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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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Gruschow SM, Yerys BE, Power TJ, Durbin DR, Curry AE. Validation of the Use of Electronic Health Records for Classification of ADHD Status. J Atten Disord 2019; 23:1647-1655. [PMID: 28112025 PMCID: PMC5843549 DOI: 10.1177/1087054716672337] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To validate an electronic health record (EHR)-based algorithm to classify ADHD status of pediatric patients. METHOD As part of an applied study, we identified all primary care patients of The Children's Hospital of Philadelphia [CHOP] health care network who were born 1987-1995 and residents of New Jersey. Patients were classified with ADHD if their EHR indicated an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "314.x" at a clinical visit or on a list of known conditions. We manually reviewed EHRs for ADHD patients ( n = 2,030) and a random weighted sample of non-ADHD patients ( n = 807 of 13,579) to confirm the presence or absence of ADHD. RESULTS Depending on assumptions for inconclusive cases, sensitivity ranged from 0.96 to 0.97 (95% confidence interval [CI] = [0.95, 0.97]), specificity from 0.98 to 0.99 [0.97, 0.99], and positive predictive value from 0.83 to 0.98 [0.81, 0.99]. CONCLUSION EHR-based diagnostic codes can accurately classify ADHD status among pediatric patients and can be used by large-scale epidemiologic and clinical studies with high sensitivity and specificity.
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Affiliation(s)
| | - Benjamin E Yerys
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
| | - Dennis R Durbin
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
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Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder. SAFETY 2018. [DOI: 10.3390/safety4030040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over the past several decades there has been a surge of research on the contextual, biological, and psychological factors associated with transportation safety in adolescence. However, we know much less about the factors contributing to transportation safety among adolescents who do not follow a typical developmental trajectory. Adolescents with developmental disabilities (DD) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have a wide range of behavioral and psychological deficits that may make the complex task of driving even more challenging. Because these adolescents often retain characteristic symptoms of their disorder into adulthood, it may impede their ability to achieve important milestones during the developmental transition from adolescent to adult. As the motivating force behind autonomous living and employment, the capacity for independent transportation is paramount to an adolescent’s overall success. This critical review will draw from the current body of literature on adolescent drivers with developmental disabilities to determine (1) areas of impairment; (2) safety risk factors; and (3) effective interventions for improving driving safety in this vulnerable population of adolescent drivers between the ages of 15–22. This review will also identify important unanswered research questions, and summarize the current state of the literature.
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Daley MF, Newton DA, DeBar L, Newcomer SR, Pieper L, Boscarino JA, Toh S, Pawloski P, Nordin JD, Nakasato C, Herrinton LJ, Bussing R. Accuracy of Electronic Health Record-Derived Data for the Identification of Incident ADHD. J Atten Disord 2017; 21:416-425. [PMID: 24510475 DOI: 10.1177/1087054713520616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the accuracy of electronic health record (EHR)-derived diagnoses in identifying children with incident (i.e., newly diagnosed) ADHD. METHOD In 10 large health care organizations, electronic diagnoses data were used to identify all potential cases of incident ADHD among 3- through 9-year-old children. A random sample of records was manually reviewed to determine whether a diagnosis of ADHD was documented in clinician notes. RESULTS From electronic diagnoses data, a total of 7,362 children with incident ADHD were identified. Upon manual review of 500 records, the diagnosis of incident ADHD was confirmed in clinician notes for 71.5% (95% confidence interval [CI] = [56.5, 86.4]) of records for 3- through 5-year-old children and 73.6% (95% CI = [65.6, 81.6]) of records for 6- through 9-year-old children. CONCLUSION Studies predicated on the identification of incident ADHD cases will need to carefully consider study designs that minimize the likelihood of case misclassification.
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Affiliation(s)
- Matthew F Daley
- 1 Kaiser Permanente Colorado, Denver, CO, USA.,2 University of Colorado, Aurora, CO, USA
| | | | - Lynn DeBar
- 3 Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Lisa Pieper
- 1 Kaiser Permanente Colorado, Denver, CO, USA
| | | | | | - Pamala Pawloski
- 6 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - James D Nordin
- 6 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
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Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr 2014; 35:448-57. [PMID: 25180895 DOI: 10.1097/dbp.0000000000000099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSMIV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.
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Bussing R, Narwaney KJ, Winterstein AG, Newton DA, DeBar L, Boscarino JA, Toh S, Pawloski P, Nordin JD, Herrinton LJ, Mason D, Daley MF. Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics. Curr Med Res Opin 2014; 30:1687-99. [PMID: 24635013 DOI: 10.1185/03007995.2014.905461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This study examines incident treatment patterns for attention-deficit/hyperactivity disorder (ADHD) in children seen in eight integrated healthcare delivery systems and identifies factors associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) quality measures developed by the National Committee for Quality Assurance (NCQA). METHOD A retrospective cohort analysis using electronic healthcare data from children aged 3 through 17 years with newly diagnosed ADHD between January 1, 2009 and December 31, 2010 was conducted. NCQA quality definitions for initiation and for continuation and maintenance (C&M) of ADHD medications were expanded to include preschoolers and adolescents. Poisson regression models with robust error variance were used to evaluate the association between NCQA HEDIS adherence measures, provider type, patient characteristics and care process measures. RESULTS Of 6864 children aged 3-17 years old qualifying for incident treatment analyses, 5538 (80.7%) were started on ADHD medication within a year of diagnosis. Adherence to NCQA HEDIS measures was 49.8% for initiation and 45.8% for C&M, with adherence rates higher for mental health than non-mental health providers, school-aged children than adolescents, and for patients concurrently on other psychotropic medications than those who were not. Of those started on ADHD medication, 62.3% were not eligible for C&M analyses according to HEDIS guidelines, because they did not receive continuous (210 of 300 days) ADHD medication treatment, with adolescents less likely than school-aged children to persist with medications. CONCLUSION Study limitations must be considered, including reliance on electronic medical record data, absence of patient race and sociodemographic data, and limited generalizability to other care contexts. Nevertheless, findings suggest novel strategies are needed to improve the quality of ADHD care processes for children of all ages, because even within integrated delivery systems less than half of children with ADHD received care consistent with NCQA HEDIS standards for initiation and C&M care. RESULTS suggest the need to refine quality measures by including follow-up care in those children not receiving or discontinuing medication treatment, a considerable quality concern not currently captured in NCQA HEDIS standards.
