Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts

Chang, Zheng; Quinn, Patrick D.; O’Reilly, Lauren M.; Sjölander, Arvid; Hur, Kwan; Gibbons, Robert D.; Larsson, Henrik; D’Onofrio, Brian M.

doi:10.1016/j.biopsych.2019.12.003

Cited by 34 publications

(52 citation statements)

References 25 publications

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“…It also supports pharmacological treatment of comorbid ADHD in individuals with ASD. In a recent meta-analysis, 25-32% of individuals with ASD also fulfill criteria for ADHD 13 , yet only 15-16% are treated with ADHD medications 52,53 , despite strong evidence of beneficial effects on the core symptoms of ADHD and potentially also reduced risk of injuries 54 , depression 55 , suicidal behavior 56 and improved academic performance 57 . Moreover, it indicates that pharmacological treatment of symptoms like hyperactivity, inattention, impulsivity, aggression and tics in cases diagnosed with either ADHD or ASD may be guided by the individual symptomatology regardless of the given diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Identification of shared and differentiating genetic risk for autism spectrum disorder, attention deficit hyperactivity disorder and case subgroups

Mattheisen

Grove

et al. 2021

Preprint

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Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are highly heritable neurodevelopmental disorders with a considerable overlap in their genetic etiology. We dissected their shared and distinct genetic architecture by cross-disorder analyses of large data sets, including samples with information on comorbid diagnoses. We identified seven loci shared by the disorders and the first five genome-wide significant loci differentiating the disorders. All five differentiating loci showed opposite allelic directions in the two disorders separately as well as significant associations with variation in other traits e.g. educational attainment, items of neuroticism and regional brain volume. Integration with brain transcriptome data identified and prioritized several significantly associated genes. Genetic correlation of the shared liability across ASD-ADHD was strong for other psychiatric phenotypes while the ASD-ADHD differentiating liability correlated most strongly with cognitive traits. Polygenic score analyses revealed that individuals diagnosed with both ASD and ADHD are double-burdened with genetic risk for both disorders and show distinctive patterns of genetic association with other traits when compared to the ASD- only and ADHD-only subgroups. The results provide novel insights into the biological foundation for developing just one or both of the disorders and for driving the psychopathology discriminatively towards either ADHD or ASD.

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Section: Discussionmentioning

confidence: 99%

Identification of shared and differentiating genetic risk for autism spectrum disorder, attention deficit hyperactivity disorder and case subgroups

Mattheisen

Grove

et al. 2021

Preprint

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“…Activity (2) Lower levels of physical activity in treated vs untreated periods (1) 300 and youths (1) 301 Height (12) and weight (5) Growth delay (2) 302,303 and decreased growth (6) 297,[304][305][306][307][308] or weight (3) 304,305,308 No change observed and substantial heterogeneity (5) 267,301,303,309,310 Psychological (20) Other (2) Increased risk of psychosis (1) 311 and tics (1) 312 Substance abuse (12) No association of treatment with later substance abuse (4), [313][314][315][316] reduced risk (5), [317][318][319][320][321] and increased risk of stimulant abuse (1) 322 Prescription stimulant misuse or diversion in youths with or without ADHD (2) 323,324 Suicidal behavior (6) No association of treatment with risk of suicidal behavior (2), 325,326 reduced risk (3), [327][328][329] and increased risk (1) 330 Social and emotional (11) Emotional (3) Increased risk of irritability with amphetamine treatment (1) 331 Mixed outcomes for various emotional behaviors with stimulant treatment (1) 332 Decrease in happiness after increased medication treatment (1) 256…”

Section: Benefits May Be Outweighed By Harms In Youth With Milder Adhd Symptomsmentioning

confidence: 99%

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

et al. 2021

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IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged Յ18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included.Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCEThis review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.

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“…Of particular note, there is emerging evidence to suggest that therapy with psychostimulants (including MPH) is linked to lower rates of antisocial behaviors (Lichtenstein et al 2012 ), as well as lower risk of suicide among patients with ADHD (across the age spectrum, from children to middle-aged adults) (Chang et al 2020 ). In a meta-analysis of data from 21 placebo-controlled RCTs, MPH was also found to alleviate the ADHD-related emotion regulation deficits, as experienced by adult individuals (SMD, 0.34; 95% CI, 0.23–0.45) (Lenzi et al 2018 ).…”

Section: Clinical Considerationsmentioning

confidence: 99%

Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review

2021

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Rationale Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. Objective The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. Methods While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. Results Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing ‘wearing off’ (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35–0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23–0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). Conclusions There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.

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Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts

Cited by 34 publications

References 25 publications

Identification of shared and differentiating genetic risk for autism spectrum disorder, attention deficit hyperactivity disorder and case subgroups

Identification of shared and differentiating genetic risk for autism spectrum disorder, attention deficit hyperactivity disorder and case subgroups

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review

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