Management of stimulant medications in children with attention-deficit/hyperactivity disorder.

In the United States, considerable media attention has been given to the growing number of youth diagnosed with ADHD and treated with psychotropic medications. The efficacy of stimulant medications long has been recognized clinically and is well documented in research. Studies suggest that treatment with stimulant therapy, when properly done, is more effective than psychosocial interventions that did not yield any significant benefits on a range of behavioral, emotional, psychosocial, and academic measures. The purpose of this article is to provide clinicians with everything they need to know but were afraid to ask about stimulant therapy for children and adolescents with ADHD.

Predictors of weight loss in children with attention deficit hyperactivity disorder treated with stimulant medication.

OBJECTIVE: A retrospective study was undertaken to examine predictors of weight loss in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication. DESIGN: Children diagnosed with ADHD and treated with methylphenidate hydrochloride (MPH) or dextroamphetamine sulfate (DEX) for at least 5 months were identified by retrospective chart review. Analyses were performed on 32 children (29 boys) treated with MPH and 28 children (25 boys) treated with DEX. Variables examined included pretreatment weight, pretreatment body mass index (BMI), duration of treatment, total daily dose, and weight-adjusted dose. RESULTS: The MPH-treated group was initially seen at a mean age (+/- standard deviation) of 7.5 years (+/- 2.1). Mean duration of follow-up was 11.2 months (+/- 3.8). Mean total daily dose was 25.5 mg (+/- 8.2) and mean weight-adjusted dose was 1.0 mg/kg/day (+/- .5). Mean change in weight as expressed in z scores was -0.4 SD (+/- .7). The DEX-treated group was initially seen at a mean age of 9.3 years (+/- 2.7). Mean duration of follow-up was 10.8 months (+/- 4.1). Mean total daily dose was 14.9 mg (+/- 8.2) and mean weight-adjusted dose was .5 mg/kg/day (+/- .3). Mean change in weight was -0.6 SD (+/- .6). Although the MPH group was younger than the DEX group, there were no between-group differences in weight or height either before treatment or at follow-up when adjusted for age and gender. Using linear regression analysis, significant correlations were found between pretreatment weight and change in weight for both the MPH-treated group (r = .63) and the DEX-treated group (r = .47). Stepwise multiple-regression analysis indicated that pretreatment age, weight-adjusted dose, and duration of follow-up did not significantly contribute to the variance in change of weight for either the MPH- or DEX-treated groups. To adjust for height, changes in BMI were also analyzed. For both medication groups, no differences were found between the heavier (BMI > or = 50%) and thinner (BMI < 50%) children in duration of follow-up, total daily dose, or weight-adjusted dose. When the medication groups were combined, a greater proportion of heavier children experienced a decrease relative to their predicted BMI compared with thinner children (80% vs 52%). Comparisons of mean BMI slopes revealed that the heavier group experienced an absolute decrease in their BMI (-.139) in contrast to the thinner group (+.014) (t = 2.70). CONCLUSIONS: Pretreatment weight, adjusted for age, gender, and height, is a significant predictor of weight loss in children with ADHD treated with either MPH or DEX. In contrast, pretreatment age, duration of treatment, and weight-adjusted dose were not found to be significant predictors.

Tics and dyskinesias associated with stimulant treatment in attention-deficit hyperactivity disorder.

OBJECTIVE: To determine the incidence of tics or dyskinesias (T/D) and examine associated clinical factors in children treated with stimulant medications for attention-deficit hyperactivity disorder. DESIGN: Cross-sectional analysis of a clinic cohort with chart review. SETTING: Hospital-based clinical service within a division of developmental and behavioral pediatrics. PATIENTS: One hundred twenty-two children with attention-deficit hyperactivity disorder treated with stimulant medication. All children currently or recently treated were included. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Determinations were made of medication used, medication dosage, presence or absence of T/D, time of T/D onset, and history and family history of T/D. Incidence of T/D was 9.0% of children or 8.2% of medication trials. One child (0.8%) had development of Tourette's syndrome. Age, medication, dosage, history of tics, or family history of tics was not related to onset of T/D. CONCLUSION: Approximately 9% of children with attention-deficit hyperactivity disorder treated with stimulant medication had development of T/D, predominantly transient in nature, with less than 1% having development of chronic tics or Tourette's syndrome. Personal or family tic history, medication selection, or dosage was not related to onset of T/D.

Therapeutic adherence to oral medication regimens by adolescents with cancer. II. Clinical and psychologic correlates.

The focus of our study was to identify specific demographic, treatment, and psychologic factors that may differentiate patients who complied with cancer therapy from those who did not. In a companion study, bioassay techniques revealed frequent nonadherence to oral medication regimens among 50 adolescents and young adults with acute lymphoblastic leukemia or Hodgkin disease. In this sample, compliers and noncompliers did not differ with respect to either demographic variables (age, gender) or treatment variables (treatment duration, continuity, complexity, or parental involvement). Psychologic variables were assessed in 34 patients. Patients who adhered poorly to the therapeutic regimen had significantly less developed concepts of the illness (specifically, concepts of causality and prognosis), less perceived vulnerability (especially as related to subclinical disease), higher levels of denial as a psychologic defense, and less cohesive future orientation. The perceived health locus of control was not a significant factor. The results suggest that patients construct their own subjective view of the illness and its treatment, which then has implications for adherence to medication regimens.

Otitis media in children with learning disabilities and in children with attention deficit disorder with hyperactivity.

A retrospective study was conducted to compare history of middle ear disease children with an attention deficit disorder with hyperactivity (ADD-H) and children with a learning disability. Of 138 children evaluated in a child development clinic, learning disability without ADD-H was diagnosed in 45 (29 boys, 16 girls; mean age = 9.5 years) and ADD-H without learning disability was diagnosed in 21 (17 boys, 4 girls; mean age = 8.5 years). Based on parental report, children with ADD-H had significantly more complaints of earaches during the preceding 3 months and significantly more ear infections during the preceding year. Specifically, no between-group differences were observed for total number of ear infections since birth, extended antibiotic therapy, tympanostomy tube placement, or recent hearing problems. Although middle ear disease in preschool children has repeatedly been linked to later language deficits, this study suggests that middle ear disease in school-age children may also be associated with hyperactivity and/or inattention, independently of learning disability.