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Affiliation(s)
- Regina Bussing
- University of Florida, College of Medicine , Gainesville, FL , USA
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Sclar DA, Robison LM, Bowen KA, Schmidt JM, Castillo LV, Oganov AM. Attention-deficit/hyperactivity disorder among children and adolescents in the United States: trend in diagnosis and use of pharmacotherapy by gender. Clin Pediatr (Phila) 2012; 51:584-9. [PMID: 22399571 DOI: 10.1177/0009922812439621] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Sclar
- Pharmacoeconomics and Pharmacoepidemiology Research Unit, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Spokane,WA 99210-1495, USA.
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Abstract
OBJECTIVE This pilot study examined whether methylphenidate (MPH) was effective in enhancing cognitive performance and attention for children with sickle cell disease (SCD) with cerebrovascular complications who evidence attention problems. METHODS In this multisite, pilot study, we evaluated 2 separate double-blind controlled clinical trials, including a laboratory trial of the short-term efficacy of MPH, with the second study a 3-week home/school crossover trial evaluating the efficacy of MPH. The laboratory trial included 14 participants between the age of 7 and 16 years. Assessments included measures of sustained attention, reaction time, executive functions, and verbal memory. The home/school trial included 20 participants. The outcome measures were parent and teacher ratings of attention. The first study compared MPH with placebo, while the second trial compared placebo, low-dose (LD) MPH, and moderate-dose MPH. RESULTS In the laboratory trial, significant effects were revealed for measures of memory and inhibitory control. Parent and teacher reports from the home/school trial indicate that moderate-dose MPH produced superior improvement in attention relative to the placebo and LD MPH. CONCLUSIONS Stimulant medication positively impacted select measures of memory and inhibitory control in some children with SCD. Attention, as rated by parent and teachers, was improved for a greater number of children and adolescents on higher doses of MPH relative to LD MPH and placebo. Stimulant medication may provide an effective intervention for some children with SCD and cerebrovascular complications who demonstrate attention problems.
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Faber Taylor A, Kuo FEM. Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children's Play Settings. Appl Psychol Health Well Being 2011. [DOI: 10.1111/j.1758-0854.2011.01052.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blum LM. “Not This Big, Huge, Racial-Type Thing, but … ”: Mothering Children of Color with Invisible Disabilities in the Age of Neuroscience. SIGNS 2011. [DOI: 10.1086/658503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Quality of care for childhood attention-deficit/hyperactivity disorder in a managed care medicaid program. J Am Acad Child Adolesc Psychiatry 2010; 49:1225-37, 1237.e1-11. [PMID: 21093772 PMCID: PMC3018146 DOI: 10.1016/j.jaac.2010.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 08/13/2010] [Accepted: 08/23/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether clinical severity is greater among children receiving attention-deficit/hyperactivity disorder (ADHD) care in primary care compared with those in specialty mental health clinics, and to examine how care processes and clinical outcomes vary by sector across three 6-month time intervals. METHOD This was a longitudinal cohort study of 530 children aged 5 to 11 years receiving ADHD care in primary care or specialty mental health clinics from November 2004 through September 2006 in a large, countywide managed care Medicaid program. RESULTS Clinical severity at study entry did not differ between children who received ADHD care in solely primary or specialty mental health care clinics. At three 6-month intervals, receipt of no care ranged from 34% to 44%, and unmet need for mental health services ranged from 13% to 20%. In primary care, 80% to 85% of children had at least one stimulant prescription filled and averaged one to two follow-up visits per year. Less than one-third of children in specialty mental health clinics received any stimulant medication, but all received psychosocial interventions averaging more than five visits per month. In both sectors, stimulant medication refill prescription persistence was poor (31%-49%). With few exceptions, ADHD diagnosis, impairment, academic achievement, parent distress, and parent-reported treatment satisfaction, perceived benefit, and improved family functioning did not differ between children who remained in care and those who received no care. CONCLUSION Areas for quality improvement are alignment of clinical severity with provider type, follow-up visits, stimulant use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatment, and stimulant medication refill prescription persistence.
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Guevara JP, Mandell DS. Costs associated with attention deficit hyperactivity disorder: overview and future projections. Expert Rev Pharmacoecon Outcomes Res 2010; 3:201-10. [PMID: 19807367 DOI: 10.1586/14737167.3.2.201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The costs associated with attention deficit hyperactivity disorder are considerable. These costs are incurred for the provision of health services, out-of-pocket family expenditures, educational services and juvenile justice services. In this review, we present the components of these costs and discuss factors likely to make a significant impact. It is shown that pharmaceuticals and ambulatory care services, in particular outpatient mental healthcare, account for the majority of healthcare costs. Finally, data are presented that suggest attention deficit hyperactivity disorder is associated with increased educational costs, while increased costs associated with juvenile justice may be due to mental health comorbidity. We speculate on future costs for attention deficit hyperactivity disorder given the introduction of new pharmaceutical agents and discuss projected increases in the prevalence of the disorder in under-represented populations.
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Affiliation(s)
- James P Guevara
- University of Pennsylvania School of Medicine, 3535 Market Street, Rm. 1531, Philadelphia, PA 19104, USA.
