Long-term medication for ADHD and development of cognitive functions in children and adolescents

Johnson, Mats; Johnels, Jakob Åsberg; Östlund, Sven; Cedergren, Katarina; Omanovic, Zerina; Hjalmarsson, Kerstin; Jakobsson, Klara; Högstedt, Jenny; Billstedt, Eva

doi:10.1016/j.jpsychires.2021.07.055

Cited by 11 publications

(9 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the measures for cognitive and social difficulties included in the NSCH survey provide some relevant data for the outcomes of interest, other validated measures for cognitive difficulties [ 83 ] and social difficulties [ 84 ] could be used in future research including controlled studies designed to examine the effects of meeting 24-HMB guidelines on these outcomes in children and adolescents with ADHD. Future studies should be designed to use objective and reliable measures of movement behaviors in order to gain a more nuanced understanding of their influence on health-related outcomes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

Taylor

Kong

Zhang

et al. 2023

Child Adolesc Psychiatry Ment Health

View full text Add to dashboard Cite

Background Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9–11 h for 5 to 13-year-olds; 8–10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD. Methods Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children’s Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders. Results In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12–0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21–0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39–0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26–0.76, p = .003) in relation to none of the guidelines. Conclusion Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

show abstract

Section: Strengths and Limitationsmentioning

confidence: 99%

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

Taylor

Kong

Zhang

et al. 2023

Child Adolesc Psychiatry Ment Health

View full text Add to dashboard Cite

show abstract

“…However, these treatments are also associated with certain side effects, including headache, insomnia, loss of appetite, abdominal pain, and twitching. ey can also lead to drug abuse, negatively affect growth and development, and lead to depression [23,37].…”

Section: Discussionmentioning

confidence: 99%

“…e Animal Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine, approved the design and consented to the conduction of this study (21)(22)(23)(24)(25)(26)(27).…”

Section: Abbreviationsmentioning

confidence: 99%

“…It has been shown to be efficient in ADHD patients of different ages, genders, and subtypes (inattentive, hyperactive-impulsive, and combined inattentive/hyperactive-impulsive) and commonly used to improve children's cognitive and executive function [22]. However, due to this disease being lifelong, the use of medications is long term [23]. Furthermore, recent studies have reported certain adverse events resulting from ATX exposure, such as decreased appetite, nausea, headache, dry mouth, and liver injury [24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

“Jing-Ning Granules” Can Alleviate Attention Deficit Hyperactivity Disorder in Rats by Modulating Dopaminergic D2/D1-Like Receptor-Mediated Signaling Pathways

Ding

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulsivity. Jing-Ning Granules (JNG) is a traditional Chinese medicine (TCM) that can alleviate ADHD. Although JNG is commonly used for the effective treatment of ADHD and has obtained the national invention patent, the exact mechanism of action remains unclear. Objective. In this study, we examined the effect and mechanism of JNG in spontaneously hypertensive rats (SHRs). We hypothesized that JNG affects dopaminergic D2/D1-like receptors and related pathways. Materials and Methods. Six rat groups were used in the experiment: Wistar-Kyoto rats (WKY, control group) and five SHR groups, including a model group; atomoxetine (ATX, positive control) group; and low, medium, and high-dose JNG groups. The corresponding treatments were daily administered to each group for 6 weeks. A behavioral test, including a step-down test and open field test (OFT), was carried out at the end of treatment. After the behavioral test, all animals were sacrificed, and the brain tissue was collected and analyzed ex vivo; histopathological analysis was performed to assess the pathological changes of the hippocampus; expression of D1-like and D2-like receptors, sensor protein calmodulin (CaM), protein kinase A (PKA), and calcium/calmodulin-dependent serine/threonine protein kinase (CaMKII) in the striatum and hippocampus was measured by western blot and real-time quantitative PCR (RT-PCR); cyclic adenosine monophosphate (cAMP) levels in the striatum were analyzed using an enzyme-linked immunosorbent assay (ELISA), while the level of Ca2+ in the striatum was analyzed by a calcium kit. Results. Our results showed that ATX or JNG could ameliorate the hyperactive/impulsive behavior and cognitive function of ADHD by promoting neuroprotection. Mechanistically, ATX or JNG could prompt the expressions of Dl-like and D2-like receptors and improve the mRNA and protein levels of cAMP/PKA and Ca2+/CAM/CAMKII signaling pathways. Conclusion. These results indicate that JNG can produce therapeutic effects by regulating the balance of D2/D1-like receptor-mediated cAMP/PKA and Ca2+/CaM/CaMKII signaling pathways.

