Practitioner Review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents

Abstract

Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.

Developments and challenges in the diagnosis and treatment of ADHD

“…112 Recommendations from the EAGG to manage growth deficit involve: managing loss of appetite (highcaloric snacks, medication after meals, late evening meals); monitoring appetite, weight, height and body mass index regularly; alternative options (i.e., medication holidays, pausing medication on weekends); and referring to a growth specialist if necessary. 111 Table 2 displays clinical recommendations for managing appetite loss and growth delay in children treated with ADHD medications.…”

“…110 The European ADHD Guidelines Group (EAGG) recently reviewed the most common adverse effects and proposed recommendations for clinical management. 111 The most common adverse effects associated with stimulants are reduction of appetite, sleep disturbance, tics, seizures, and psychotic symptoms. The impact of stimulants on growth and its cardiovascular risks prompted significant concerns among clinicians and authorities and debate in the media.…”

“…It is recommended to investigate history of heart disease and family history of sudden death under the age of 40, and to refer the patient to a complete cardiologic evaluation before commencing treatment if either of those is present. 111 Heart rate and blood pressure should be assessed at baseline and monitored regularly during the course of treatment, but there is no evidence to support routine electrocardiogram before prescribing ADHD medication. 111 Table 3 shows recommendations regarding monitoring and managing cardiovascular risk in children and adolescents treated with ADHD medications.…”

“…111 Heart rate and blood pressure should be assessed at baseline and monitored regularly during the course of treatment, but there is no evidence to support routine electrocardiogram before prescribing ADHD medication. 111 Table 3 shows recommendations regarding monitoring and managing cardiovascular risk in children and adolescents treated with ADHD medications.…”

Does psychostimulant treatment in children with ADHD increase later risk of substance use disorder?

“…Psychostimulants (including methylphenidate and amphetamines) are indicated by several guidelines (e.g., Pliszka, 2007; NICE, 2008) as first choice medication for children with attention-deficit/hyperactivity disorder (ADHD). Whereas a large body of randomised controlled trials supports the high efficacy of psychostimulants on ADHD core symptoms (at least in the short-term), concerns continue to be raised regarding their adverse effects, including possible increased risk of substance use disorders (SUDs) (Cortese et al 2013).To address the effects of psychostimulant treatment in childhood on later risk for SUDs, Groenman et al (2013) analysed data from the International Multicenter ADHD Genetics study (IMAGE), a multi-site longitudinal, prospective study including probands with ADHD and healthy controls (HC). The authors assessed the relation between exposure to psychostimulants in childhood (age range: 5-17 years) and rates of SUDs (including nicotine dependence) at follow-up, on average 4.4 (±0.7) years after study entry.…”