Changes in Emotions Related to Medication Used to Treat ADHD. Part II: Clinical Approaches

Abstract

ADHD is one of the most common neurobehavioral disorders of childhood, and FDA-approved medications offer an efficacious treatment option. However, case reports and anecdotal sources suggest that children can have emotional responses, both salutary and detrimental, to these agents. We have previously conducted a comprehensive literature review and found very few research studies systematically examining changes in emotional expression (EE) associated with ADHD medication use. In addition, no empirical data pertaining to the management of these responses could be found. Although few methodologically stringent data are available for changes in EE, such changes should be recognized and measured to determine appropriate responses by clinicians and to maximize treatment benefits and reduce side effects. In this companion report, we draw on available research evidence and clinical experience to explore typical clinical manifestations, differential diagnosis, scales for monitoring, and management approaches of EE observed with pharmacologic treatment of ADHD. In the future, controlled clinical trials of ADHD pharmacotherapy should employ standardized ratings of EE at baseline, during and after treatment. In addition, future research studies should examine various management approaches of these EE changes, to ensure maximal treatment benefits and minimal risks to patients with ADHD who are treated with medication. (J. of Att. Dis. 2011; 15(2) 113-121)

Keywords

ADHD emotional expression stimulants

Get full access to this article

View all access options for this article.

References

Amiri, S. , Mohammadi, M.R. , Mohammadi, M. , Nouroozinejad, G.H. , Kahbazi, M. , & Akhondzadeh, S. (2008). Modafinil as a treatment for attention-deficit/hyperactivity disorder in children and adolescents: A double blind, randomized clinical trial. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 32, 145-149.

Barkley, R.A. , McMurray, M.B. , Edelbrock, C.S. , & Robbins, K. ( 1990). Side effects of methylphenidate in children with attention deficit hyperactivity disorder: A systemic, placebo-controlled evaluation . Pediatrics, 86, 184-192.

Biederman, J. , Krishnan, S. , Zhang, Y. , McGough, J.J. , & Findling, R.L. (2007). Efficacy and tolerability of lisdexamfetamine dimesylate (NRP-104) in children with attention-deficit/ hyperactivity disorder: A phase III, multicenter, randomized, double-blind, forced-dose, parallel-group study. Clinical Therapeutics, 29, 450-463.

Carlson, G.A. , & Kelly, K.L. ( 2003). Stimulant rebound: How common is it and what does it mean? Journal of Child and Adolescent Psychopharmacology, 13, 137-142.

Conners, C.K. ( 2000). Conners’ Rating Scales-Revised: Technical Manual . North Tonawanda, NY: Mutli-Health Systems.

Gioia, G.A. , Isquith, P.K. , Retzlaff, P.D. , & Espy, K.A. ( 2002). Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample. Child Neuropsychology, 8, 249-257.

Guy, W. ( 1976). ECDEU Assessment Manual for Psychopharmacology-Revised . Rockville, MD: US National Institute of Health, Psychopharmacology Research Branch.

James, R.S. , Sharp, W.S. , Bastain, T.M. , Lee, P.P. , Walter, J.M. , Czarnolewski, M. , & Castellanos, F.X. (2001). Double-blind, placebo-controlled study of single-dose amphetamine formulations in ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1268-1276.

Kratochvil, C.J. , Faries, D. , Vaughan, B. , Perwien, A. , Busner, J. , Saylor, K. , . . . Swindle, R. ( 2007). Emotional expression during attention-deficit/hyperactivity disorders treatment: Initial assessment of treatment effects. Journal of Child and Adolescent Psychopharmacology, 17, 51-62.

10.

Manos, M.J. , Brams, M. , Childress, A. , Findling, R.L. , Lopez, F.A. , & Jensen, P. (In press). Changes in emotions related to medication used to treat ADHD. Part I: A literature review. Journal of Attention Disorders .

11.

Manos, M.J. , Short, E. , & Findling, R.L. (1998). Differential effectiveness of methylphenidate and Adderall in school-aged children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 813-819.

12.

March, J. , Karayal, O. , & Chrisman, A. ( 2007, October 23-28). CAPTN: The Pediatric Adverse Event Rating Scale. Paper presented at the 2007 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Boston, MA.

13.

Pelham, W.E. ( 1993). Pharmacotherapy for children with attention-deficit hyperactivity disorder. School Psychology Review, 22, 199-227.

14.

Perwien, A.R. , Kratochvil, C.J. , Faries, D. , Vaughan, B. , Busner, J. , Saylor, K.E. , . . . Swindle, R. ( 2008). Emotional expression in children treated with ADHD medication: Development of a new measure. Journal of Attention Disorders , 11, 568-579.

15.

Pliszka, S. ( 2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894-921.

16.

Pliszka, S.R. ( 1998). Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: An overview. Journal of Clinical Psychiatry, 59(Suppl. 7), 50-58.

17.

Spencer, T.J. ( 2006). ADHD and comorbidity in childhood. Journal of Clinical Psychiatry, 67(Suppl. 8), 27-31.

18.

Spencer, T.J. , Wilens, T.E. , Biederman, J. , Weisler, R.H. , Read, S.C. , & Pratt, R. ( 2006). Efficacy and safety of mixed amphetamine salts extended release (Adderall XR) in the management of attention-deficit/hyperactivity disorder in adolescent patients: A 4-week, randomized, double-blind, placebo-controlled, parallel-group study. Clinical Therapeutics, 28, 266-279.

19.

Swanson, J.M. ( 1992). School-based assessments and interventions for ADD students . Irvine, CA: KC Publications.

20.

Swanson, J.M. , Wigal, S. , Greenhill, L.L. , Browne, R. , Waslik, B. , Lerner, M. , . . . Cantwell, D.P. (1998). Analog classroom assessment of Adderall in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 519-526.

21.

Taylor, F.B. , & Russo, J. ( 2000). Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults. Journal of Child and Adolescent Psychopharmacology, 10, 311-320.

22.

Wigal, S.B. , McGough, J.J. , McCracken, J.T. , Biederman, J. , Spencer, T.J. , Posner, K.L. , . . . Tulloch, S.J. ( 2005). A laboratory school comparison of mixed amphetamine salts extended release (Adderall XR) and atomoxetine (Strattera) in school-aged children with attention deficit/hyperactivity disorder. Journal of Attention Disorders, 9, 275-289.

23.

Wolraich, M.L. , Lambert, W. , Doffing, M.A. , Bickman, L. , Simmons, T. , & Worley, K. ( 2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28, 559-567.