Journal of child and adolescent psychopharmacology最新文献

Objectives/Background: Multiple factors influence symptom severity in Attention Deficit/Hyperactivity Disorder (ADHD). We examined four of these: diet, sleep hygiene, exercise, and lighting, in the International Collaborative ADHD Neurofeedback (ICAN) randomized clinical trial, which found large significant improvement with both active neurofeedback and control condition without treatment difference. Methods: A total of 142 participants aged 7-10 had breakfast and lunch intake and exercise recorded at each neurofeedback session. Parents completed the Children's Sleep Habits Questionnaire (CSHQ). Parents and teachers rated inattention on Conners3. Lifestyle changes were correlated with inattention changes. Results: At baseline, CSHQ correlated with parent-rated inattention (r = 0.17, p = 0.04), and length of sleep correlated with teacher-rated inattention (r = 0.20, p = 0.03). From baseline to treatment end food group variety (p = 0.029, d = 0.22) and sleep problems (p < 0.0001, d = -0.49) improved significantly, exercise time and protein intake marginally (p = 0.06 - 0.08). Parent-rated inattention improvement correlated with CSHQ improvement (Rho = 0.26, p = 0.002) and marginally with protein intake increase (Rho = 0.18, p = 0.06). The three components of the light-emitting-diode (LED)-induced circadian pathway hypothesis were significant. Conclusions: Most measures improved, but few significantly. How much they impact classroom attention remains unclear. Although parent ratings of inattention improvement correlated with sleep problems improvement, composited parent/teacher ratings (primary outcome) did not. The circadian pathway hypothesis associated with LED lighting was supported. These findings warrant further studies examining the role sleep hygiene can play in improving ADHD symptoms. Meanwhile, attention to sleep hygiene seems appropriate in any treatment plan for ADHD.

Objective: Weight loss is a well-documented adverse effect of psychostimulants. Given their frequent coprescription with second-generation antipsychotics (SGA) in pediatric patients, this study aims to examine whether concomitant use of psychostimulants mitigates SGA-associated weight gain in children and adolescents. Method: This study utilized the IQVIA Ambulatory electronic medical record-U.S. database (2016-2021) to identify patients aged 6-17 years who initiated an SGA. Those who started psychostimulants within 7 days of SGA initiation and maintained ≥90 days of use were classified as concomitant users, while those who initiated psychostimulants later with ≥90 days of overlap were add-on users. Patients never prescribed psychostimulants were SGA-only users. After adjusting for the baseline covariates using propensity scores, 6- and 12-month body mass index (BMI) z-score trends following psychostimulant initiation were compared between (1) concomitant and SGA-only users and (2) add-on and SGA-only users, using a linear mixed-effects regression model. Results: The results of linear mixed effect regression models indicate that concomitant users experienced a 0.0143 less monthly BMI z-score increase (p = 0.0063) compared with the SGA-only users over the 6 months following psychostimulant initiation. Similarly, add-on users had a significantly lower rate of weight gain compared with SGA-only users (β = -0.0463, p < 0.0001). When the follow-up period was extended to 12 months, the sensitivity analyses for both concomitant and add-on users were consistent with their primary analyses. Conclusions: Concomitant and add-on psychostimulants appear to mitigate SGA-associated weight gain in children and adolescents. Further investigation is needed to understand their effectiveness and safety relative to other interventions for antipsychotic-associated weight gain.