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Günther T, Herpertz-Dahlmann B, Konrad K. Sex differences in attentional performance and their modulation by methylphenidate in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2010; 20:179-86. [PMID: 20578930 DOI: 10.1089/cap.2009.0060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Still little is known about neuropsychological differences between boys and girls with attention-deficit/hyperactivity disorder (ADHD) and whether there are sex-specific differences in the modulation of attentional performance by methylphenidate (MPH). METHOD In this study, 27 males and 27 females between 8-12 years old and with ADHD were investigated in a double-blind, placebo-controlled trial on five computerized attention tests (0.25 vs. 0.5 mg/kg MPH as a single dose, versus placebo). RESULTS Boys and girls with ADHD did not differ with respect to age, intelligence quotient (IQ), symptom severity, co-morbidity patterns, and ADHD subtype. However, ADHD boys were more impulsive on a sustained attention task, whereas girls with ADHD had more deficits on tasks measuring selective attention. Attentional performance increased differentially as a function of MPH dose, with some tasks showing linear improvement with higher dosage whereas more complex tasks in particular showed inverse U-shaped patterns of MPH effects. However, these effects were comparable between girls and boys. CONCLUSIONS Our data suggest that there are some gender differences in attentional performance in subjects with ADHD in a clinical sample, even if symptom severity and co-morbidity are controlled; however, modulation of attention by MPH does not seem to differ between sexes.
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Affiliation(s)
- Thomas Günther
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, University Hospital of the RWTH Aachen, Aachen, Germany.
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Halloran DR, Swindle J, Takemoto SK, Schnitzler MA. Multiple psychiatric diagnoses common in privately insured children on atypical antipsychotics. Clin Pediatr (Phila) 2010; 49:485-90. [PMID: 20118088 PMCID: PMC3807865 DOI: 10.1177/0009922809347369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the prevalence of atypical antipsychotic use in privately insured children and the diagnoses associated with treatment. STUDY DESIGN Claims were used to conduct a retrospective cohort study of children aged 2 through 18 years in the Midwest, covered by private insurance between 2002 and 2005 (n = 172,766). The 1-year prevalence of children receiving atypical antipsychotics was determined along with associated diagnoses. RESULTS The 1-year prevalence of atypical antipsychotics ranged from 7.9 per 1000 in 2002 to 9.0 in 2005. The leading diagnoses were disruptive behavior disorders (67%), mood disorders (65%), and anxiety disorders (43%).The authors found that 75% of children on atypical antipsychotics had more than one psychiatric diagnosis. CONCLUSIONS Atypical antipsychotic use is primarily seen in children who have multiple psychiatric diagnoses. Studies are needed to assess the long-term safety and effectiveness in such patients with multiple diagnoses.
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Affiliation(s)
- Donna R Halloran
- Department of Pediatrics, Saint Louis University, Saint Louis, MO 63104-1095, USA.
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Yu ZJ, Parker-Kotler C, Tran K, Weller RA, Weller EB. Peripheral vasculopathy associated with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2010; 12:111-5. [PMID: 20425295 DOI: 10.1007/s11920-010-0093-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychostimulants (methylphenidate and amphetamine salt) are the pharmacologic treatment of choice for children with attention-deficit/hyperactivity disorder. However, psychostimulants have been linked to a variety of vascular problems, including peripheral vasculopathy. This article describes four boys with attention-deficit/hyperactivity disorder who developed vasculopathy during treatment with psychostimulants.
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Affiliation(s)
- Zheya Jenny Yu
- Hall-Mercer MH/MR Center, Pennsylvania Hospital, University of Pennsylvania Health System, 245 South 8th Street, Philadelphia, PA 19107, USA.
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Conklin HM, Helton S, Ashford J, Mulhern RK, Reddick WE, Brown R, Bonner M, Jasper BW, Wu S, Xiong X, Khan RB. Predicting methylphenidate response in long-term survivors of childhood cancer: a randomized, double-blind, placebo-controlled, crossover trial. J Pediatr Psychol 2010; 35:144-55. [PMID: 19465537 PMCID: PMC2902831 DOI: 10.1093/jpepsy/jsp044] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/22/2009] [Accepted: 04/22/2009] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the methylphenidate (MPH) response rate among childhood survivors of acute lymphoblastic leukemia (ALL) and brain tumors (BTs) and to identify predictors of positive MPH response. METHODS Cancer survivors (N = 106; BT = 51 and ALL = 55) identified as having attention deficits and learning problems participated in a 3-week, double-blind, crossover trial consisting of placebo, low-dose MPH (0.3 mg/kg), and moderate-dose MPH (0.6 mg/kg). Weekly teacher and parent reports on the Conners' Rating Scales were gathered. RESULTS Following moderate MPH dose, 45.28% of the sample was classified as responders. Findings revealed that more problems endorsed prior to the medication trial on parent and teacher ratings were predictive of positive medication response (p < .05). CONCLUSIONS MPH significantly reduces attention problems in a subset of childhood cancer survivors. Parent and teacher ratings may assist in identifying children most likely to respond to MPH so prescribing may be optimally targeted.
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Affiliation(s)
- Heather M Conklin
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Rabbani A, Alexander GC. Impact of family structure on stimulant use among children with attention-deficit/hyperactivity disorder. Health Serv Res 2009; 44:2060-78. [PMID: 19732168 DOI: 10.1111/j.1475-6773.2009.01019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the impact of family structure on pharmacologic stimulant use among children with attention-deficit/hyperactivity disorder (ADHD). DATA SOURCE Nationally representative, population-based sample of the National Health Interview Survey from 1997 to 2003 linked with drug event files from the Medical Expenditure Panel Survey from 1998 to 2005. STUDY DESIGN Stepwise multivariate logistic regression was used to examine the likelihood of stimulant use for each individual during 2 years of observation after adjustment for sociodemographic, health, and family characteristics. Stratified analyses were also conducted to examine whether family characteristics had different impacts within single-mother and dual-parent households. PRINCIPAL FINDINGS Stimulant use varied based on children's sociodemographic and health characteristics. In multivariate analyses, associations between children's household structure, parental education, and stimulant use appeared to be mediated by children's access to care and health status. However, in full multivariate models, there remained a robust positive association between family size and stimulant use. CONCLUSIONS These findings highlight the influence that nonclinical factors such as family size may have in mediating the use of pharmacologic therapies for children.
