Risks and Benefits of Drugs Used in the Management of the Hyperactive Child

Abstract

Childhood hyperactivity is a common behavioural complaint. The therapeutic options for physicians caring for children with hyperactivity are considerable and varied; current recommendations call for a multidisciplinary approach, including when necessary the use of drug therapy. Central nervous system stimulants are the primary agents used in the therapy of hyperactivity. The majority of children with hyperactivity diagnosed using careful clinical criteria will demonstrate short term benefits in cognitive and behavioural terms, but long term efficacy remains controversial. There appears to be a subset of patients who do not demonstrate a beneficial response to stimulants, although there is controversy as to whether this may be dose dependent. The adverse effects of most concern are suppression of growth, the development of tics and the potential for abuse. Antidepressants and clonidine are useful agents for the therapy of patients resistant to stimulant therapy. Although the most frequent adverse events of antidepressant therapy are associated with the anticholinergic activity of these agents, the most common serious adverse events are associated with antidepressant overdose. Concern has been expressed because of case reports describing an association between antidepressant therapy for hyperactivity and sudden death. A number of other therapies have been used for hyperactivity. Although these therapies may be effective in subsets of patients with hyperactivity, there is little research detailing how to identify patients who might be expected to respond to such treatment.

Retrospective Review of Modafinil Use for Cerebral Palsy

“…[15][16][17] A recent article on the use of modafinil for attentiondeficit disorder in 15 children noted only "transient and readily managed" side effects. 18 The authors felt that the modafinil side effects compared well with other stimulants used for attention-deficit disorder [18][19][20][21][22] ; this experience is similar to the current review of modafinil for cerebral palsy, revealing only minor and reversible side effects in our treatment group.…”

Methylphenidate Abuse and Psychiatric Side Effects

“…The pharmacokinetic half-life of methylphenidate is approximately 2 hours 25 and ranges from 2 to 7 hours. 26 The pharmacologic clinical effects are seen from 4 to 6 hours after an oral dose of immediate-release methylphenidate and 3 to 9 hours after sustained-release methylphenidate. 15,26,27 Methylphenidate is metabolized through de-esterification to ritalinic acid.…”

“…26 The pharmacologic clinical effects are seen from 4 to 6 hours after an oral dose of immediate-release methylphenidate and 3 to 9 hours after sustained-release methylphenidate. 15,26,27 Methylphenidate is metabolized through de-esterification to ritalinic acid. 25 Less than 1% of methylphenidate is excreted unchanged in the urine, while 80% of an oral dose is excreted as ritalinic acid.…”

The Relation Between Parental Coping Styles and Parent-Child Interactions Before and After Treatment for Children With ADHD and Oppositional Behavior

“…In addition, combined treatment and medication management alone were generally more effective than standard community care, whereas behavioral treatment alone was not; although it should be noted that 68% of the children in the community care group were also treated with medication. Even so, many parents may prefer behavior therapy to medication, because of medication side effects (Fox & Rieder, 1993;Varley, Vincent, Varley, & Calderon, 2001) and lack of research on the long-term effects of medication (Pelham et al, 1998). Furthermore, the common regimen of stimulant medication results in the effects typically wearing off by evening (Garland, 1998), so even parents whose children are on medication may benefit from parent training.…”