|Preschoolers with Three or More Coexisting Disorders
Show No Response to ADHD Medication Treatment
Preschoolers who are diagnosed with ADHD are not likely to respond
to treatment with the stimulant methylphenidate, regardless of
dosage, if they also have three or more coexisting disorders, according
to a recent analysis of data from the Preschoolers with ADHD Treatment
Study (PATS). PATS was funded by the National Institutes of Health’s
National Institute of Mental Health (NIMH).
Previously reported PATS results <http://www.nimh.nih.gov/science-news/2006/preschoolers-with-adhd-improve-with-low-doses-of-medication.shtml> showed
that overall, low doses of methylphenidate were safe and effective
in treating 3-5-year-olds diagnosed with ADHD. This most recent
study, one of seven new PATS articles published November 5, 2007,
in the Journal of Child and Adolescent Psychopharmacology,
sought to identify individual characteristics that may affect how
a child would respond to treatment. The other articles examine
topics such as the effectiveness of methylphenidate over a follow-up
phase, the effects of the medication on functional outcomes for
the preschoolers, and others.
"This new data is an important step forward in bridging the
gap between research results and clinical practice, bringing potentially
valuable information to clinicians about ways to better customize
treatments for their patients," said NIMH Director Thomas
R. Insel, M.D. "It also identifies a group of young children
who have significant and multiple problems, and for whom more research
is needed to identify effective treatments."
Analyzing data from 165 children, Jaswinder Ghuman, M.D., of the
University of Arizona, and colleagues examined demographic and
family characteristics that may predict response to ADHD treatment.
Among the children, 29 percent had no coexisting disorders, 42
percent had one coexisting disorder, 21 percent had two coexisting
disorders, and 9 percent had three or more coexisting disorders.
Oppositional defiant disorder, conduct disorder and anxiety disorders
were the most common coexisting disorders.
The researchers found that children with no or only one coexisting
disorder were most likely to respond to methylphenidate, while
those with two coexisting disorders were moderately likely to respond.
Children with three or more coexisting disorders did not respond
at all to the treatment.
They also found no demographic characteristics (e.g., gender,
age, ethnicity) that predicted how a child would respond to methylphenidate.
However, children with three or more coexisting disorders were
more likely to have a lower socioeconomic status, and lived with
parents who were less educated and unemployed. In addition, these
children also were more likely to live in a single-parent household.
"These results need to be replicated before they can be translated
into practical recommendations," said Dr. Ghuman. "But
they are a solid reminder that we need to find better treatments
for children with multiple disorders and challenging circumstances."
The findings are consistent with the NIMH-funded Multimodal Treatment
Study of Children with ADHD (MTA), <http://www.nimh.nih.gov/health/trials/nimh-research-on-treatment-for-attention-deficit-hyperactivity-disorder-adhd-questions-and-answers-about-the-multimodal-treatmen.shtml> which
found that school-aged children with more coexisting disorders
were less likely to respond to ADHD treatment.
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.