCartan D, Xenitidis K: Evaluation of group cognitive behavioral therapy for adults with ADHD. J Atten Disord. 2009, 12 (5): 434-441. 10.1177/1087054708314596. source

In the paper

“Likewise, medications may improve some but not all aspects of cognitive functioning, and even when both symptoms and cognitive function are improved, the two are not necessarily correlated [130].”

What the sources say

• Not checked yetcites [130] Coghill DR, Rhodes SM, Matthews K: The neuropsychological effects of chronic methylphenidate on drug-naive boys with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007, 62 (9): 954-962. 10.1016/j.biopsych.2006.12.030. source

In the paper

“There were more treatment responders in the CBT group (53%) relative to the relaxation training and educational support group (23%), and gains were maintained over periods of 6 and 12 months [119].”

What the sources say

• Not checked yetcites [119] Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW: Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. Jama. 2010, 304 (8): 875-880. 10.1001/jama.2010.1192. source

In the paper

“New stimulant formulations have made it possible to tailor treatment to the duration of efficacy required by patients and to help mitigate the potential for abuse, misuse and diversion.”

In the paper

“Although they tend to be less efficacious than stimulants, new non-stimulant options also allow for extended duration of treatment without the adverse consequences associated with stimulant therapy.”

In the paper

“Poor treatment adherence and psychiatric comorbidity clearly complicate treatment and negatively affect outcomes.”

In the paper

“ADHD symptoms, especially hyperactive-impulsive symptoms, tend to decline through adolescence into adulthood, so that the adult presentation of ADHD differs somewhat from the childhood presentation.”