Stimulant Medication Shortens the Duration of Impairing Emotional Outbursts

JAACAP open Pub Date : 2025-03-01 DOI:10.1016/j.jaacop.2024.01.002

Lauren M. Spring MD, Joseph E. Schwartz PhD, Gabrielle A. Carlson MD

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Abstract

Objective

Emotional dysregulation, often presenting as severe emotional outbursts, is being increasingly recognized as a source of considerable impairment for individuals with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to conduct a secondary analysis of data examining the impact of standing stimulant medication on the duration of emotional outbursts.

Method

The as needed (PRN)–medicated outbursts of psychiatrically hospitalized children, 5 to 12 years of age, were tracked by psychiatric nurses using the Behavioral Activity Rating Scale from the time of PRN administration until the child became calm. The impact of extended-release (ER), immediate-release (IR) stimulant and dose, type and reason for outburst/PRN (aggression, agitation, distress), standing concomitant psychotropic medications and time of day, and days since admission were examined.

Results

Forty-seven children had a total of 405 outbursts, 96 of which occurred when no stimulant was prescribed and 309 with stimulant medication. Controlling for time of day and standing neuroleptic dose, outbursts that occurred on an ER stimulant medication were statistically significantly shorter than those that occurred on no stimulant by about 20 minutes (52.7 vs 72.4 minutes), or 30 minutes for aggressive outbursts. Results were unchanged when further controlling for stimulant type and dose, α-agonist, days since admission, PRN medication type, or reason for PRN/outburst. Immediate-release stimulants and short-acting stimulants did not shorten outburst duration.

Conclusion

In children with ADHD with severe outbursts, ER stimulants were associated with shorter outburst duration than IR stimulants.

Plain language summary

This study examined psychiatrically hospitalized children with attention-deficit/hyperactivity disorder who had emotional outbursts requiring as-needed medication. Children who took extended-release stimulant medication (stimulants that are designed to last throughout the day) had shorter outbursts (by about 20 minutes) than children on no stimulant medication or short-acting stimulant medication.

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