Effect of Anxiety on Cognition, Behavior, and Stimulant Response in ADHD

Pliszka, Steven R.

doi:10.1097/00004583-198911000-00012

Cited by 276 publications

(162 citation statements)

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“…Excluded from the study were subjects with a conduct disorder, internalizing disorder (e.g., anxiety), and low intelligence (IQ Ͻ 80). Children with coexisting anxiety were excluded because of the evidence that they may have a differential medication response (Pliszka 1989). A coexisting conduct disorder was used to exclude children in an attempt to reduce the heterogeneity of the sample.…”

Section: Methods Participantsmentioning

confidence: 99%

Effect of Methylphenidate on Attention in Children with Attention Deficit Hyperactivity Disorder (ADHD) ERP Evidence

Sunohara

Malone

Rovet³

et al. 1999

Neuropsychopharmacology

109

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Methylphenidate is the most common treatment for attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is the most common pediatric psychiatric disorder (Swanson et al. 1995), with an estimated childhood prevalence of 9% in boys and 3% in girls (Szatmari et al. 1989). Surface symptoms of inattentiveness and impulsivity (Shue and Douglas 1992;Shaywitz and Shaywitz 1988) are often, though not invariably, accompanied by hyperactivity (Gittelman and Mannuzza 1985). ADHD is highly heterogeneous with several distinct subtypes and often comorbid with learning, anxiety, and conduct problems. During childhood, ADHD is associated with greater risk of low academic achievement, grade failure, delinquency (Barkley 1997) and during adulthood, with psychiatric disorders and substance abuse (Wender 1987). Stimulant medication, primarily methylphenidate, is the most common treatment for ADHD. Because methylphenidate may be associated with altered neurotransmitter levels (Mefford and Potter 1989; Voeller 1991), several investigators have attributed ADHD to a neuroFrom the Novartis Pharmaceuticals Canada Inc., (GAS), Dorval, Quebec, Canada; and The Hospital for Sick Children, Divisions of Neurology (MAM, TH, WR, MJT) and Psychology Research (JR), Toronto, Ontario, Canada.Address correspondence to: Dr. Molly A. Malone, Child Development Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.Received August 26, 1998; revised December 30, 1998; accepted February 05, 1999. N EUROPSYCHOPHARMACOLOGY 1999 -VOL . 21 , NO . 2 Methylphenidate and Attention in ADHD Children 219 chemical imbalance in catecholarnine regulation (Malone et al. 1994;McCracken 1991;Pliszka et al. 1996).Methylphenidate effectively reduces hyperactivity, impulsivity, and inattention in 60-90% of children diagnosed with ADHD (Whalen and Henker, 1991). Improved social skills and school performance have also been documented (e.g., Swanson et al. 1995). However, the optimal dosages have not yet been established and clinical anecdotal descriptions report some children as becoming overfocused, cognitively constricted, introverted, and "zombie-like" on higher doses (Swanson et al. 1991; Thurston et al. 1979). These descriptions are not consistently substantiated by empirical studies, however, which show both linear improvements with dose (Douglas et al. 1995;Solanto and Wender 1989) and adverse effects of high dose levels (Dyme et al. 1982;Malone et al. 1988;Sprague and Sleator 1977). A recent study by Tannock and Schachar (1992) has shown opposing effects of a high dose level at different test sessions with children making more perseverative errors in the first session and fewer in the second, while another study by this same group reported that despite clinical observations of overfocusing, measured attention performance was not affected by a high dose (Tannock et al. 1989).Children with ADHD are thought to have a primary attentional deficit in inhibitory (Barkley 1994;Schachar ...

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Section: Methods Participantsmentioning

confidence: 99%

Effect of Methylphenidate on Attention in Children with Attention Deficit Hyperactivity Disorder (ADHD) ERP Evidence

Sunohara

Malone

Rovet³

et al. 1999

Neuropsychopharmacology

109

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“…These difficulties can lead to low selfesteem, feelings of incapacity and inadequacy w h i c h maybe increased by the existence of a comorbid a nxious disord e r 6 , 7 . 9 . Clinicians must be aware of comorbid conditions among ADHD patients and make eff o rts to identify these symptoms early in t h e t reatment as anxiety shall cause clinically signific a n t impairment and distress during daily activities .…”

Section: Resumo -O B J E T I V O: Avaliar a Presença De Transtornos Dmentioning

confidence: 99%

Anxiety disorders in an attention-deficit/hyperactivity disorder clinical sample

Souza

Pinheiro²,

Mattos

2005

Arq. Neuro-Psiquiatr.