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Affiliation(s)
- Atonu Rabbani
- Center for Health and Social Sciences, The University of Chicago, 5841 S. Maryland, Chicago, IL, USA
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Practice parameter on the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry 2009; 48:961-973. [PMID: 19692857 DOI: 10.1097/chi.0b013e3181ae0a08] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this practice parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication prescribing. The evidence base supporting the use of psychotropic medication for children and adolescents with psychiatric disorders has increased for the past 15 to 20 years, as has their use. It is hoped that clinicians who implement the principles outlined in this parameter will be more likely to use medications with the potential for pharmacological benefit in children safely and to reduce the use of ineffective and inappropriate medications or medication combinations. The best practice principles covered in this parameter include completing a psychiatric and medical evaluation, developing a treatment and monitoring plan, educating the patient and family regarding the child's disorder and the treatment and monitoring plan, completing and documenting assent of the child and consent of the parent, conducting an adequate medication treatment trial, managing the patient who does not respond as expected, establishing procedures to implement before using medication combinations, and following principles for the discontinuation of medication.
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Rise in psychotropic drug prescribing in children and adolescents during 1992–2001: a population-based study in the UK. Eur J Epidemiol 2009; 24:211-6. [DOI: 10.1007/s10654-009-9321-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 02/23/2009] [Indexed: 11/27/2022]
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Abstract
Attention-deficit/hyperactivity disorder (ADHD) holds the distinction of being the most extensively studied pediatric mental disorder and one of the most controversial, in part because it is also the most commonly diagnosed mental disorder among minors. Currently, almost 8% of youth aged 4 to 17 years have a diagnosis of ADHD, and approximately 4.5% both have the diagnosis and are using a stimulant (methylphenidate or amphetamine) as treatment for the disorder. Yet a diagnosis of ADHD is not simply a private medical finding; it carries with it a host of policy ramifications. The enduring controversy over ADHD in the public arena therefore reflects the discomfort over what happens when science is translated into policies and rules that govern how children will be treated medically, educationally, and legally. This article (1) summarizes the existing knowledge of ADHD, (2) provides the relevant history and trends, (3) explains the controversy, (4) discusses what is and is not unique about ADHD and stimulant pharmacotherapy, (5) outlines future directions of research, and (6) concludes with a brief analysis of how two North Carolina counties have established community protocols that have improved the screening, treatment, and societal consensus over ADHD and stimulants.
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Affiliation(s)
- Rick Mayes
- Department of Political Science, University of Richmond, Richmond, VA 23173, USA.
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Mitchell B, Carleton B, Smith A, Prosser R, Brownell M, Kozyrskyj A. Trends in psychostimulant and antidepressant use by children in 2 Canadian provinces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:152-9. [PMID: 18441661 DOI: 10.1177/070674370805300305] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We used population-based administrative prescription medication data to examine regional differences in psychostimulant and antidepressant (AD) use among children from 2 Canadian provinces: British Columbia (BC) and Manitoba (MB). METHOD Using 1997 to 2003 prescription data, annual rates of psychostimulant and AD use were determined for children aged 19 years and under in both provinces. Further comparisons of rates were made according to sex, age group, and specific classes of dispensed medications. RESULTS During 1997 to 2003, psychostimulant use rose by 44.9% in MB and 13.3% in BC. Among male children, psychostimulant use increased by 40.2% in MB, compared with an increase of only 8.6% in BC. AD utilization was similar between provinces, with increases of 80% and 75% in MB and BC, respectively. In both provinces, AD use was highest among older children. CONCLUSIONS Our observations of regional variation in psychotropic medication use potentially reflect provincial differences in drug benefit policies, disease prevalence, and (or) physician diagnosis and treatment.
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Rosenblum S, Epsztein L, Josman N. Handwriting performance of children with attention deficit hyperactive disorders: a pilot study. Phys Occup Ther Pediatr 2008; 28:219-34. [PMID: 19064457 DOI: 10.1080/01942630802224934] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to compare the handwriting characteristics of children diagnosed with attention deficit hyperactive disorder (ADHD), while on and off medication, as well as with a control group. METHODS Twelve children with ADHD and 12 control children, aged 8-10, performed a paragraph-copying task using a computerized system. The children with ADHD performed the task both while on and off medication. The handwriting product of both groups was then evaluated with the Hebrew Handwriting Evaluation tool. CONCLUSION Results provide evidence for poorer performance of children with ADHD in comparison to children without ADHD on most handwriting process and product measures. Children with ADHD demonstrated significantly more total time including in-air time spent in handwriting performance when off medication. The possible implications of these results regarding the future use of handwriting process and product evaluations for children with ADHD in school settings are discussed.
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Affiliation(s)
- Sara Rosenblum
- Department of Occupational Therapy, a joint program of the Faculty of Social Welfare & Health Sciences, University of Haifa, and the Technion, Haifa, Israel.
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Schlander M. Impact of attention-deficit/hyperactivity disorder (ADHD) on prescription dug spending for children and adolescents: increasing relevance of health economic evidence. Child Adolesc Psychiatry Ment Health 2007; 1:13. [PMID: 18005403 PMCID: PMC2216002 DOI: 10.1186/1753-2000-1-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 11/15/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the last decade, pharmaceutical spending for patients with attention-deficit-hyperactivity disorder (ADHD) has been escalating internationally. OBJECTIVES First, to estimate future trends of ADHD-related drug expenditures from the perspectives of the statutory health insurance (SHI; Gesetzliche Krankenversicherung, GKV) in Germany and the National Health Service (NHS) in England, respectively, for children and adolescents age 6 to 18 years. Second, to evaluate the budgetary impact on individual prescribers (child and adolescent psychiatrists and pediatricians treating patients with ADHD) in Germany. METHODS A model was developed to predict plausible scenarios of future pharmaceutical expenditures for treatment of ADHD. Model inputs were derived from demographic and epidemiological data, a literature review of past spending trends, and an analysis of new pharmaceutical products in development for ADHD. Only products in clinical development phase III or later were considered. Uncertainty was addressed by way of scenario analysis. For each jurisdiction, five scenarios used different assumptions of future diagnosis prevalence, treatment prevalence, rates of adoption and unit costs of novel drugs, and treatment intensity. RESULTS Annual ADHD pharmacotherapy expenditures for children and adolescents will further increase and may exceed euro 310 m (D; E: 78 m) in 2012 (2002: approximately euro 21.8 m; approximately 7.0 m). During this period, overall drug spending by individual physicians may increase 2.3- to 9.5-fold, resulting from the multiplicative effects of four variables: increased number of diagnosed cases, growing acceptance and intensity of pharmacotherapy, and higher unit costs of novel medications. DISCUSSION Even for an extreme low case scenario, a more than six-fold increase of pharmaceutical spending for children and adolescents is predicted over the decade from 2002 to 2012, from the perspectives of both the NHS in England and the GKV in Germany. This budgetary impact projection represents a partial analysis only because other expenditures are likely to rise as well, for instance those associated with physician services, including diagnosis and psychosocial treatment. Further to this, by definition budgetary impact analyses have little to nothing to say about clinical appropriateness and about value of money. CONCLUSION Providers of care for children and adolescents with ADHD should anticipate serious challenges related to the cost-effectiveness of interventions.