show abstract

“…With a view to provide a comprehensive assessment of long-term effects of ADHD medication, we started (in 2014) a prospective observational 1-year trial of medication in children and adolescents with ADHD (the “Qb-trial”) in which a wide range of outcome measures were included; ADHD core symptoms, daily functioning, comorbidity symptoms, and cognitive functioning (IQ). Results from this 1-year trial have recently been published [ 26 , 27 ]. In 2016, we extended the trial to 2 years of follow-up (the “Long-term Medication for ADHD in children and adolescents (LMA) trial”) and added measures of functioning in various life domains and of Health-related Quality of Life (HRQL) to obtain more data on overall functioning and well-being in the longer term (the HRQL data will be presented in a forthcoming publication).…”

Section: Introductionmentioning

confidence: 99%

Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes

Johnson,

Johnels,

Östlund

et al. 2024

Eur Arch Psychiatry Clin Neurosci

Self Cite

View full text Add to dashboard Cite

More knowledge is needed about long-term ADHD medication and symptom, daily functioning, comorbidity, and tolerability outcomes. This “Long-term Medication for ADHD (LMA) trial” was a prospective observational 2-year trial in children and adolescents aged 6–18 years (extension of 1-year trial). Participants met criteria for DSM-5 ADHD (inattentive or combined), with complex comorbidities; autism spectrum disorder (31%), autistic traits (24%), oppositional symptoms (59%), anxiety (32%), dyslexia/language disorder (16%), borderline intellectual functioning (17%). Medication was individually tailored and followed-up at clinical visits (1, 2, 3, 6, 12, 18, 24 months). Primary outcome: Clinical Global Impression-Severity and Improvement scales (CGI-S, CGI-I). Secondary outcomes: Investigator-rated ADHD-Rating Scale, Weiss Functional Impairment Rating Scale-Parent report (WFIRS-P; Family, School Learning and Behavior, Life Skills, Self-Concept, Social Activities, and Risky Activities domains), comorbidity symptoms and adverse events (AEs). One hundred twenty-eight participants were enrolled (1-year trial only n = 27, LMA trial n = 101). Of these 29 (23%) discontinued, mainly due to AEs (n = 7), moving (n = 7), or no longer needing medication (n = 6). Main AEs were poor appetite, low mood, anxiety, irritability, fatigue. Improvements from baseline to 2 years were large in CGI-S (effect size (ES) 2.28), ADHD-RS (ES 2.06), and moderate to large in WFIRS-P (ES total 0.73, learning 0.4, family 0.67). Overall, the trial showed robust and sustained improvements in ADHD symptom severity and daily functioning over a period of 2 years of ADHD medication in children and adolescents with ADHD and complex comorbidities. Most AEs were mild. Comorbidity symptoms were improved after 1 year, particularly oppositional symptoms, depression, and anxiety.

show abstract

Long-term medication for ADHD and development of cognitive functions in children and adolescents

Cited by 11 publications

References 24 publications

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

“Jing-Ning Granules” Can Alleviate Attention Deficit Hyperactivity Disorder in Rats by Modulating Dopaminergic D2/D1-Like Receptor-Mediated Signaling Pathways

Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes

Contact Info

Product

Resources

About