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Pharmacotherapy of the Preschool ADHD Treatment Study (PATS) Children Growing Up
Journal of the American Academy of Child & Adolescent Psychiatry, 2015
Objective-To describe the long-term psychopharmacological treatment of children first diagnosed with attention-deficit/hyperactivity disorder (ADHD) as preschoolers. Method-In a systematic, prospective, naturalistic follow-up, 206 (68.0%) of the 303 children who participated in the Preschool ADHD Treatment Study (PATS) were reassessed 3 years (mean age 7.4 years), and 179 (59.1%), 6 years (mean age 10.4 years), after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50% of the days in the previous 6 months. Results-At year 3, 34.0% were on no pharmacotherapy, 41.3% were on stimulant monotherapy, 9.2% on atomoxetine, alone or with a stimulant, 8.3% on an antipsychotic, usually together with a stimulant, and the remaining 7.2% on other pharmacotherapy; overall, 65.0% were on an indicated ADHD medication. At year 6, 26.8% were on no pharmacotherapy, 40.2% were on stimulant monotherapy, 4.5% on atomoxetine, alone or with a stimulant, 13.4% on an antipsychotic, and 15.1% on other pharmacotherapy; overall, 70.9% were on an indicated ADHD medication.
Recent Progress in Psychosocial and Psychopharmacologic Treatments for ADHD
Current Treatment Options in Psychiatry, 2015
In this article, we review several new psychosocial and psychopharmacologic treatment approaches for attention deficit hyperactivity disorder (ADHD). Several of the treatments reviewed are promising and offer opportunities for augmenting current evidence-based approaches. However, others are not yet ready for prime time. Consequently, existing algorithms for ADHD treatment should still be followed. Current guidelines include those from the American Academy of Pediatrics (Wolraich et al. Pediatrics. 128 5:1007-22 2011), the American Academy of Child and Adolescent Psychiatry (AACAP) (Pliszka S and AACAP Work Group on Quality Issues. J Am Acad Child Adolesc Psychiatry. 46 7:894-921 2007), and the Texas Department of Mental Health and Mental Retardation (Pliszka et al. J Am Acad Child Adolesc Psychiatry. 45 6:642-57 2006). These treatment recommendations and algorithms are based on results from both controlled clinical trials and expert opinion. For core symptoms, medication is considered superior to psychosocial treatment. However, the full range of ADHD-associated impairments is best addressed by combined treatment, with an emphasis on behavioral interventions as first-line approaches when treating preschool children with ADHD. The availability of an evidencebased organizational skills training program is a welcome addition for targeting problems with organization and attention-related impairments in children. Among available medication treatments, stimulants are considered to have the most robust effects on core symptoms; however several non-stimulant medications are available and others are being investigated for possible utility. Combined pharmacotherapy with stimulants and α2 agonists is now an FDA-approved treatment and can be considered in youth who are not fully responsive to stimulants or who have other problems which may represent indications for α2 agonist treatment. Combined treatment with stimulants plus risperidone has merit in youth with severe aggressive behavior but remains off-label and should generally be considered when other options fail. The potential risk and benefits of stimulant treatment for subsequent substance abuse remains an important topic. In the main, stimulant treatment is considered safe and may even provide protection against development of substance abuse. However, the possibility that stimulant exposure could be problematic in youth with elevated risk for substance abuse disorders should be considered.
Drugs & Therapy Perspectives, 2013
Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that can result in significant functional impairment, and if not adequately treated can lead to impaired quality of life. Pharmacotherapy is considered the first-line treatment for ADHD in children and adolescents. We review both recent literature and seminal studies regarding the pharmacological treatment of ADHD in children and adolescents. There is ample evidence for the efficacy and safety of both stimulants and nonstimulants in the treatment of ADHD. We review important aspects of evaluation and assessment and discuss first-line pharmacological treatments and as well as when to consider using alternative pharmacological agents. Treatment approaches to manage frequently seen comorbid disorders with ADHD are also covered.
ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN CHILDHOOD: CURRENT TRENDS IN MULTIDISCIPLINARY THERAPY (Atena Editora), 2023
Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neuropsychiatric disorder in children, with a prevalence of 5% in schoolchildren in Brazil. The primary symptoms are attention deficit, hyperactivity and impulsivity, other presentations may be difficult to perform basic activities that require concentration, low academic performance, anxiety, feelings of guilt and inadequacy. In this context, ADHD presents a heterogeneous clinical picture, requiring an assertive diagnostic approach and multifactorial therapy. Given the importance of the topic, the present work consists of a literature review with articles published in the Scielo and Pubmed databases, with the combined descriptors "ADHD", "children", "treatment", and aims to present and discuss the pharmacological and non-pharmacological approaches currently used in the treatment of ADHD in children. In the therapeutic approach to ADHD, the process begins with family and school guidance, aiming for better adherence to treatment. The first-line pharmacological treatment recommended for children with ADHD is methylphenidate (MFD), which is available in immediate-release or prolonged-release form. The use of tricyclic and atypical antidepressants, such as imipramine and bupropion, respectively, also has good evidence. In this sense, the pharmacological choice requires an individualized assessment, and must be associated early with non-drug interventions, especially in the context of psychotherapy, highlighting Cognitive Behavioral Therapy (CBT), which uses techniques such as self-instruction, self-monitoring, planning and creation of reward systems that motivate the child during therapy. Therefore, ADHD in childhood appears to be a very complex condition, which demands treatment that involves the participation and understanding of the family, with a focus on social inclusion in different sectors, such as the school environment, aiming at continued care, which is value of the pharmacological and non-pharmacological devices available in the health system.
Translational pediatrics, 2018
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children and adolescents. ADHD affects multiple aspects of an individual's life and functioning in family, social, and academic realms. Effective management of ADHD is necessary for children and adolescents and may include non-pharmacologic treatments, pharmacologic therapy including use of stimulant and non-stimulant medications, or a combination of the different treatment modalities. In general, medications used to treat ADHD are safe and effective. Medical practitioners can follow a step-wise approach in the selection and adjustment of pharmacologic agents to treat ADHD, while working closely with families, caregivers, and other medical and educational professionals to form appropriate treatment plans. This article reviews practical aspects of pharmacological treatment of ADHD in children and adolescents.