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Affiliation(s)
- Michael Schlander
- Institute for Innovation & Valuation in Health Care (INNOVALHC), Eschborn, Germany.
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Greydanus DE, Pratt HD, Patel DR. Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult. Dis Mon 2007; 53:70-131. [PMID: 17386306 DOI: 10.1016/j.disamonth.2007.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Revised: 01/04/2007] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
Management of a child, adolescent, college student, or adult with ADD/ADHD (ADHD) is reviewed with emphasis on pharmacologic approaches in the adult. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants (psychostimulants), antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Psychopharmacology approved and/or used in pediatric patients are also used in adults with ADHD, though most are not officially FDA-approved. It is emphasized that ADHD management should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient of any age, and judicious use of medications. Such an approach is recommended to benefit those with ADHD achieve their maximum potential across the human life span.
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Affiliation(s)
- Donald E Greydanus
- Pediatrics and Human Development, Michigan State University College of Human Medicine, Sindecuse College Health Center, USA
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Liu F, Minami H, Silva RR. Dexmethylphenidate hydrochloride in the treatment of attention deficit hyperactivity disorder. Neuropsychiatr Dis Treat 2006; 2:467-73. [PMID: 19412495 PMCID: PMC2671958 DOI: 10.2147/nedt.2006.2.4.467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) affects a large number of children. For decades, the stimulants have been the mainstay of pharmacological treatment for ADHD. Dexmethylphenidate (d-MPH), the d-isomer of the traditional racemic mixtures of d,l-threo-(R,R)-MPH, was recently introduced as another potential option in the stimulant class of medications. This paper reviews and summarizes the available research literature on d-MPH regarding pharmacodynamic, pharmacokinetic, chemical structure, receptor binding, toxicology, and clinical perspectives. d-MPH potentially may offer some advantages in the realms of absorption and duration of action compared with its racemic counterpart. The differences in pharmacokinetics and clinical implications of the immediate-release and extended-release forms of d-MPH are also compared and contrasted.
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Affiliation(s)
- Feng Liu
- New York University School of Medicine, Division of Child and Adolescent Psychiatry, New York, NY, USA.
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Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45:771-91. [PMID: 16832314 DOI: 10.1097/01.chi.0000220851.94392.30] [Citation(s) in RCA: 274] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Despite increasing use of psychotropic medications in children and adolescents, data regarding their efficacy and safety are limited. Endocrine and metabolic adverse effects are among the most concerning adverse effects of commonly used psychotropic medications. METHOD Selective review of endocrine and metabolic effects of psychotropic medications in pediatric populations, with a focus on monitoring and management strategies. RESULTS Because youth are still developing at the time of psychotropic drug exposure, most reference values need to be adjusted for gender and age. As in adults, youngsters receiving lithium require monitoring for thyroid dysfunction. Psychostimulants appear to cause mild reversible growth retardation in some patients, most likely because of decreased weight or slowing of expected weight gain; some patients may experience clinically significant reductions in adult height. Although still controversial, valproate use has been associated with an increased risk for polycystic ovary syndrome, in addition to causing weight gain. Although more data are required, children and adolescents appear to be at higher risk than adults for antipsychotic-induced hyperprolactinemia, weight gain, and possibly, associated metabolic abnormalities, which is of particular concern. CONCLUSIONS Clinicians and caregivers need to be aware of potential endocrine and metabolic adverse effects of psychiatric medications. A careful selection of patients, choice of agents with potentially lesser risk for these adverse events, healthy lifestyle counseling, as well as close health monitoring are warranted to maximize effectiveness and safety.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
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Silva RR, Muniz R, Pestreich L, Childress A, Brams M, Lopez FA, Wang J. Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2006; 16:239-51. [PMID: 16768632 DOI: 10.1089/cap.2006.16.239] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess changes in symptomatology of attention-deficit/ hyperactivity disorder (ADHD) with extended-release dexmethylphenidate (d-MPHER) versus placebo in a laboratory classroom setting. METHODS This double-blind, placebo-controlled, crossover study randomized 54 children 6-12 years of age, stabilized on methylphenidate 20-40 mg/day. Patients participated in a practice day, then received 5 days of treatment with d-MPH-ER 20 mg/day or placebo. After a 1-day wash-out, they returned to the classroom and received 1 dose of their assigned treatment. Evaluations occurred predose and at postdose hours 1, 2, 4, 6, 8, 9, 10, 11, and 12. Children were then crossed over to the alternate treatment, using identical protocol. Primary efficacy variable was the Swanson, Kotkin, Agler, M-Flynn, and Pelham rating scale (SKAMP)-Combined scores, and primary analysis time point was 1 hour postdose; secondary efficacy variables over 12 hours included SKAMP-Attention and -Deportment scores and written math test results. Safety was assessed by adverse event (AE) recording following each period. Vital signs were recorded at each visit; laboratory tests were conducted at screening and final visit. RESULTS D-MPH-ER 20 mg/day showed a significant advantage over placebo as early as 1 hour postdose on SKAMP-Combined scores (p < 0.001). When analyzing the entire sample of 54 children, d-MPH-ER maintained significant superiority over placebo from hours 1 through 12 (p-values ranged from < 0.001 to 0.046). D-MPH-ER was well tolerated, with no severe AEs reported. CONCLUSIONS D-MPH-ER is safe and effective and improves classroom attention, deportment, and performance in children with ADHD.
