Counseling Points - January 2009 - (Page 13)

Caring for Individuals with ADHD Throughout the Lifespan Pharmacologic Treatment Strategies for Children, Adolescents, and Adults with ADHD • No treatment has been found to cure attention deficit hyperactivity disorder (ADHD), but there are a number of pharmacologic interventions that have been demonstrated to manage symptoms effectively. • The primary goal of pharmacologic treatment is to improve the individual’s functioning in society (e.g., reduce disruptive behaviors, inattentiveness, and impulsivity, improve academic/work performance, and better relationships with others). • Stimulants such as methylphenidate (Concerta®, Daytrana™, Focalin®, and Ritalin®) and dextroamphetamine (Adderall®, Dexedrine®, Vyvanse™) are the drugs of choice for the initial treatment of ADHD in children, adolescents, and adults. • Dextroamphetamine-containing agents should not be used in patients with a history of structural/congenital heart defects due to a risk of sudden cardiac death. • Side effects of stimulants are similar: Both methylphenidate and dextroamphetamine cause appetite suppression, but negative emotional symptoms are more often seen with dextroamphetamine than methylphenidate. Other side effects include anorexia, weight loss, abdominal discomfort, and headache. • Although in the past it was believed stimulants might suppress growth in children and adolescents, that notion has recently been disproved. • The nonstimulant atomoxetine improves the core symptoms of ADHD similar to methylphenidate. • When starting children, adolescents, and adults on stimulants, clinicians should choose the lowest dose possible to avoid unwanted side effects and titrate slowly. • The presence of psychiatric and learning disorder co-morbidities should be considered when managing ADHD symptoms in all individuals with ADHD. 45. Chang KD, Ketter TA. Special issues in the treatment of paediatric bipolar disorder. Expert Opin Pharmacother. 2001;2:613-622. 46. Lambert MT, Copeland LA, Sampson N, et al. New-onset type-2 diabetes associated with atypical antipsychotic medications. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:919-923. 47. Geller D, Biederman J, Griffin S, et al. Comorbidity of juvenile obsessivecompulsive disorder with disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry. 1996;35:1637-1646. 48. Lewin AB, Storch EA, Adkins J, et al. Current directions in pediatric obsessive-compulsive disorder. Pediatr Ann. 2005;34:128-134. 49. Geller DA, Biedermann J, Stewart SE, et al. Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. Am J Psychiatry. 2003;160:1919-1928. 50. Eilam D, Szechtman H. Psychostimulant-induced behavior as an animal model of obsessive-compulsive disorder: An ethological approach to the form of compulsive rituals. CNS Spectrums. 2005;10:191-202. 51. Koler D, Keller A, Golfinopoulos M, et al. Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat. 2008;4: 389-403. 52. Newcorn J, Weiss M. Adult ADHD: Effective Treatment Strategies based on the Adult ADHD Academic Council Monograph. 2006. Accessed 10/15/08 at www.medscape.com/viewprogram/5376_pnt. 53. Arnold LE. Methylphenidate vs. amphetamine: Comparative review. J Attention Disord. 2000. 3:200-211. 54. Doyle B. Understanding and Treating Adults with ADHD. Arlington, Va: American Psychiatric Association. 2006. 55. Ramsay J, Rostain A. A Cognitive Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach. New York, NY: Taylor and Frances Group. 2008. 56. Adler L, Friedlander R. Diagnosing ADHD in Adults. In: Biederman, J, ed. ADHD Across the Lifespan: An Evidence-Based Understanding from Research to Clinical Practice. Veritas Institute for Medical Education, Inc. and MedLearning, Inc. 2006. 57. Adler L, Spencer T, Stein M, et al. Best Practices in Adult ADHD: Epidemiology, Impairments, and Differential Diagnosis. CNS Spectrums. 2008;13:2-19. 58. Newcorn J, Weiss M, Stein M. The complexity of ADHD: Diagnosis and treatment of the adult patient with comorbidities. CNS Spectrums. 2007;12(8 Suppl 12):1-16. 59. Wilens T. Attention-deficit/hyperactivity disorder and the substance use disorders: The nature of the relationship, subtypes at risk and treatment issues. Psychiatr Clin No Am. 2004;27:283-301. CP Counseling Points ™ 13 JANUARY 2009 http://www.medscape.com/viewprogram/5376_pnt

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Counseling Points - January 2009

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