Why Do Children With ADHD Discontinue Their Medication?

Toomey, Sara L.; Sox, Colin M.; Rusinak, Donna; Finkelstein, Jonathan A.

doi:10.1177/0009922812446744

Cited by 100 publications

(62 citation statements)

References 20 publications

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“…One major problem of medication treatment, which is common with both AXT and MPH, is the high discontinuation rate estimated at between 36 and 85% (Adler and Nierenberg, 2010; Habel et al, 2005). Since guardians' subjective feelings about the efficacy of medication stand as a major cause for the discontinuation of medication treatment with ADHD children (Toomey et al, 2012), encouragement of family members of ADHD children by demonstrating therapeutic success may facilitate successful ATX treatment. Objective demonstration of ATX effects as visualized with cortical activation observed with fNIRS-based measurements could act as an informative guide, encouraging ADHD children and their guardians to continue ATX treatment.…”

Section: Discussionmentioning

confidence: 99%

Acute neuropharmacological effects of atomoxetine on inhibitory control in ADHD children: A fNIRS study

Nagashima¹,

Monden²,

Dan

et al. 2014

NeuroImage: Clinical

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The object of the current study is to explore the neural substrate for effects of atomoxetine (ATX) on inhibitory control in school-aged children with attention deficit hyperactivity disorder (ADHD) using functional near-infrared spectroscopy (fNIRS). We monitored the oxy-hemoglobin signal changes of sixteen ADHD children (6–14 years old) performing a go/no-go task before and 1.5 h after ATX or placebo administration, in a randomized, double-blind, placebo-controlled, crossover design. Sixteen age- and gender-matched normal controls without ATX administration were also monitored. In the control subjects, the go/no-go task recruited the right inferior and middle prefrontal gyri (IFG/MFG), and this activation was absent in pre-medicated ADHD children. The reduction of right IFG/MFG activation was acutely normalized after ATX administration but not placebo administration in ADHD children. These results are reminiscent of the neuropharmacological effects of methylphenidate to up-regulate reduced right IFG/MFG function in ADHD children during inhibitory tasks. As with methylphenidate, activation in the IFG/MFG could serve as an objective neuro-functional biomarker to indicate the effects of ATX on inhibitory control in ADHD children. This promising technique will enhance early clinical diagnosis and treatment of ADHD in children, especially in those with a hyperactivity/impulsivity phenotype.

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Section: Discussionmentioning

confidence: 99%

Acute neuropharmacological effects of atomoxetine on inhibitory control in ADHD children: A fNIRS study

Nagashima¹,

Monden²,

Dan

et al. 2014

NeuroImage: Clinical

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“…Overall, ambulatory care visits for ADHD have been declining 31 and lower visit frequency for ADHD care in primary care compared to mental health has been reported 7 . Reduced visit frequency may adversely impact ADHD medication treatment because potential medication side effects may not be picked up in a timely fashion, which can contribute to patient morbidity and higher patient dropout 32,33 . Thus, efforts to optimize the timing of follow-up visits during ADHD medication treatment appear indicated.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics

Bussing

Narwaney

Winterstein

et al. 2014

Current Medical Research and Opinion

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Study limitations must be considered, including reliance on electronic medical record data, absence of patient race and sociodemographic data, and limited generalizability to other care contexts. Nevertheless, findings suggest novel strategies are needed to improve the quality of ADHD care processes for children of all ages, because even within integrated delivery systems less than half of children with ADHD received care consistent with NCQA HEDIS standards for initiation and C&M care. RESULTS suggest the need to refine quality measures by including follow-up care in those children not receiving or discontinuing medication treatment, a considerable quality concern not currently captured in NCQA HEDIS standards.

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“…However, although pharmacological treatments are relatively safe, these treatments are not without adverse side-effects, such as, suppression of growth, sleep problems, tiredness, loss of appetite, stomach upset, headaches, nausea, and increases in heart rate and blood pressure 12,23–27. Nonpharmacological interventions, such as psychoeducational programs, behavioral interventions, and cognitive behavioral therapy are also recommended 28–30.…”

Section: Introductionmentioning

confidence: 99%

The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

Parker¹,

Wales²,

Chalhoub³

et al. 2013

PRBM

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PurposeTo systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD) interventions following randomized controlled trials with children and young people.MethodA systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982– July 2012), MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA]), Psych info, Science Direct (Elsevier), and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool.ResultsEight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up). The total number of participants in the studies was 1,057, of whom 579 (54.7%) were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period.ConclusionThis review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not include newer medications currently available or consider significant contextual and cultural differences, such as UK/European and Asian populations. Longitudinal studies are required to examine the long-term outcomes for children and young people with ADHD managed with currently recommended service interventions. They should also include the whole spectrum of ADHD, with its full range of coexisting conditions, and cultural and contextual diversity.

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Why Do Children With ADHD Discontinue Their Medication?

Cited by 100 publications

References 20 publications

Acute neuropharmacological effects of atomoxetine on inhibitory control in ADHD children: A fNIRS study

Acute neuropharmacological effects of atomoxetine on inhibitory control in ADHD children: A fNIRS study

Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics

The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

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