Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents
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Despite a large body of evidence for both the validity of the diagnosis of attention deficit hyperactivity disorder (ADHD) and the efficacy of its treatment with medication, there is an equally long history of controversy. This article focuses on presenting safety information for medications approved by the US FDA for the treatment of individuals with ADHD.
Stimulant medications are generally safe and effective. The common adverse effects of stimulant medications, including appetite suppression and insomnia, are usually of mild severity and manageable without stopping the medication. The more severe adverse effects such as tics or bizarre behaviours occur with low frequency and usually resolve when the medication is stopped. The possible impact on growth requires careful monitoring. Several rare but potentially severe adverse effects including sudden cardiac death and cancer following long-term treatment have been reported; however, these effects have not been adequately demonstrated to be of significant concern at this time. Atomoxetine also has a mild adverse effect profile in terms of severity and frequency although the numbers of studies and years of clinical experience is considerably less with this drug than for the stimulant medications.
When the risks are juxtaposed to the clear efficacy in significantly reducing dysfunctional symptoms of ADHD, benefit-risk analyses support the continued use of these pharmacological treatments for patients with ADHD.
KeywordsAttention Deficit Hyperactivity Disorder Sudden Cardiac Death Methylphenidate Attention Deficit Hyperactivity Disorder Atomoxetine
No sources of funding were used in the preparation of this review. Laura McGuinn and Melissa Doffing have no conflicts of interest relevant to the content of this review. Mark Wolraich is a consultant to Shire and Eli Lilly and has received research support from Eli Lilly. He has also acted as a consultant to McNeil.
- 2.Bradley C. The behavior of children receiving benzedrine. A J of Psychiatry 1937; 94: 577–85Google Scholar
- 3.Clements SD. Minimal brain dysfunction in children: terminology and identification. Washington, DC: US Department of Health, Education and Welfare, 1966Google Scholar
- 6.Miller A, Lee SK, Raina P, et al. A review of therapies for attention deficit/hyperactivity disorder. Vancouver: Research Institute for Chilldren’s and Women’s Health and University of British Columbia, 1998Google Scholar
- 7.Swanson JM, McBurnett K, Wigal T, et al. Effect of stimulant medication on children with ADD: a “Review of Reviews”. Exceptional Children. 1993; 60: 154–62Google Scholar
- 13.Michelson D, Adler L, Spencer T, et al. Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry 2003, 20Google Scholar
- 22.MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics 2004 113: 754–61Google Scholar
- 23.Avigan M. Review of AERS data from marketed safety experience during stimulant therapy: death, sudden death, cardiovascular SAEs (including stroke): Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Drug Evaluation and Research; April 27, 2004, D030403Google Scholar
- 29.US Drug Enforcement Agency. Yearly aggregate production quotas. Washington, DC: Drug Enforcement Administration Office of Public Affairs, 1995Google Scholar
- 31.Anonymous. Another long-acting methylphenidate (Metadate CD). Med Lett Drugs Ther 2001 43: 83–4Google Scholar
- 38.Transdermal methylphenidate (Daytrana) for ADHD. Med Lett Drugs Ther 2006 Jun 19; 48 (1237): 49–51.Google Scholar
- 42.MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004 113: 762–9Google Scholar
- 57.Physicians’ Desk Reference. Montvale, NJ: Thomson Healthcare, 2006Google Scholar
- 64.Wong DT, Threlkeld PG, Best KL, et al. A new inibitor of norepinehrine uptake devoid of affinity for receptors in rat brain. J Pharmacolog Exp Ther 1982; 222: 61–5Google Scholar