Stimulant Treatment Over Five Years: Adherence, Effectiveness, and Adverse Effects

Charach, Alice; Ickowicz, Abel; Schachar, Russell

doi:10.1097/00004583-200405000-00009

Cited by 258 publications

(170 citation statements)

References 28 publications

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“…Although it is true that the majority of individuals with ADHD initially respond positively to stimulants, long-term effectiveness is much more modest (Charach et al, 2004). Being able to predict which individuals are likely to respond positively or which individuals do not tolerate stimulants would alter the trial and error approach to stimulant treatment of ADHD.…”

Section: Discussionmentioning

confidence: 99%

Dopamine Transporter Genotype and Methylphenidate Dose Response in Children with ADHD

Stein

Waldman

Sarampote

et al. 2005

Neuropsychopharmacol

129

117

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Stimulant medications, such as methylphenidate (MPH), are the most commonly used, effective treatment for ADHD. MPH acts primarily by inhibiting the dopamine transporter (DAT), a protein responsible for the reuptake of dopamine from the synapse into presynaptic terminals. We sought to evaluate the relationship between DAT1 3 0 -untranslated region (3 0 -UTR) variable number tandem repeats (VNTR) genotypes and dose response to MPH. Children with ADHD (n ¼ 47), ages 5-16 years (mean ¼ 9.02 years), underwent a 4-week, double-blinded, crossover trial with forced weekly dosage changes. Children were genotyped for the DAT1 VNTR and evaluated on placebo and three dosage levels of OROS s MPH. Parents and clinicians who were blind to genotype and medication status rated ADHD symptoms, impairment, and stimulant side effects each week. Children who were homozygous for the less common, 9-repeat DAT1 3 0 -UTR genotype displayed a distinct dose-response curve from that of the other genotype groups, with an absence of typical linear improvement when the dose was increased from 18 mg to 36 and 54 mg. Further research is needed to determine the mechanisms related to poor response in patients with the 9/9-repeat genotype, and to determine if this group responds differentially to alternative treatments.

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Section: Discussionmentioning

confidence: 99%

Dopamine Transporter Genotype and Methylphenidate Dose Response in Children with ADHD

Stein

Waldman

Sarampote

et al. 2005

Neuropsychopharmacol

129

117

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“…11,37,38 Qualitative methods, such as those employed in the current study, are essential to develop a richer understanding of this phenomenon. Parents in the current study and others 6,7,39,40 continue to experience fears and worries related to the potential for long-term adverse effects, even if their child shows marked improvement.…”

Section: Table 4 Domain 3: Continued Doubt and Uncertaintymentioning

confidence: 99%

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

Sherman²,

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Initiation of medication for ADHD is variable and persistence with therapeutic regimens is poor. Parents play a key role in managing medication use for their child with ADHD. WHAT THIS STUDY ADDS:This study identifies factors that influence parent decision-making about the initiation and continuation of medication treatment. Awareness of these factors may help physicians address the concerns of families while managing ADHD.abstract BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral conditions of childhood and adolescence. Despite availability of effective treatment options, initiation of treatment is variable and persistence with therapeutic regimens is poor. OBJECTIVE:We sought to better understand how parents make decisions about treatment for their child or adolescent with ADHD. METHODS:We conducted a qualitative study among parents of children and adolescents; 52 parents participated in 1 of 12 focus groups. Parents answered questions about decision-making, information sharing, and sources of conflict and uncertainty. Sessions were audiotaped and transcribed verbatim. Themes were coded independently by 4 of the investigators, who then agreed on common themes. RESULTS:Parents in our study made decisions about treatment for their child with ADHD in the midst of experiencing a variety of emotions as they witnessed child functional impairments at home and at school. In addition, parents felt stress as a result of their daily efforts to manage their child's struggles. Multiple factors influenced the decision to initiate medication. Subsequently, revisiting the decision to give their child medicine for ADHD was common. Many parents contrasted time on and off medicine to help inform management decisions. Trials stopping medication were almost always parent-or child-initiated. CONCLUSIONS:Decisions about medication use for children and adolescents with ADHD are made and frequently revisited by their parents. Choices are often made under stressful conditions and influenced by a variety of factors. Striking a balance between benefits and concerns is an ongoing process that is often informed by contrasting time on and off medication. Development of strategies to support families across the continuum of decisions faced while managing ADHD is warranted.

