Long-Term Effects of Psychiatric Medications in Children with ADHD - Research Paper Example

13 December Long-term Effects of Psychiatric Medications in children with ADHD Introduction Attention Deficit Hyperactivity Disorder (ADHD) in children is a neurobehavioral disorder that occurs in children and includes various neurological and psychiatric symptoms such as restlessness, inattentivity, difficulty concentrating, distraction, impulsivity, and hyperactivity. Besides, the children affected with ADHD also have other problems including troubled relationship with peers, talking excessively, interrupts others during conversation, poor performance at school, and poor self-esteem. The two primary features of ADHD include inattentivity and hyperactivity-impulsivity. The child does not seem to listen to anybody and fails to follow instructions or fails to fiinish tasks assigned to him. The condition is usually noticeable in children by the age of 7 years, though in some it may be recognizable by the age of 2 to 3 years. The condition more often occurs in boys than in girls, and the hyperactive variant is more frequently seen in boys, compared to girls who have the inattentive form (Mayo 2011). The prevalence of ADHD amongst children is between 3 and 10% (Saito, 2000). In several instances ADHD may actually be associated with several cormobidities including substance abuse, psychiatric disorders, anxiety, depression (from bipolar disorders, Tourette syndrome, oppositional defiant disorder, learning disorders, conduct disorder, dyslexia (reading and writing disorders), developmental coordination disorders, personality disorders, etc (AACAP & APA, 2010). Background The exact cause for the development of ADHD is not known, but genes have an important role to play and are noted as the leading contributor. The condition usually runs in families, and about 75% of the children with the condition have relative affected with the disorder. Children with ADHD have several altered functions of the brain and this can be visualized through brain scans. Areas of the brain that control attentivity and impulsivity are affected in children with ADHD (Mayo, 2011). There are several other factors that play a vital role in the development of ADHD including maternal smoking, drug usage during pregnancy, exposure to toxins during pregnancy, early childhood exposure to toxins, certain food additives and coloring agents, etc (Mayo, 2011). The DSM-IV-TR specifies guidelines for the diagnosis of ADHD. Broadly, the symptoms are divided into two groups, namely the inattentivity group and the Hyperactivity-impulsivity group. There are a number of symptoms listed out in each group, and for a child to be classified as suffering from ADHD, at least 6 symptoms should be present from either one of the groups for at least 6 months and the symptoms should cause significant dysfunction at home, school, workplace or in a social setting (DSM-IV-TR, 2011). Based on the predominance of the type of symptoms, ADHD can be grouped into either inattentive-group or the hyperactivity-impulsivity group. There is third type, called as the combined or the mixed group where the symptoms are mixed in nature (Mayo, 2011). The National Institute of Mental Health (NIMH) suggests multi-modal schemata for the treatment of ADHD which includes administration of medications, behavioral therapy and close monitoring of the condition (Mayo, 2011). Medications can help reduce hyperactivity in the young, improve the attention span and improve the manner in which the individual would react to people and work with others. Combination behavioral therapy aids in resolving several problems that occur at home, school, and workplace or in social settings. Through behavioral therapy, the dosage of drugs required would be reduced, and hence combination treatment along with close monitoring is utmost needed (AACAP & APA, 2010). On a broad category, the medications for treating ADHD are divided into two types, namely stimulants and non-stimulants. There are also other drug categories such as antidepressants, antihypertensive, etc, which have some positive effect in treating ADHD. Psychostimulants are the most colony prescribed drugs and include methylphenidate, amphetamine and dextroamphetamine. They tend to balance out the level of the neurotransmitters in the brain and control the symptoms of impulsivity, inattentivity and hyperactivity (AACAP & APA, 2010). They are further divided into long-acting and short-acting. Long acting last from 6 to 12 hours, whereas short acting between 2 to 4 hours. Non-stimulants are drugs such as amoxetine are given when stimulants are not really effective or safe. The other groups of drugs are used to treat ADHD in case stimulants or non-stimulants are not effective or safe, or in case certain comorobidities are present which also require treatment (Mayo 2011). In this paper, the long-term effects of medications used for managing ADHD would be studied in order to understand the long-term outcome. Currently, not much literature has been performed in this area, and the data analysis of the same