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For many years, childhood anxiety was considered a benign and transitory disorder with a good o u tcome. More recent studies, however, show this b elief was wro n g 1 . Anxiety disorders are now considered chronic and pervasive and their prevalence increases throughout adolescence 2 . These children show a generalized anxious feeling with excessive w o rries about their parents, school tests, future events and visits to a doctor or past behavior. They a re also distressed about their competence, behavior and performance in different settings such as school, sports and social relationships and experience physical distress with flushing, rapid heart b e a t , headache, insomnia, agitation, muscles cramps a n d u r i n a ry urg e n c y. Young children might also show separation anxiety, which is a very particular feeling of distress, along with worries about separating f ro m parents or other close ones. These symptoms are usually expressed by refusing to go to school and inability to perf o rm social functions. Some anxious children develop specific fears with avoidance behaviors and social impairment. Obsessive-compulsive disorder can also be diagnosed in children.Anxiety disorders are one of the most studied fields of comorbid conditions with attention deficit hyperactivity disorder (ADHD). Several studies documented a high prevalence of comorbidity in child ren and adolescents suffering from ADHD (Ta b l e 1). There are two Brazilian studies re p o rting pre v alence rates similar to those described in intern a t i onal literature. Also, when using strict diagnostic criteria, there is no diff e rence in the prevalence rates ABSTRACT -Objective: To evaluate the prevalence of anxiety disorders in a clinical referred sample of child ren and adolescents with attention deficit/hyperactivity disorder (ADHD). M e t h o d : 78 children and adolescents with ADHD according to DSM-IV criteria were investigated with a semi-structured interview (P-CHIPS), complemented by clinical interviews with the children or adolescents and their parents. Their IQ was calculated with neuropsychological testing. Results: A high prevalence of anxiety disorders (23.05%) was found in the sample. Generalized anxiety disorder was the most prevalent disorder (12,8%), followed by social phobia (3,84%) and separation anxiety disorder (3,8%). Two children showed more than one anxiety disord e r. C o n c l u s i o n : C h i l d ren and adolescents with ADHD seem to be more prone to have comorbid anxiety disorders, at least in clinical samples referred to specialized units.KEY WORDS: ADHD, attention deficit hyperactivity disorder, anxiety, comorbidity.Transtorno de ansiedade em amostra de pacientes com déficit de atenção e hiperatividade RESUMO -O b j e t i v o: Avaliar a presença de transtornos de ansiedade numa amostra clínica referida de crianças e adolescentes com transtorno do déficit de atenção e hiperatividade (TDAH). M é t o d o:78 crianças c o m TDAH de acordo com os critérios da DSM-IV foram avaliadas através de entrevista semi-estruturada...

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“…These children also had higher rates of side effects from stimulants, including tics. Dr. Barkley: Several studies [27][28][29][30][31][32][33][34] found a link between internalizing symptoms and a reduced response to methylphenidate. Two large recent studies are the exceptions: the MTA study 35 and the study by Abikoff et al 36 Neither of these new studies found a connection between anxiety and stimulant response.…”

Section: Dr Adlermentioning

confidence: 99%

“…Weiss: Have any researchers dissected the methodological differences between the 8 negative studies [27][28][29][30][31][32][33][34] and the 3 positive studies [35][36][37] of pharmacotherapy use in children with ADHD and comorbid anxiety? If the methodological differences were closely examined, that examination could lay the foundation for an accurate interpretation of why the findings are different.…”

mentioning

confidence: 99%

“…Barkley: The earlier studies [27][28][29][30][31][32][33][34] used dimensional ratings of anxiety, like the Child Behavioral Checklist, whereas the MTA 2 and the Abikoff et al 36 studies used diagnoses more closely aligned with the DSM. The obvious methodological problem in the use of different scales is simply that anxiety disorders were measured differently in the 2 studies, which can alter diagnosis.…”

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confidence: 99%

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Managing ADHD in Children, Adolescents, and Adults With Comorbid Anxiety in Primary Care

2007

Prim. Care Companion J. Clin. Psychiatry

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Effect of Anxiety on Cognition, Behavior, and Stimulant Response in ADHD

Cited by 276 publications

References 15 publications

Effect of Methylphenidate on Attention in Children with Attention Deficit Hyperactivity Disorder (ADHD) ERP Evidence

Effect of Methylphenidate on Attention in Children with Attention Deficit Hyperactivity Disorder (ADHD) ERP Evidence

Anxiety disorders in an attention-deficit/hyperactivity disorder clinical sample

Managing ADHD in Children, Adolescents, and Adults With Comorbid Anxiety in Primary Care

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