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Archive - ADHD Medication RSS Feed

ADHD and Anxiety

Children of all ages with ADHD (Attention Deficit Hyperactivity Disorder) frequently suffer from varying degrees of anxiety. Anxiety may be provoked for many reasons in the child with ADHD: The frustration coming from having to work harder in order to keep up academically is a common and significant stressor. The incessant negative feedback that is all too common in the life of the child with ADHD creates a numbing pressure. Then the difficultly getting along with peers sets the child a part socially and fosters a sense of not belonging. All of these issues lead to low self-esteem which makes the child with ADHD even more vulnerable to stress.

A study reported recently at the American Neuropsychiatric Association meeting found that stimulants administered for ADHD also help relieve anxiety in the patients. In fact stimulants alone were as effective in treating anxiety as stimulant plus anti-psychotic medication.

The study evaluated 134 children and teens with a mean age of ten years. They were evaluated in terms of the change over time in anxiety scores on the parent-completed Child Behavior Checklist.

Eighty children were on stimulants only. Another 54 were on a stimulant plus antipsychotic drug. Twenty four of the patients had clinically significant anxiety, as determined by a baseline Achenbach anxiety score prior to starting medication. After four months of therapy with stimulant medication, 83% of the children had a reduction in their anxiety scores.

This study did not evaluate the reasons why anxiety was lessened with stimulant treatment. Two possible mechanisms, however, could be responsible. First, it is possible that stimulants have a direct anti-anxiety effect when used to treat ADHD. However, this is not proven. A more likely possibility is that with effective treatment of the ADHD behaviors, the patients experienced less conflict with his or her environment and, therefore, experienced a reduction in anxiety.

Those of us working with children with ADHD should remember that they are often dealing with significant stress and anxiety. We need to look for such complications and address them when needed. It is good to know that effective stimulant therapy, itself, has a measurable anti-anxiety effect.

Non-Stimulant Medication Approved for Treatment of ADHD

The FDA has approved a new medication for the treatment of ADHD (Attention Deficit Hyperactivity Disorder). Kapvay is the first non-stimulant approved to treat ADHD in children and adolescents. It can be used either with or one of the traditional stimulant medications or can be used alone in the treatment of ADHD.

Clonidine extended-release tablets (Kapvay) acts on the brain in a different way, and acts in a different part of the brain, than the stimulants. Taken twice a day, Clonidine, in these early studies, improved core ADHD symptoms. In clinical trials, the most common adverse effects were sleepiness and sedation.

We will need more experience with this medication in order to know its long term usefulness. Clonidine in its original form has been around for years. It is used primarily in adults as a treatment for high blood pressure. This older form has been used off label by some psychiatrists to treat oppositional behavior and certain types of sleep problems in children with ADHD.

Most likely, the primarily use of Kapvay will be as an adjunct medication used along with stimulants when the involved child has more impulsive behavior and or/has sleep problems. Those of us treating children with ADHD are pleased to have an additional option available in the management of children with various forms of ADHD.

ADHD, Medication, and Growth

Over the years, there has been concern that children with ADHD taking stimulants do not grow normally due to the appetite effects of the medication.  Various studies over the years have looked at this issue and the results suggest that there are little, if any, stunting of growth from the stimulants. But questions persist in some circles.

A recent study performed at Massachusetts General Hospital in Boston and reported in the Journal of Pediatrics (October 2010) clarifies the growth tendencies of children with ADHD. This study looked at the growth patterns of over 240 boys and girls with ADHD and compared their growth with that of matched controls without ADHD.

The subjects were observed over a ten year period. No difference was noted in the trajectory of growth in height or weight in the children with ADHD compared with those without ADHD. In addition, there were no significant difference in height growth in those treated with stimulants and those who were not. Nor were there any associations between duration of stimulant treatment and growth patterns.

This carefully done study demonstrates that kids with ADHD, whether treated with medication or not, grow at the same rate as the non-ADHD population.

Editor’s Note: This study is re-assuring to parents and to physicians treating children with stimulants. In spite of this, it is important for children taking stimulants to be seen by their physician on a regular basis with monitoring of appetite and growth factors. Among other observations, their height and weight should be measured and plotted on a growth curve regularly. If there is any evidence in loss of appetite or fall off in the growth pattern, the physician and parents can make appropriate adjustments in type, amount, or timing of the medication.

Association of ADHD to Obesity

A large of study of over 12,000 people in the U.S. has suggested an association of ADHD and obesity in children and young adults. In an analysis that controlled for age, sex, race, ethnicity, education, depression, alcohol use, smoking, and physical activity, survey participants with ADHD had a significant 63% increased risk of being obese compared with those without these symptoms. People with only inattention (ADD) had a smaller increase risk of 23%.  In the study, the more intense and widespread the symptoms of hyperactivity and impulsiveness, the worse the obesity risk.

The study did not evaluate the reasons for this association of ADHD and obesity. However, one of the characteristics of ADHD is impulsiveness. It is possible impulsive eating, maybe related to increased stress of coping with ADHD symptoms could contribute to the increased risk. Further study is needed to get a better picture of the cause of the obesity and how to prevent it. Also it would be of interest to know if optimum treatment with medication and cognitive behavior therapy would reduce this risk. I suspicion is that it would to the degree that intervention helped in the control of impulsiveness.

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