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Medical Practice Updates by Richard Rubin, MD. Persisting anxiety in ADHD children, adolescents, and adults is often due to co-occurring disorders, not just reactions to coping problems. The traditional stimulant medicines usually do not help such anxiety, even if the ADHD improves. In addition, the stimulants, both methyphenidate and amphetamines, carry warnings about use if someone has marked anxiety, tension, and agitation. Combining a serotonin medicine for the anxiety with a stimulant for ADHD has been done commonly, but this increases possible side effect difficulties and current warnings about harmful behavioral reactions. Therefore, the non-stimulant atomoxetine (Strattera) has been studied recently as a single treatment for ADHD with Generalized, Social, or Separation Anxiety Disorders. A double-blind trial treated 175 such children and adolescents age 8-17 with atomoxetine or placebo over 12 weeks. Results were first presented at the 2005 American Psychiatric Association Annual Meeting, showing that the ADHD Rating Scale DSM core symptom scores improved significantly, with a mean decrease of 10.5 points compared to 1.4 points on placebo, p<.001. This degree of response is similar to atomoxetine benefit for ADHD alone. The Pediatric Anxiety Rating Scale (PARS) was the primary measure of effect on the anxiety problems. The mean PARS total score improved significantly for the atomoxetine group, a 5.5 point decrease versus 3.2 on placebo, p=.008. A "p" statistic indicates the probability a study result could occur by chance, i.e. .008 means eight chances out of a thousand events. A p of < .05, less than 50 chances out of a thousand events, is the usual threshold for considering a medicine effect meaningful. Additional measurements were presented at the May, 2006 American Psychiatric Association Annual Meeting in a New Research Poster co-authored by Dr. Rubin who also participated in the study. Besides the ADHD Rating Scale core symptom change, significant improvement occurred in a wide range of ADHD functioning impairments, such as social skills and family relationships, as measured by the Life Participation Scale for ADHD and the Child Health Questionnaire. The Multidimensional Anxiety Scale for Children was also employed. This is a self-report completed by the child, different from the structured parent and child interview procedure of the PARS. While the atomoxetine treated group's MASC scores also showed significant anxiety improvement, those on placebo actually reported anxiety worsening. This finding suggests that clinicians should be sure to allow the children opportunity to privately report their internal distress, relieved of their embarrassment or need to please in an interview situation. Dr. Rubin practices Child and Adult Psychiatry, directs The Clinical Study Center in Burlington Vermont, and serves as Clinical Associate Professor at the University of Vermont College of Medicine. Click here for more information about Dr. Rubin and ADHD.
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