has been minimal. Review of Literature 8 papers were selected that were considered appropriate to be included in this study. These 8 papers were from the Pubmed and EBSCO database and met the requirements of providing data required for assess the long-term effects of medication in children with ADHD. Zachtor and Alicia 2006 performed a study to identify the long-term effects of psychostimulant group of drugs on the growth of children with ADHD. They followed a group of 89 children who were treated with psychostimulant over a 36-month duration, and recorded anthropometric data frequently. The other means of assessing the data included studying the patient medical records, medication history, and BMI index. It was found that initially during the initiation of treatment with psychostimulant, significant body weight loss occurred. However, throughout the rest of the treatment, the BMI index was normal for the child. The weight-loss was more in pre-pubertal children and was higher in obese children. The effect of the drug on the height was difficult to determine. Hence, long-term treatment with stimulants may not have a significant impact on children with ADHD. Sara and Pelham 2009 studied the social information processing abilities in children with ADHD and compare the same with children with ADHD who did not receive medication treatment. About 75 children including 56 girls and 19 boys were included in the study. Following drug administration of methylphenidate, the children were presented with various scenarios and the asked to interpret the same. Children with ADHD who were administered Methylphenidate were more hostile than were the controls. However, children with ADHD and who received a placebo thus suggesting that the drug had an effect on the development of hostile responses and aggression. Aggression responses are likely to be aggravated from the administration of methylphenidate. In general it was also noted that children with ADHD even irrespective of their medication status provided a hostile response. The third study by Lisa and Kerstein 2009 was to study the child’s self-reports which included the perceived effects of consuming stimulant medication for the treatment of ADHD. 79 children formed a part of this study who was taking medications for the treatment of ADHD. The children were given a data entry sheet and the same had to input by the child along with a parent. This study was conducted in Sweden. The children who consumed the medication felt that the drug had a positive effect on their condition, especially when it comes to performing at school and desired to further continue the medication. However, there was a smaller group of children who had negative effects. When the effects were positive, there was reduced number of differences of opinion between what the parent and what the child said. When the effect was negative, the number of differences of opinion was higher, but the parents reported more negative events than the child. The child was willing to continue the medication, if it found that the effects were positive. Huang and Tsai 2011 conducted study to assess the current state of knowledge of long-term outcomes for ADHD after consuming medications. The author reports that most of the drug administration for ADHD has been given on a short-term basis and the information on the long-term administration was not known. In ADHD, the treatment has to be continued for years especially if the symptoms are severe and if co-morbidities are present. Stimulants and non-stimulants are effective for short-term administration. They can be given in various forms including extended release. The medication administered is effective for the initial 24-month period and the side-effects present during the first 24- months are more or less tolerable compared during the later duration. The outcome during the first 24-months is also better than the outcome during the later 24-months. Huang and Tsai 2011 conducted another study to determine the effects of medications of ADHD on sleep on a short-term and a long-term basis. This was because, there is currently a lot of research being generated on sleeps problems of children with ADHD and when the sleep is seriously impacted the quality of life and the symptoms present in the condition are impacted. Most of the drugs for the treatment of ADHD have a dopaminergic or a noradrenergic release in the CNS. Previously, various stimulants have been found to impact sleep negatively causing insomnia and other sleep disturbances. Methylphenidate is known not to cause any significant problems with short-term or long-term sleep due to which the quality of life and the symptoms of children using methylphenidate is improving. Zuvekas and Vitiello 2011, studied the utilization of stimulant medication for treating ADHD in US school children for a period of 13 years from 1996 to 2008, and the database they created was known as the “Medication Expenditure Panel Survey”. Trends with relation to age, sex, ethnicity, socioeconomic group and the geographical area of location were being studied. As a reference, the