New treatments and approaches for attention deficit hyperactivity disorder

Abstract

This has been a very exciting year for clinical trials in child and adolescent psychiatry. Never before has there seemed to be such a concentrated frenzy of activity, with important findings from several federal and industry-sponsored initiatives coming to the fore. Some of these findings have appeared in peer-reviewed journals. Many others were presented at national meetings but have not yet been published. The long lag time between presentation and publication is well-known. However, it is particularly problematic for fields such as pediatric psychopharmacology, in which there is a high demand for new and effective treatments, and off-label prescribing is the rule for many conditions. Because of the high degree of interest in pharmacologic trials in children, and the potential impact of findings from these trials on clinical care now and in the near future, this review not only focuses on findings published in peer-reviewed articles, but also on findings from studies that were peer-reviewed for presentations at national meetings and published in abstract form this past year.Last year's clinical trials review focused on the principal results of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ie, the MTA Study). In head-to-head comparison, well-crafted medication treatment, given alone or in combination with a comprehensive behavioral therapy program, was superior to intensive behavioral therapy offered alone (but faded over the course of treatment), or communitystandard care (including medication treatment given outside the study). This finding has received considerable attention in the past year, and rightly so. Yet, the interpretations that medication treatments are preferable for all children with attention deficit hyperactivity disorder (ADHD), and that combination treatment adds little to well-crafted pharmacotherapy (as has been reported in some periodicals), do not do justice to the richness of the study findings. This year, two special sections in the

Circuit Specific Functions of Cannabinoid CB1 Receptor in the Balance of Investigatory Drive and Exploration

“…Dysfunctional exploratory profiles have been found in several distinct neuronal disorders, such as attention deficit disorder and schizophrenia-like diseases, expressed by modulated social behaviour and novelty seeking [1]–[5]. Thus, identifying control mechanisms of exploratory behaviour might allow new treatment strategies.…”

Sex and genetic associations with cerebrospinal fluid dopamine and metabolite production after severe traumatic brain injury

“…38 The DAT1 gene is associated with attention deficit hyperactivity disorder, a syndrome related to altered DA function and characterized by inattention, impulsivity, and dyscontrol. 7,40 Increased DAT binding has also been shown with single-photon emission CT to occur in those with attention deficit hyperactivity disorder, compared with controls, 30 and individuals with DAT 9/10 heterozygosity have approximately 22% lower DAT binding capacity than DAT 10/10 homozygotes. 21 Estrogen exerts a significant influence over the regulation of DA systems through genomic and nongenomic mechanisms.…”

Control of exploration, motor coordination and amphetamine sensitization by cannabinoid CB1 receptors expressed in medium spiny neurons

“…Well‐balanced exploration represents a fundamental behaviour for survival and is often dysfunctional in psychiatric disorders and is controlled by CB 1 Rs (Häring et al, 2011; Newcorn, 2001; Sarris et al, 2020). To our knowledge, no study tested the involvement of CB 1 R in locomotion using real‐time monitoring of spontaneous locomotion in a home‐cage system and over several days of light and dark cycles.…”