Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review

Treuer, Tamás; Méndez, Luis; Montgomery, William; Wu, Sheng Hu

doi:10.2147/ndt.s97724

Cited by 14 publications

(4 citation statements)

References 65 publications

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“…Moreover, in most studies, adherence was limited to compliance with and discontinuation of treatment in controlled settings. The inclusion of real-world observational trials may provide a better understanding of treatment adherence in naturalistic settings (Treuer, Me´ndez, Montgomery, & Wu, 2016).…”

Section: Limitationsmentioning

confidence: 99%

Challenges in ADHD care for ethnic minority children: A review of the current literature

Slobodin

Masalha

2020

Transcult Psychiatry

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While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.

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Section: Limitationsmentioning

confidence: 99%

Challenges in ADHD care for ethnic minority children: A review of the current literature

Slobodin

Masalha

2020

Transcult Psychiatry

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“…Clinical guidelines suggest that drug treatment is the preferred treatment for school-aged children with ADHD (10), and the side effects of most drugs are mild and gradually tolerated. However, parents, especially the parents of the younger age group, are still worried about the potential side effects, causing a low acceptance of and adherence to pharmacological intervention (47). Further, given that some parents might not be able to take part in field parent training due to varieties of reasons while children participated in GEF training, we launched the OPT course.…”

Section: Discussionmentioning

confidence: 99%

Effects of Combing Group Executive Functioning and Online Parent Training on School-Aged Children With ADHD: A Randomized Controlled Trial

Chu

Zhu

et al. 2022

Front. Pediatr.

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ObjectiveThe acceptance of drug treatment for younger children with attention-deficit/hyperactivity disorder (ADHD) in China remains low. Here, we explored the clinical benefits of a non-pharmaceutical intervention method combining a group and executive function training and an online parent training program, termed group executive functioning and online parent training (GEF-OPT), for school-aged students with ADHD through a randomized controlled trial.MethodA total of 145 children (aged 6–8 years) were formally registered and randomized to the intervention group (n = 73) and waitlist group (n = 72). The enrolled children received eight sessions of GEF-OPT treatment, which consists of a hospital-based children executive function (EF) training program and an online parent training program. Treatment outcome was assessed by a parent/teacher report questionnaire and neurophysiological experiment.ResultsAfter eight sessions of intervention, children in the intervention group showed a significant improvement in inattentive symptom compared to the waitlist group (14.70 ± 4.35 vs. 16.03 ± 2.93; p = 0.024), but an insignificant difference in hyperactive-impulsivity (9.85 ± 5.30 vs. 10.69 ± 5.10; p = 0.913). Comorbid oppositional defiant disorder was significantly reduced in the intervention group (7.03 ± 4.39 vs. 8.53 ± 4.41; p = 0.035). Children in the intervention group had greater reduction in the scores of behavioral regulation index (inhibition, emotional control) and metacognition index (working memory, planning/organization, monitoring) in executive function than those in the waitlist group (p < 0.05). Significant effects were also found in learning problem of Weiss Functional Impairment Scale–Parent form and parental distress between two groups at post-treatment (p < 0.05). In line with this, the result of go/no-go task showed significant improvements in accuracy change (4.45 ± 5.50% vs. 1.76 ± 3.35%; p = 0.001) and reaction time change (47.45 ± 62.25 s vs. 16.19 ± 72.22 s; p = 0.007) in the intervention group compared with the waitlist group.ConclusionWe conclude that participants in the GEF-OPT program improved outcomes for inattentive symptom, executive function, learning problems, and parental distress. GEF-OPT is a promising non-pharmaceutical therapeutic option for younger children.Trial RegistrationChiCTR2100052803.

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“…A retrospective study showed that 47% of patients responded well to atomoxetine, 13% had a minimal response, and 40% did not respond (Newcorn, Sutton, Weiss & Sumner, 2009). Furthermore, discontinuation of atomoxetine ranged from 8.4% to 26% due to the lack of efficacy (Sugimoto et al, 2021;Treuer, Méndez, Montgomery & Wu, 2016). Marked differences in atomoxetine concentrations may explain some of the variability in its clinical efficacy.…”

Section: Introductionmentioning

confidence: 99%

Personalizing Atomoxetine Dosing in Children with ADHD: What Can We Learn from Current Supporting Evidence

Guo

et al. 2022

Preprint

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Atomoxetine is the first non-stimulant medication approved by the US Food and Drug Administration for the treatment of attention deficit/hyperactivity disorder (ADHD). It can significantly improve ADHD symptoms, with good efficacy and tolerability. However, its efficacy was not consistent among all patients, especially for pediatric population. Due to marked heterogeneity in treatment response, a precision therapy should be developed and evaluated to guide treatment planning at the individual level. We have gained a better understanding of the pharmacokinetic profile. This review summarized some factors affecting peak concentrations of atomoxetine, including food, CYP2D6 and CYP2C19 phenotypes, and drug-drug interactions. The association between response and genetic polymorphisms of genes encoding the pharmacological targets such as norepinephrine transporter (NET/SLC6A2) and dopamine β hydroxylase (DBH) was also discussed. Based on the well-developed and validated assays for monitoring plasma concentrations of atomoxetine, the therapeutic reference range in pediatric patients with ADHD proposed by several studies was summarized. However, supporting evidence on the relationship between systemic atomoxetine exposure levels and clinical response is far from sufficient. We have to create evidence to characterize clearly the dose-exposure relationship, to establish clinically relevant metric for systemic exposure, to define a therapeutic exposure range, and to provide a dose-adaptation strategy before implementing personalized dosing for atomoxetine in children with ADHD. Personalizing atomoxetine dosage may be even more complex than we anticipated, but we can be optimistic about the future based on the remarkable advances in understanding the nature and causes of ADHD, as well as environmental stressors.

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Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review

Cited by 14 publications

References 65 publications

Challenges in ADHD care for ethnic minority children: A review of the current literature

Challenges in ADHD care for ethnic minority children: A review of the current literature

Effects of Combing Group Executive Functioning and Online Parent Training on School-Aged Children With ADHD: A Randomized Controlled Trial

Personalizing Atomoxetine Dosing in Children with ADHD: What Can We Learn from Current Supporting Evidence

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