Adverse reactions of Methylphenidate in children with attention deficit-hyperactivity disorder: Report from a referral center

Khajehpiri, Zahra; Mahmoudi-Gharaei, Javad; Faghihi, Toktam; Karimzadeh, Iman; Khalili, Hossein; Mohammadi, Mostafa

doi:10.4103/2279-042x.145389

Cited by 16 publications

(4 citation statements)

References 36 publications

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“…The exact mechanism of action of MPH in ADHD is not completely understood, but they are presumed to act through the dopaminergic and adrenergic pathways of the frontostriatal areas in the brain by blocking the reuptake of dopamine into the presynaptic cleft ( 53 ) supported by executive dysfunction theoretical constructs on dopamine signaling deficits. The efficacy of MPH as documented in terms of reduction of at least one core symptom as determined by a parent or teacher using rating scales has been estimated at 70% ( 54 ), however, with adverse effects largely associated (most common are anorexia, insomnia, irritability) ( 55 ) and an estimated 30% of ADHD children resulting with severe negative outcomes ( 56 ) suggesting a different neural mechanism for their symptoms.…”

Section: Executive Dysfunction Theorymentioning

confidence: 99%

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Isaac,

Lopez,

Escobar

2024

Front. Psychiatry

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Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, that continues to have an elusive etiological background. A number of extant models and theories have historically intended to explain the many factors contributing to ADHD behaviors. One of the most accepted hypotheses has been the executive dysfunction theory associating reduction in executive control to abnormalities in structure and operational dysfunction of dopaminergic signaling networks. Nevertheless, executive functions are not always impaired in ADHD, and the literature describes other symptoms commonly reported suggesting individuals with ADHD would appear to suffer from a more general deficit. Another existing line of research, that has gained much attention recently, establishes that ADHD would have dysregulated states of brain arousal that would account for its commonly observed cognitive deficits and behavioral symptoms, described as the state regulation theory, which has now included measures of autonomic function. This article describes some important aspects that compose and challenge these two most influential theoretical constructs, executive dysfunction and state-regulation, based on their empirical evidence, implying the need to reevaluate the norms used to classify individuals and establish ADHD diagnosis. Large number of controversial results continue to exist within the study of ADHD biological and/or performance markers, possibly due to such heterogeneity and variability within the same diagnosis. The need to resolve these issues and establish newly revised diagnostic criteria for ADHD is critical, as therapeutic success depends on having accurately identified underlying neurophysiological factors in order to appropriately address them in treatment.

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Section: Executive Dysfunction Theorymentioning

confidence: 99%

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Isaac,

Lopez,

Escobar

2024

Front. Psychiatry

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“…This is incredibly important clinically as the current "first-line" treatments for ADHD which include stimulant class drugs such as methylphenidate and dexamphetamine have a suite of undesirable effects and carry high risk for adverse outcomes. Adverse effects such as nausea, insomnia, nervousness and reduced appetite occur very commonly following the use of these stimulant medications (97,98). Antidepressants and alpha agonists are also used in the treatment of ADHD and these come with their own adverse effect profiles and also aren't able to modify the course of this pathology (99,100).…”

Section: Role Of Neurosteroids In Preterm Birth Cerebellar Damagementioning

confidence: 99%

Potential for a cerebellar role in moderate-late preterm associated behavioural disorders

Pavy,

Shaw,

Moloney

et al. 2024

Front. Pediatr.

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Preterm birth is known to cause impaired cerebellar development, and this is associated with the development of neurobehavioral disorders. This review aims to identify the mechanisms through which preterm birth impairs cerebellar development and consequently, increases the risk of developing neurobehavioral disorders. The severity of these disorders is directly related to the degree of prematurity, but it is also evident that even late preterm births are at significantly increased risk of developing serious neurobehavioral disorders. Preterm birth is associated with hypoxic events and increased glutamatergic tone within the neonatal brain which contribute to excitotoxic damage. The cerebellum is a dense glutamatergic region which undergoes relatively late neurodevelopment up to and beyond birth. Evidence indicates that the cerebellum forms reciprocal connections to regions important in behaviour regulation such as the limbic system and frontal cortex. Studies using fMRI (functional magnetic resonance Imaging), BOLD (blood oxygen level dependent) response and morphology studies in humans show the cerebellum is often involved in disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety. The vulnerability of the cerebellum to preterm birth insult and its connections to behaviour associated brain regions implicates it in the development of neurobehavioral disorders. Protection against preterm associated insults on the cerebellum may provide a novel avenue through which ADHD and anxiety can be reduced in children born preterm.

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“…Five patients (8%) had side effects known to be associated with MPH use 20 (see Table 4). Side effects were reported for doses ranging from 0.28 to 0.97 mg/kg/d (the highest recorded dose in the study).…”

Section: Side Effects Of Methylphenidatementioning

confidence: 99%

The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns

Caliendo,

Lowder,

McLaughlin

et al. 2023

Journal of Head Trauma Rehabilitation

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Objective: To understand how methylphenidate (MPH) is used in youth with traumatic brain injury (TBI) during inpatient pediatric rehabilitation. Setting: Inpatient pediatric rehabilitation. Participants: In total, 234 children with TBI; 62 of whom received MPH and 172 who did not. Patients were on average 11.6 years of age (range, 2 months to 21 years); 88 of 234 were female; the most common mechanism of injury was motor vehicle collision (49%); median (IQR) acute hospital length of stay (LOS) and inpatient rehabilitation LOS were 16 (10-29) and 23 (14-39), respectively; 51 of 234 were in a disorder of consciousness cognitive state at time of inpatient rehabilitation admission. Design: Multicenter, retrospective medical record review. Main Measure(s): Patient demographic data, time to inpatient pediatric rehabilitation admission (TTA), cognitive state, MPH dosing (mg/kg/day). Results: Patients who received MPH were older (P = .011); TTA was significantly longer in patients who received MPH than those who did not (P =.002). The lowest recorded dose range by weight was 0.05 to 0.89 mg/kg/d, representing an 18-fold difference; the weight-based range for the maximum dose was 0.11 to 0.97 mg/kg/d, a 9-fold difference. Patients in lower cognitive states at admission (P = .001) and at discharge (P = .030) were more likely to receive MPH. Five patients had side effects known to be associated with MPH; no serious adverse events were reported. Conclusion: This multicenter study indicates that there is variable use of MPH during acute inpatient rehabilitation for children with TBI. Children who receive MPH tend to be older with lower cognitive states. Dosing practices are likely consistent with underdosing. Clinical indications for MPH use during inpatient pediatric rehabilitation should be better defined. The use of MPH, as well as its combination with other medications and treatments, during inpatient rehabilitation needs to be further explored.

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Adverse reactions of Methylphenidate in children with attention deficit-hyperactivity disorder: Report from a referral center

Cited by 16 publications

References 36 publications

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Potential for a cerebellar role in moderate-late preterm associated behavioural disorders

The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns

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