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Affiliation(s)
- Raul R Silva
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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Leibson CL, Barbaresi WJ, Ransom J, Colligan RC, Kemner J, Weaver AL, Katusic SK. Emergency department use and costs for youth with attention-deficit/hyperactivity disorder: associations with stimulant treatment. ACTA ACUST UNITED AC 2006; 6:45-53. [PMID: 16443183 DOI: 10.1016/j.ambp.2005.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 08/18/2005] [Accepted: 08/26/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate whether, among youth with attention-deficit/hyperactivity disorder (ADHD), stimulant treatment is associated with reduced emergency department (ED) use and medical costs. METHODS We previously reviewed the complete and detailed school and medical records of all individuals born 1976-1982 in Rochester, Minn, to identify those who met criteria for ADHD between age 5 years and emigration from the area. Stimulant treatment (all start/stop dates, dosages) was also abstracted. This study followed birth cohort members with ADHD in provider-linked billing data from January 1, 1987 (billing data first available), to age 18 for outcomes: ED visits, ED costs, and medical costs. For each outcome, we analyzed associations with 1) any stimulants (yes/no), 2) proportion of follow-up time on stimulants, and 3) among those treated with stimulants, periods on versus off stimulants. RESULTS Of 313 youth with ADHD, 231 (74%) received any stimulants; treatment duration ranged from 14 days to 11.8 years. Treated and untreated youth were similar with respect to median annual ED visits (0.5 vs 0.5) and medical costs (661 US dollars vs 741 US dollars) (P > .05); however, increasing proportion of follow-up on stimulants was associated with fewer ED visits (P= .02) and higher medical costs (P< .001). The 231 treated youth experienced an average of 3.7 periods on and off stimulants; while receiving stimulants, they exhibited fewer ED visits (P= .02), lower ED costs (P = .03), and higher medical costs (P< .001) compared with periods off stimulants. CONCLUSIONS Among youth with ADHD, extended stimulant treatment is associated with decreased ED visits and ED costs, but higher total medical costs.
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Affiliation(s)
- Cynthia L Leibson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr 2006; 27:1-10. [PMID: 16511362 DOI: 10.1097/00004703-200602000-00001] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSM-IV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.
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Affiliation(s)
- William J Barbaresi
- Department of Pediatric and Adolescent Medicine, Division of Developmental and Behavioral Pediatrics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Silva R, Muniz R, Pestreich LK, Brams M, Childress A, Lopez FA. Efficacy of two long-acting methylphenidate formulations in children with attention- deficit/hyperactivity disorder in a laboratory classroom setting. J Child Adolesc Psychopharmacol 2005; 15:637-54. [PMID: 16190795 DOI: 10.1089/cap.2005.15.637] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to compare efficacy and safety of two long-acting formulations of methylphenidate (MPH) for attention-deficit/hyperactivity disorder (ADHD) in school-age children. METHODS Children 6-12 years of age diagnosed with ADHD and stabilized on MPH (20-40 mg/day) participated in a five-way, randomized, placebo-controlled, single-blind, crossover study conducted in a laboratory classroom setting. Children alternately received single doses of extended-release MPH (ER-MPH) 20 and 40 mg, modified-release MPH (OROS-MPH) 18 and 36 mg, and placebo over 6 consecutive weeks. Efficacy was assessed using SKAMP rating subscales and written math tests. Data were examined using between-treatment comparisons of area under the curve (AUC) for change from predose values during hours 0-4, 0-8, 8-12, and 0-12. Safety was assessed. RESULTS Fifty-three children completed the study. For all efficacy measures, improvements from predose were significantly greater with ER-MPH 40 mg than with OROS-MPH 36 mg in terms of AUC(0-4) (p < or = 0.005), AUC(0-8) (p < or = 0.006), and AUC(0-12) (p < or = 0.035). For most measures, ER-MPH 20 mg was equivalent to both doses of OROS-MPH in AUC(0-4), AUC(0-8), and AUC(0-12). No serious adverse events were reported. CONCLUSIONS The efficacy of ER-MPH 20 mg is similar to that of OROS-MPH 18 and 36 mg during the first 8 hours postdose. Statistically greater benefits are observed with ER-MPH 40 mg than with OROS-MPH 36 mg and persist through hour 8. Active treatments show comparable efficacy from 8 to 12 hours postdose. Both doses of each MPH formulation are well tolerated.
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Affiliation(s)
- Raul Silva
- Department of Psychiatry, New York University School of Medicine, New York, New York 10016, USA.
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Sanchez RJ, Crismon ML, Barner JC, Bettinger T, Wilson JP. Assessment of Adherence Measures with Different Stimulants Among Children and Adolescents. Pharmacotherapy 2005; 25:909-17. [PMID: 16006269 DOI: 10.1592/phco.2005.25.7.909] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE To examine adherence measures with different stimulants in children and adolescents. DESIGN Retrospective analysis. DATA SOURCE Texas Medicaid prescription claims database. PATIENTS A total of 9549 patients aged 5-18 years with attention-deficit-hyperactivity disorder. MEASUREMENTS AND MAIN RESULTS Paid prescription claims for newly started stimulants during the 2001-2002 school year were extracted from a database; 28,344 prescriptions (9549 patients) were available for analysis. Adherence was evaluated based on the drug therapy prescribed (i.e., mixed amphetamine salts, immediate-release methylphenidate, and extended-release methylphenidate-OROS [oral-osmotic formulation]) and the age and sex of the patient. Adherence measures were persistence and medication possession ratio (MPR). Persistence was higher for extended-release methylphenidate-OROS (0.50 +/- 0.33) than for mixed amphetamine salts (0.42 +/- 0.29) or immediate-release methylphenidate (0.37 +/- 0.26; p < 0.001). The MPR was also higher for extended-release methylphenidate-OROS (0.76 +/- 0.37) than for mixed amphetamine salts (0.73 +/- 0.37) or immediate-release methylphenidate (0.69 +/- 0.37; p < 0.001). Patients aged 5-9 years had equal or better persistence and MPR than those aged 10-14 and 15-18 years (p < 0.001). No sex-related differences in adherence were observed. CONCLUSION Adherence measures in our study were low. Although they were significantly better for extended-release methylphenidate-OROS than the other stimulants, the clinical significance of these differences are unclear. Further research should be conducted regarding pharmaceutical products, administration methods, and clinical interventions that may enhance adherence.