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“…One 5-year prospective study demonstrated that over half of the participants failed to continue medication into the second treatment year, and many of those who did continue therapy reported clinically significant side effects [60]. The authors concluded that side effects and perceived tolerability were major factors in the decision by patients to discontinue treatment.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…In acute treatment studies, stimulant medications generally demonstrate large effect sizes on ADHD symptom reduction relative to placebo, with slightly smaller effect sizes in adult studies [2]. Surprisingly, only a minority of children and adolescents with ADHD remain on medication consistently [3] despite persistence of symptoms and impairments. Even among responders, there is marked variability in optimal dosage, duration of effect, and tolerability.…”

Section: Introductionmentioning

confidence: 99%

The Pharmacogenomic Era: Promise for Personalizing Attention Deficit Hyperactivity Disorder Therapy

Stein

McGough²

2008

Child and Adolescent Psychiatric Clinics of North America

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SynopsisCurrently, ADHD treatment is often determined empirically through trial and error until an adequate response is obtained or side effects occur. ADHD is highly heritable and there is wide individual variability in response to ADHD medications, suggesting that the mechanism of action of stimulant medications may provide clues for genetic predictors of response. The promise of ADHD pharmacogenetics is far reaching, and includes the potential to develop individualized medication regimens that improve symptom response, decrease risk for side effects, improve long-term tolerability, and thus contribute to long-term treatment compliance and improved general effectiveness. Early ADHD pharmacogenetic studies have focused predominantly on catecholamine pathway genes and response to methylphenidate. Future efforts will also examine a wider range of stimulant and non-stimulant medications on a range of outcome measures and time periods. Based upon these studies, the potential for personalizing ADHD treatment in clinical practice will be determined. IntroductionAttention-Deficit/Hyperactivity Disorder (ADHD) is a common and treatable behavioral syndrome that typically emerges during childhood or adolescence and often persists into adulthood. There are an increasing number of stimulant and non-stimulant medication options for ADHD, with numerous new compounds in development [1]. In acute treatment studies, stimulant medications generally demonstrate large effect sizes on ADHD symptom reduction relative to placebo, with slightly smaller effect sizes in adult studies [2]. Surprisingly, only a minority of children and adolescents with ADHD remain on medication consistently Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. despite persistence of symptoms and impairments. Even among responders, there is marked variability in optimal dosage, duration of effect, and tolerability. Moreover, in spite of acute symptom reduction from ADHD medications, as yet there is little evidence of long-term response and improvement in functioning among those children who received treatment [4,5]. Furthermore, there are few reliable predictors of medication response. In the absence of these data, treatment is often determined "empirically" in clinical practice through a gradual titration of different dosages and trial and error approach to different medications. NIH Public AccessADHD is a highly heritable disorder [6]. The search for candidate genes associated with ADHD has been largely driven by the understanding that medications for the disorder have drug targets in the catecholamine system [7]. Conve...

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Stimulant Treatment Over Five Years: Adherence, Effectiveness, and Adverse Effects

Cited by 258 publications

References 28 publications

Dopamine Transporter Genotype and Methylphenidate Dose Response in Children with ADHD

Dopamine Transporter Genotype and Methylphenidate Dose Response in Children with ADHD

Parental Angst Making and Revisiting Decisions About Treatment of Attention-Deficit/Hyperactivity Disorder

The Pharmacogenomic Era: Promise for Personalizing Attention Deficit Hyperactivity Disorder Therapy

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