Intensive Use of Stimulants at Start Often Beneficial in ADHD

By McNamara, Damian | Clinical Psychiatry News, February 2007 | Go to article overview

Intensive Use of Stimulants at Start Often Beneficial in ADHD


McNamara, Damian, Clinical Psychiatry News


ORLANDO -- Start with a long-acting stimulant for treatment of attention-deficit hyperactivity disorder for most patients, increase the dose before adding a short-acting drug, and monitor response with a rating scale, Dr. Peter S. Jensen advised at a psychopharmacology congress sponsored by the Neuroscience Education Institute.

Begin with intensive treatment, because studies show it can make a difference up to 2 years out, Dr. Jensen said. "We now have studies of the stimulants--the methylphenidate preparations, the amphetamine, dextroamphetamine, and atomoxetine--showing sustained benefit through 12 months and up to 2 years."

The symptom profile for attention-deficit hyperactivity disorder (ADHD) evolves with age. Hyperactivity, impulsivity, aggression, distractibility, a low frustration tolerance, and difficulty with establishing routines are among the childhood symptoms. "Individuals with predominantly inattentive symptoms are more likely to be overlooked," said Dr. Jensen, director, Center for the Advancement of Children's Mental Health, department of child psychiatry, Columbia University, New York.

Adolescents with ADHD are often easily distracted/inattentive, easily bored, impatient, and emotionally immature, compared with peers. "ADHD--the full syndrome--is rarely seen in adults. So many kids initially diagnosed with the full syndrome lose a lot of the hyperactivity and impulsivity as they get older," Dr. Jensen said. "What remains? Inattention (J. Clin. Psychol. 2005;61:535-47).

Monitor treatment response with age-appropriate rating scales, Dr. Jensen suggested. Examples include the Early Childhood Attention Deficit Disorder Evaluation scale for preschool children; the Child Behavior Checklist for school-age children; and the Adolescent Symptom Inventory for adolescents. In addition, the Brown Attention Deficit Disorder scales are useful for patients who are primarily inattentive.

"If we don't use these, we are shooting from the hip. We get parent ratings and teacher ratings with these and it's great documentation," Dr. Jensen said. "I graph them and show them to families--they love them."

Stimulant medications can be effective for both motor and attention symptoms of ADHD. …

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Intensive Use of Stimulants at Start Often Beneficial in ADHD
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