Pharmacotherapy of Attention-Deficit Hyperactivity Disorder in Adolescents

Abstract

Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioural disorder in children and adolescents, consisting of developmentally inappropriate levels of inattention and/or hyperactivity and impulsivity. The majority of children with ADHD will continue to experience significant ADHD symptoms as teens. ADHD in adolescents can result in significant functional impairment and poorer quality of life. Children and adolescents with ADHD are at higher risk of developing other psychiatric illnesses such as mood, conduct and substance abuse disorders. Stimulants (amphetamines and methylphenidates) and nonstimulants (atomoxetine, guanfacine extended-release (XR) and clonidine XR) have been found to be effective and are approved by the US FDA for the treatment of ADHD in adolescents in the US. Of the agents approved in the US, only guanfacine XR and clonidine XR are not approved in any other countries. There is growing evidence that treatment of ADHD with stimulants reduces the risk of development of other psychiatric co-morbidities, including substance abuse disorders. To date, all FDA-approved stimulants and nonstimulants that have been adequately studied have been demonstrated to be safe and effective in treating ADHD in both children and adolescents. Therefore, clinical decisions used in selecting pharmacotherapy to treat ADHD in children aged 6-12 years can be applied in the adolescent population.

Differential roles for cortical versus sub-cortical noradrenaline and modulation of impulsivity in the rat

“…Our results suggest that amphetamine and atomoxetine differentially interact with the NA system when different regions are impaired, something which may also be relevant to the clinical presentation of ADHD. Although, it should be noted that this work was done in normal rats by using a dose range consistent with the recommended daily dose prescribed in patients (Childress and Berry 2012; Sharma and Couture 2014). Further studies to investigate these findings and understand more about the underlying neurobiology may help in providing better management of patients with the most appropriate treatments.…”

Stress weakens prefrontal networks: molecular insults to higher cognition

“…Microglia and astrocytes are activated by β-AR stimulation, while activated microglia are deactivated by α2A-AR stimulation 102 . As guanfacine is approved by the US Food and Drug Administration for use in adolescents 103 , it may offer a practical approach for reducing the inflammatory response and gray matter loss found in prodromal schizophrenia 5 .…”

Pure Autonomic Failure

“…Atomoxetine is a selective norepinephrine reuptake inhibitor. It is FDA-approved for the treatment of attention deficit hyperactivity disorder [67]. In neurogenic orthostatic hypotension, atomoxetine has been shown to be most helpful in increasing orthostatic blood pressure in a central autonomic disorder such as MSA, whereas the effect on a peripheral autonomic disorder such as PAF is not significant [68].…”