data obtained from 1987 was used. In 1996, about 2.4% received stimulant medication compared to 3.5 % in 2008. The use of stimulants increased by 3.4% each year. Amongst adolescents, the use of the drugs increased, reduced in smaller children (6 to 12 years), and reduced in preschool children. Minorities and lower economic groups used stimulants less often. Hence, it can be considered that the use of stimulants has been rising since 1996, as adolescents are using greater quantities. Schachter and Pham 2001 conducted a study to study the efficacy and safety of short-acting methylphenidate for managing ADHD. Data for the same was searched from various databases including MEDLINE, EMBASE, CINAHL, Cochrane, etc. More than 3000 patients were a part of this study. As per the findings of this study, the effects of the drug vs. a placebo were closely compared and nothing untoward was demonstrated. The drug effect beyond 4 weeks was difficult to monitor for the scope of this study. The authors suggest using short-acting methylphenidate for up to 4 weeks duration, and beyond this duration the placebo-controlled effect may be difficult to calibrate. Lerner and Wiqal 2008 report certain problems with long-term use of ADHD drugs in children including growth, cardiovascular and tics problems. Besides, children below the age of 6 years have demonstrated carcinogenic and reproductive problems following long-term administration of Stimulant medication. Conclusion It can be seen that in general not much data has been obtained regarding the long-term benefits of stimulants and other medications on the treatment of ADHD. There were some concerns that increased cardiovascular risks may be present, along with risks for cancer and growth problems. The short-term safety and effectiveness of methylphenidate has been established, and more number of studies has to be organized for determining the long-term safety and effectiveness (especially after 24-month duration). In fact, a lot has been known of the efficacy of the drug during the first 24 months, and during the second 24 months, the drug may not be as effective as during the first. Hence, greater clarification has to be sought in this area. As methylphenidate is not the cause of disturbance to short-term and long-term sleep, there are chances that the quality of care provided and the outcome would be better for children who consume the drug. Through stimulants administered for a long duration of time, social function and performance at school would improve. Inferences Works Cited (EBSCO Highlighted in Bold) American Academy of Child and Adolescent Psychiatry and American Psychiatric Association. “Attention-De?cit/Hyperactivity Disorder” AACAP & APA. 2011. Parents Med Guide. 11 Dec 2011. < http://www.parentsmedguide.org/ParentGuide_English.pdf> Huang Y.S., Tsai, M.H. “Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge.” CNS Drugs. 25.7 (2011):539-54. http://www.ncbi.nlm.nih.gov/pubmed/21699268 Huang Y.S., Tsai, M.H. “Pharmacological treatment of ADHD and the short and long term effects on sleep.” Curr Pharm Des. 17.15 (2011):1450-8. http://www.ncbi.nlm.nih.gov/pubmed/21476954 King, Sara, Daniel Waschbusch, William E Pelham. “Social Information Processing in Elementary-School Aged Children with ADHD: Medication Effects and Comparisons with Typical Children.” Journal of Abnormal Child Psychology, 37.4(2009): 579-589. http://web.ebscohost.com.ihcproxy.mnpals.net/ehost/detail?sid=818558af-364e-4afb-8fac-6f3d250aaa41%40sessionmgr4&vid=1&hid=21&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=eric&AN=EJ834944 Lerner, M., Wiqal, T. “Long-term safety of stimulant medications used to treat children with ADHD.” J Psychosoc Nurs Ment Health Serv 46.8 (2008):38-48. http://www.ncbi.nlm.nih.gov/pubmed/18777967 Mayo Clinic Staff. “Attention-deficit/hyperactivity disorder (ADHD) in children.” Mayo. 2011. Mayo Clinic. 11 Dec 2011. Saito, Takuya. “Recent Findings in ADHD.” Medscape. http://www.medscape.org/viewarticle/420851 Schachter, H.M., Pham, B. “How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis.” CMAJ. 165.11(2001): 1475-1488. http://www.ncbi.nlm.nih.gov/pubmed/11762571 Thorell, Lisa, & Kerstin Dahlstrom. “Children's Self-Reports on Perceived Effects on Taking Stimulant Medication for ADHD.” Journal of Attention Disorders 12.5(2009): 460-468. http://web.ebscohost.com.ihcproxy.mnpals.net/ehost/detail?sid=eff66479-c1e2-4c7b-b3ae-d5fb77bad64c%40sessionmgr13&vid=1&hid=21&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=eric&AN=EJ828761 Zachtor, Ditra, Alicia Roberts, Bart Hodgens. “Effects of Long-Term Psychostimulant Medication on Growth of Children with ADHD.” Research in Developmental Disabilities: A Multidisciplinary Journal 27.2(2006): 162.174. http://web.ebscohost.com.ihcproxy.mnpals.net/ehost/detail?sid=192eda0f-6b84-4e91-b488-f3acb0406b54%40sessionmgr4&vid=1&hid=21&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=eric&AN=EJ729802 Zuvekas, S.H., Vitiello B. “Stimulant Medication Use in Children: A 12-Year Perspective.” Am J Psychiatry. (2011). http://www.ncbi.nlm.nih.gov/pubmed/21955934 Read More