Response to methylphenidate in children and adolescents with ADHD: does comorbid anxiety disorders matters?

Abstract

There are controversial evidence in the literature on the role of comorbid anxiety disorders (ANX) in the improvement of attention-deficit/hyperactivity disorder (ADHD) symptoms with methylphenidate (MPH) treatment. Our main objective was to assess differences in the response to MPH treatment in children and adolescents with ADHD with and without comorbid ANX. We extensively evaluated response to MPH in a naturalistic study of 280 children and adolescent with ADHD according to DSM-IV criteria. Psychiatric diagnoses (ADHD, ANX, and other comorbidities) were assessed by semi-structured interviews (K-SADS-E). Response to MPH was assessed by means of total score in the Swanson, Nolan, and Pelham Scale-version IV (SNAP-IV) after 1 month of treatment. There was no significant between-group difference in the response to treatment with MPH after 1 month either when SNAP-IV scores were assessed dimensionally or categorically (moderate response) (P > 0.05). Our findings suggest that comorbid ANX do not interfere in the response to MPH on core ADHD symptoms.

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

“…This can be challenging, as anxiety symptoms are frequently related to a sense of being overwhelmed or to compensatory skills in patients with ADHD. Stimulants may play a larger role in managing ADHD in patients with anxiety symptoms [1424,1425]; however, in an open trial, atomoxetine improved ADHD and comorbid symptoms of depression and anxiety [1426]. …”

Anxiety reduction on atomoxetine and methylphenidate medication in children with ADHD

“…In contrast, comorbid anxiety seemed to be associated with reduction of inattention and hyperactivity . Other studies have not found differences between stimulant‐treated ADHD children with and without comorbid anxiety . Only one study of methylphenidate noted a significant effect of methylphenidate in reduction of both ADHD symptoms and anxiety, namely separation anxiety symptoms …”

“…6,14 Other studies have not found differences between stimulant-treated ADHD children with and without comorbid anxiety. [15][16][17] Only one study of methylphenidate noted a significant effect of methylphenidate in reduction of both ADHD symptoms and anxiety, namely separation anxiety symptoms. 18 Both atomoxetine and methylphenidate are widely used to treat ADHD symptoms, with similar effectiveness after 8 weeks of treatment, [19][20][21] when atomoxetine has reached its a full effect.…”

Advances in understanding and treating ADHD

“…Comorbid anxiety was not found to affect stimulant efficacy in a recent study [48], and some studies suggest that treatment with stimulants can help to lessen the likelihood of other psychiatric comorbidities during adolescence [49], including cigarette use and substance abuse [50]. However, meta-analyses of stimulants and other ADHD medications in the treatment of ADHD comorbid with tic disorders concluded that supratherapeutic doses of dextroamphetamine should be avoided in this population.…”