Current issues around the pharmacotherapy of ADHD in children and adults
- 4.7k Downloads
Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Conclusion Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine.
KeywordsAdults Attention deficit hyperactivity disorder Children and adolescents Pharmacotherapy
Conflicts of interest statement
Willemijn Meijer is an employee of PHARMO Institute. This research institute performs financially supported studies for several pharmaceutical companies. For this publication no relations apply.
In the past Adrianne Faber received a limited research grant from Janssen-Cilag. For this publication no relations apply.
Els van den Ban received following financial supports: from Janssen-Cilag for lecture, reimbursed travel to convention; from Ely-Lilly for scientific research (no personal grant), lecture, advisory board, reimbursed travel to convention; from UCB Pharma for advisory board, reimbursed travel to convention: from Eurosept for lecture (no personal grant), reimbursed travel to convention. For this publication no relations apply.
Hilde Tobi received financial support from Janssen-Cilag for other research projects. For this publication no relations apply.
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
- 1.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author: American Psychiatric Association; 1994.Google Scholar
- 3.Mental Health in the United States. Prevalence of diagnosis, medication treatment for attention-deficit/hyperactivity disorder––United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;4(34):842–7.Google Scholar
- 4.Barkley R. Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment. 3rd ed. New York: The Guilford Press; 2006.Google Scholar
- 8.Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, et al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005;57(11):1442–51. doi: 10.1016/j.biopsych.2005.04.001.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.de Graaf R, Kessler RC, Fayyad J, Ten Have M, Alonso J, Angermeyer M, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med. 2008;65:835–42.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23. doi: 10.1176/appi.ajp.163.4.716.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). NIH Consens Statement. 1998;16(2):1–37.Google Scholar
- 20.Kutcher S, Aman M, Brooks SJ, Buitelaar J, van Daalen E, Fegert J, et al. International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): clinical implications and treatment practice suggestions. Eur Neuropsychopharmacol. 2004;14(1):11–28. doi: 10.1016/S0924-977X(03)00045-2.CrossRefPubMedGoogle Scholar
- 21.Multidisciplinaire richtlijn ADHD: richtlijn voor de diagnostiek en behandeling van ADHD bij kinderen en jeugdigen. Utrecht: Trimbos-instituut. 2005.Google Scholar
- 27.Newcorn JH, Kratochvil CJ, Allen AJ, Casat CD, Ruff DD, Moore RJ, et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. Am J Psychiatry. 2008;165(6):721–30. doi: 10.1176/appi.ajp.2007.05091676.CrossRefPubMedGoogle Scholar
- 28.Nutt DJ, Fone K, Asherson P, Bramble D, Hill P, Matthews K, et al. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2007;21(1):10–41. doi: 10.1177/0269881106073219.CrossRefPubMedGoogle Scholar
- 32.Schirm E, Tobi H, Zito JM, de Jong-van den Berg LT. Psychotropic medication in children: a study from the Netherlands. Pediatrics. 2001;108(2):E25. doi: 10.1542/peds.108.2.e25.
- 48.Bogas S. “Diagnosis du jour?” Understanding attentional deficits can sharpen our treatment strategies. Fam Ther Networker. 1997;21:63–7.Google Scholar
- 49.Smelter RW, Rasch BW. Is attention deficit disorder becoming a desired diagnosis? Phi Delta Kappan. 1996;77:429–32.Google Scholar
- 64.Pliszka SR, Matthews TL, Braslow KJ, Watson MA. Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(5):520–6. doi: 10.1097/01.chi.0000205702.48324.fd.CrossRefPubMedGoogle Scholar
- 67.http://www.fda.gov/cder/drug/advisory/adderall.html. Accessed 3 Sep 2008.
- 70.Kooij JJ, Burger H, Boonstra AM, Van der Linden PD, Kalma LE, Buitelaar JK. Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial. Psychol Med. 2004;34(6):973–82. doi: 10.1017/S0033291703001776.CrossRefPubMedGoogle Scholar