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Affiliation(s)
- Robert J Sanchez
- College of Pharmacy, University of Texas at Austin; Texas Department of State Health Services, Austin, Texas 78712, USA
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Lipkin PH, Cozen MA, Thompson RE, Mostofsky SH. Stimulant dosage and age, race, and insurance type in a sample of children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005; 15:240-8. [PMID: 15910208 DOI: 10.1089/cap.2005.15.240] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association of age, race, insurance, and other factors with the prescription of stimulant medications. METHODS A retrospective chart review was conducted on 242 subjects, 4.8-19.8 years of age, treated in an urban referral center with a stable dose of stimulant medication for at least 6 months. Subjects were predominantly male (74.8%), African-American (52.9%), and insured by Medicaid (71.0%). The effects of age, race, insurance, gender, cognitive level, additional psychopharmacologic medications, and other factors on prescribed total daily dose (mg/day) and dose by weight (mg/kg/dose) were examined. RESULTS Race and insurance type together were associated with specific patterns of stimulant dosage, with higher dosing seen in Medicaid-insured non-African-American children and in privately insured African-American children. Total daily dose increased with age; however, there was an inverse relationship between age and dose by weight. There were no significant associations of gender, cognitive level, use of additional psychopharmacological medications, or other factors with total daily dose or dose by weight. CONCLUSIONS The sociocultural factors of race and insurance type were related to dosing of stimulant medications in children. Total daily doses increased with age, while younger children were treated with higher weight-based doses. Attention to these factors should be given in the titration of stimulant medications in the treatment of ADHD. Other factors, including gender, had no specific association.
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Affiliation(s)
- Paul H Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA.
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Radigan M, Lannon P, Roohan P, Gesten F. Medication patterns for attention-deficit/hyperactivity disorder and comorbid psychiatric conditions in a low-income population. J Child Adolesc Psychopharmacol 2005; 15:44-56. [PMID: 15741785 DOI: 10.1089/cap.2005.15.44] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aims of this study were two-fold: (1) to describe the patterns of comorbid psychiatric diagnosis and psychotropic drug therapy for children enrolled in a Medicaid-managed care program and diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 2000 and (2) to examine child and provider characteristics associated with psychotropic medication patterns for this population. Multivariate logistic regression models were used to examine correlates of stimulant and seven nonstimulant psychotropic medication classes (alpha-agonists, mood stabilizer/anticonvulsant, antianxiety, standard antipsychotic, atypical antipsychotic, and tricyclic antidepressant (TCA)/other antidepressant and selective serotonin reuptake inhibitor (SSRI) antidepressant). With the exception of conduct disorders (odds ratio, 1.22; 95% confidence interval, 1.06-1.40), comorbid disorders had a significant protective effect (odds ratio less than 1) on dispensing stimulants. After adjusting for covariates, stimulant dispensing was strongly correlated with the interactions of geographic region with race/ethnicity and provider type. Children residing in the upstate New York region had an approximately ten-fold greater chance of being dispensed a stimulant compared to similar children in New York City. Utilizing a mental health provider increased the chance of being dispensed a stimulant by factor of two for children from New York City of any race/ethnicity group. Models predicting nonstimulant drug dispensing were distinct from the stimulant model. After adjusting for covariates, nonstimulant psychotropic medication dispensing was correlated with clinical factors, including comorbid disorder category and use of a mental health provider, as well as notable sociodemographic factors. Complex psychotropic medication and comorbid psychiatric disorder patterns were evident for this low-income population of children with ADHD. The roles of clinical, patient, and provider factors need to be better understood to explain these patterns of stimulant and nonstimulant psychotropic medications dispensed.
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Affiliation(s)
- Marleen Radigan
- New York State Department of Health, Office of Managed Care, Bureau of Quality Management and Outcomes Research, Albany, New York 12237, USA.
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Habel LA, Schaefer CA, Levine P, Bhat AK, Elliott G. Treatment with stimulants among youths in a large California health plan. J Child Adolesc Psychopharmacol 2005; 15:62-7. [PMID: 15741787 DOI: 10.1089/cap.2005.15.62] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the use of stimulants among youths in a large and diverse health plan in California from 1996-2000. METHODS Computerized pharmacy, outpatient visit, and membership files were used to conduct a population-based analysis of stimulant use among over 500,000 enrollees aged 2-18 years. Annual prevalence rates of stimulant use were estimated by calendar year, age, gender, and geographic area. RESULTS The annual percentage of continuously enrolled 2- through 18-year-olds receiving at least one prescription for a stimulant rose from 1.86% (95% confidence interval (CI) 1.82-1.90) in 1996 to 1.93% (95% CI, 1.90-1.96) in 2000. An increase was observed only among girls 8 years of age or older and among boys 12 years or older. Use of methylphenidate decreased, whereas use of extended-release amphetamine products increased. Stimulant use was lower and use of other psychotropic drugs was higher among children with visits for attention-deficit/hyperactivity disorder (ADHD) and a coexisting psychiatric disorder than among those seen for ADHD alone. Of the 11,698 children receiving at least one stimulant in 2000, 24% of these children received a single prescription. Approximately 55% of stimulant prescriptions were written by physicians in pediatrics and 45% by physicians in psychiatry. CONCLUSIONS The prevalence of treatment with stimulants was lower than what generally has been reported in other parts of the United States; it increased by approximately 4% between 1996 and 2000, and was frequently short term or intermittent.
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Affiliation(s)
- Laurel A Habel
- Division of Research, Kaiser Permanente, Oakland, California, USA.
