Do Preschoolers with Coexisting Disorders Show Less Response to ADHD Medication Treatment?

Preschoolers who are diagnosed with ADHD are not likely to respond to treatment with the stimulant methylphenidate, regardless of dosage, if they also have three or more coexisting disorders, according to a recent analysis of data from the Preschoolers with ADHD Treatment Study (PATS). PATS was funded by the National Institutes of Health’s National Institute of Mental Health (NIMH).

Previously reported PATS results showed that overall, low doses of methylphenidate were safe and effective in treating 3-5-year-olds diagnosed with ADHD. This most recent study, one of seven new PATS articles published November 5, 2007, in the Journal of Child and Adolescent Psychopharmacology, sought to identify individual characteristics that may affect how a child would respond to treatment. The other articles examine topics such as the effectiveness of methylphenidate over a follow-up phase, the effects of the medication on functional outcomes for the preschoolers, and others.

“This new data is an important step forward in bridging the gap between research results and clinical practice, bringing potentially valuable information to clinicians about ways to better customize treatments for their patients,” said NIMH Director Thomas R. Insel, M.D. “It also identifies a group of young children who have significant and multiple problems, and for whom more research is needed to identify effective treatments.”

Analyzing data from 165 children, Jaswinder Ghuman, M.D., of the University of Arizona, and colleagues examined demographic and family characteristics that may predict response to ADHD treatment. Among the children, 29 percent had no coexisting disorders, 42 percent had one coexisting disorder, 21 percent had two coexisting disorders, and 9 percent had three or more coexisting disorders. Oppositional defiant disorder, conduct disorder and anxiety disorders were the most common coexisting disorders.

The researchers found that children with no or only one coexisting disorder were most likely to respond to methylphenidate, while those with two coexisting disorders were moderately likely to respond. Children with three or more coexisting disorders did not respond at all to the treatment.

They also found no demographic characteristics (e.g., gender, age, ethnicity) that predicted how a child would respond to methylphenidate. However, children with three or more coexisting disorders were more likely to have a lower socioeconomic status, and lived with parents who were less educated and unemployed. In addition, these children also were more likely to live in a single-parent household.

“These results need to be replicated before they can be translated into practical recommendations,” said Dr. Ghuman. “But they are a solid reminder that we need to find better treatments for children with multiple disorders and challenging circumstances.”

The findings are consistent with the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA), which found that school-aged children with more coexisting disorders were less likely to respond to ADHD treatment.

Reference

Ghuman JK, Riddle MA, Vitiello B, Greenhill LL, Chuang S, Wigal S, Kollins S, Abikoff H, McCracken J, Kastelic El, Scharko AM, McGough J, Murray D, Evans L, Swanson J, Wigal T, Posner K, Cunningham C, Davies M, Skrobala A. Comorbidity moderates response to methylphenidate in the preschoolers with attention deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology. Nov 2007; 17(5). 563-580.

Thirteen Great Books on ADHD

1. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood by Edward M. Hallowell and John J. Ratey (Paperback - Mar 2, 1995)
2. Answers to Distraction by Edward M. Hallowell and John J. Ratey (Paperback - Mar 1, 1996)
3. Odd One Out: The Maverick's Guide to Adult ADD by Jennifer Koretsky (Paperback - Sep 24, 2007)
4. Survival Tips for Women with AD/HD: Beyond Piles, Palms, & Post-its by Terry Matlen (Paperback - Jan 1, 2005)
5. ADD-Friendly Ways to Organize Your Life by Judith Kolberg and Kathleen Nadeau (Paperback - Aug 2002)
6. Organizing Solutions for People With Attention Deficit Disorder: Tips and Tools to Help You Take Charge of Your Life and Get Organized by Susan C Pinsky (Paperback - Dec 1, 2006)
7. Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder by Blythe Grossberg (Paperback - Sep 6, 2005)
8. Women with Attention Deficit Disorder: Embrace Your Differences and Transform Your Life by Sari Solden, Edward T. Hallowell, and John J. Ratey (Paperback - Nov 29, 2005)
9. Scattered Minds: Hope and Help for Adults with ADHD by Lenard Adler and Mari Florence (Hardcover - May 4, 2006) - Bargain Price
10. 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals (10 Simple Solutions) by Stephanie Sarkis (Paperback - Jan 2, 2006)
11. You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder by Kate Kelly, Peggy Ramundo, and Edward M., M.D. Hallowell (Paperback - April 25, 2006)
12. Attention Deficit Disorder in Adults, 4th Edition: A Different Way of Thinking by Lynn Weiss (Paperback - Nov 25, 2005)
13. The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents by Nancy A. Ratey (Hardcover - April 1, 2008)

Resource and Support Groups for ADHD

1. Attention Deficit Disorder Association
2. The Center
3. Adders.org 
4. Daily Strength  
5. ADHD news.com  
6. Additude  
7. About.com ADD ADHD
8. WebMD  
9. The Real Beauty of ADHD Support Groups
10. Wegohealth

Additional Resources:

• For related articles on ADHD and adults on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
• For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: ADHD: General” or type in the keyword “ADHD and Adults” into “Google Search” located in the sidebar.
• For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “ADHD and Adults” into “Amazon Search” on the Amazon banner located in the side bar.

Sources: National Institute of Mental Health, See also blogposts in: Psychiatric Disorders: ADHD: General

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Email this • Sphere: Related Content • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Share on Facebook • Stumble It! • Add to Mixx! • Discuss on Newsvine • Digg This! • outside.in: geotag this story