Objectives: Investigators and government agencies have expressed concern about the high percentage of foster youth who receive psychotropic medication, the number of psychotropic medications prescribed, and the extended duration for which many foster youth receive psychotropic medication. One contributor to the duration of medication use is the absence of clear guidelines for de-prescribing in pediatric psychiatry. The present study evaluated whether medication review letters crafted by medical professionals and sent to caregivers prompted a reduction in psychotropic medication in foster youth. Methods: The caretaker or caseworker of 52 foster children, 38 males, under 16 years of age, who received medication through Medicaid, was sent a letter assessing the use of psychotropic medication and identifying areas of concern. Recipients were encouraged to discuss the letter with the child's prescriber. These children had been referred to a university-affiliated organization that provided behavioral interventions to other children, but the children in the present study did not receive behavioral interventions from the organization. The use of psychotropic medication was assessed for 18 months before and 24 months after the letter was sent. The control group had comparable demographics and medication-use parameters. The trajectories of medication count before and after a letter (for cases) or a "phantom" letter (for controls) was sent were compared. Results: The medication review letter precipitated a decrease in medication count over the year after the letter was sent for 9- to 12-year-olds. For 13- to 16-year-olds, an increasing trend in medication use was halted. No effect was seen for 5- to 8-year-olds. No such changes occurred in the control groups. Conclusions: A single personalized letter, tailored to a child's medication list, was provided to caregivers to share with prescribers. This decreased or halted an increase in the use of psychotropic medications for children in foster care who were 9 years old or older.

Objective: To characterize the size and course of placebo response in attention-deficit/hyperactivity disorder (ADHD), with informant and moderator effects, and illustrate its importance by comparison to Multimodal Treatment Study of ADHD (MTA) 3-month data. Methods: In two randomized clinical trials parents and teachers rated DSM-IV ADHD symptoms (Sx) on pill placebo at baseline (BL), 8, 12, and 16 weeks for 57 children age 5-12 with ADHD (25 inattentive, 32 combined type) and on an intense 12-week nonmedical control condition (NMCC) for 27 children age 6-12. Results: Parent- and teacher-rated placebo effects peaked at 12 and 8 weeks, respectively. Changes from BL are significant (p = 0.001) by parent and teacher on inattentive Sx (d = .60, .56 for pill placebo; d = 1.48, .51 for NMCC) and on hyperactive/impulsive Sx by parent (d = 0.48 pill; d = 1.26 NMCC). Teacher-rated hyperactive/impulsive show greater placebo effect September-January than February-May (p = 0.017). Teacher-rated inattentive Sx shows a significant (p = 0.033) interaction of season*subtype. Compared to placebo data, MTA treatments show significant benefit (p = 0.000) at 3 months on both inattentive and HYP/IMP symptoms for medication management and combination groups but not for behavioral treatment (Beh) or community comparison groups, except for teacher-rated HYP/IMP for Beh (p = 0.002). Conclusions: Parent/teacher ratings show a medium placebo effect for pill placebo and a large effect (d > 1.2) by parent for intense, complex NMCC, suggesting that parent-rated placebo response depends on the complexity/intensity of the control condition. Raters agree on inattentive but diverge on HYP/IMP Sx. Teachers' perceptions of HYP/IMP severity change by season. Pill placebo data indirectly support the 3-month efficacy of two MTA treatments, combination and medication management.

Background: Children with intellectual disability (ID) are more susceptible to adverse effects from standard psychiatric medications, often necessitating the use of off-label treatments. In the limited studies to date, Clonidine has displayed evidence of benefit in treating attention-deficit/hyperactivity disorder (ADHD), sleep onset difficulties, behaviors that challenge, and tics. Methods: This naturalistic study involved a cross-sectional survey completed by 4 consultant psychiatrists, detailing 50 children with ID treated with Clonidine over a 3-year period. Data collected included treatment indications, dosage, and retrospective Developmental Disabilities Modification of Children's Global Assessment Scalescores to evaluate functioning before treatment and again 6-12 months later. Results: Among children who remained stable on Clonidine, ordinal regression analyses revealed that total Clonidine dose, level of ID, concomitant medications, and comorbid diagnoses significantly predicted improved functioning at 2 months, which was sustained after 1 year of treatment with Clonidine. Conclusions: Clonidine is useful to treat ADHD, sleep difficulties, tics, and behaviors that challenge. Clonidine was generally well tolerated and appears to be an effective treatment option for children with ID. This will inform the clinical practice of both pediatricians and psychiatrists who support and treat children with ID.