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Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X, Hong Y, Eckel RH. Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease. Circulation 2004; 110:2952-67. [PMID: 15509809 DOI: 10.1161/01.cir.0000145546.97738.1e] [Citation(s) in RCA: 590] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity adversely affects cardiac function, increases the risk factors for coronary heart disease, and is an independent risk factor for cardiovascular disease. The risk of developing coronary heart disease is directly related to the concomitant burden of obesity-related risk factors. Modest weight loss can improve diastolic function and affect the entire cluster of coronary heart disease risk factors simultaneously. This statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism reviews the relationship between obesity and the cardiovascular system, evaluates the effect of weight loss on coronary heart disease risk factors and coronary heart disease, and provides practical weight management treatment guidelines for cardiovascular healthcare professionals. The data demonstrate that weight loss and physical activity can prevent and treat obesity-related coronary heart disease risk factors and should be considered a primary therapy for obese patients with cardiovascular disease.
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DeBar LL, Lynch FL, Boles M. Healthcare use by children with attention deficit/hyperactivity disorder with and without psychiatric comorbidities. J Behav Health Serv Res 2004; 31:312-23. [PMID: 15263869 DOI: 10.1007/bf02287293] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined healthcare services used by children with attention-deficit/hyperactivity disorder (ADHD), with and without psychiatric comorbidities. The study was conducted in a large health maintenance organization in the Pacific Northwest on all continuously enrolled children aged 5 to 12 from January 1997 through July 1998. The study measured all outpatient medical care, specialty mental health care services, and prescription drug dispensings from computer records. Children with ADHD, with and without other psychiatric comorbidities, use more general medical services than do other groups of children, including outpatient visits, acute care (emergency room [ER] urgent care) visits. ADHD and other psychiatric comorbidities lead to higher use of specialty mental health services and greater use of psychotropic medications.
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Affiliation(s)
- Lynn L DeBar
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Köster I, Schubert I, Döpfner M, Adam C, Ihle P, Lehmkuhl G. Hyperkinetische Störungen bei Kindern und Jugendlichen: Zur Häufigkeit des Behandlungsanlasses in der ambulanten Versorgung nach den Daten der Versichertenstichprobe AOK Hessen/KV Hessen (1998-2001). ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2004; 32:157-66. [PMID: 15357012 DOI: 10.1024/1422-4917.32.3.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Für die Jahre 1998 bis 2001 wird untersucht, wie häufig und von welchen Arztgruppen der Behandlungsanlass «Hyperkinetische Störung» (HKS) bei Kindern und Jugendlichen in der ambulanten Versorgung als Abrechnungsdiagnose dokumentiert wird. Methode: Die Untersuchung basiert auf personenbezogen erhobenen pseudonymisierten Daten der Gesetzlichen Krankenversicherung. Die Stichprobe umfasst n = 41930 Kinder/Jugendliche bis zu 15 Jahren (1998). Für die Jahre 1998 und 1999 wurden Klartextdiagnosen, für die Jahre 2000 und 2001 die HKS-Kodierung ICD-10: F90.0-F90.9 zur Definition herangezogen. Ergebnisse: In der Altersgruppe der 3- bis 15-Jährigen steigt der Anteil mit einer HKS-Krankenscheindiagnose von 1,6% (1998) auf 2,4% (2001). Jungen erhalten ca. vier mal häufiger eine HKS-Diagnose als Mädchen (2001: 3,8% vs. 1,0%). Die höchste administrative Prävalenz liegt sowohl für Jungen (2001: 5,8%) wie für Mädchen (2001: 1,4%) in der Altersgruppe der 7- bis 10-Jährigen. Bei 54% der Kinder mit HKS wurde 2001 die Diagnose beim Kinderarzt dokumentiert, es folgen Allgemeinärzte (29%) und Kinder- und Jugendpsychiater (15%). Über vier Jahre betrachtet, zeigt sich bei den Kinder- und Jugendpsychiatern und Polikliniken eine deutliche Zunahme in der Behandlungshäufigkeit des HKS. Schlussfolgerung: Die Daten zeigen eine Zunahme in der administrativen Prävalenz des HKS im Zeitraum 1998 und 2001. Diese liegt im unteren Bereich der in repräsentativen Bevölkerungsstichproben ermittelten Prävalenzen.
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Affiliation(s)
- Ingrid Köster
- PMV Forschungsgruppe an der Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln.
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Abstract
Treatment of hyperactive child is multimodal, a combination of behaviour therapy and medication. Stimulant drugs are the most often prescribed medications. In France, we use methylphenidate (Ritaline); its efficacy was demonstrated with mild side effects. New formulations of methylphenidate with prolonged action, and non-psychostimulant treatment (atomoxetine) are available in some countries, but not yet in France.
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Affiliation(s)
- M-F Le Heuzey
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris 19, France.
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Healthcare Use by Children With Attention Deficit/Hyperactivity Disorder With and Without Psychiatric Comorbidities. J Behav Health Serv Res 2004. [DOI: 10.1097/00075484-200407000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Psychopharmakaverordnungen bei Kindern und Jugendlichen mit Behandlungsanlass „Hyperkinetische Störung“. J Public Health (Oxf) 2003. [DOI: 10.1007/bf02957772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Greydanus DE, Pratt HD, Sloane MA, Rappley MD. Attention-deficit/hyperactivity disorder in children and adolescents: interventions for a complex costly clinical conundrum. Pediatr Clin North Am 2003; 50:1049-92, vi. [PMID: 14558681 DOI: 10.1016/s0031-3955(03)00081-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) is reviewed, including psychological and pharmacologic approaches. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, educator/teacher training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants, antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Management of ADHD should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient (child or adolescent), and judicious use of medications. Parents, school officials, and clinicians must work together to help all children and adolescents with ADHD achieve their maximum potential.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatrics & Human Development, Michigan State University College of Human Medicine, A110 East Fee Hall, East Lansing, MI 48824, USA.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:621-36. [PMID: 12462142 DOI: 10.1002/pds.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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