stimulant medication
Research Papers
Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up
Background: Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment. Aim: The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents. Methods: This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents’ and teachers’ forms taken from Barkley’s Defiant Children: A Clinician’s Manual for Assessment and Parent Training, and a self-report questionnaire. Results: Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants. Conclusions: Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.
View Full Paper →The Utility of EEG in Attention Deficit Hyperactivity Disorder: A Replication Study
The routine use of stimulants in pediatrics has increased dramatically over the past 3 decades and the long-term consequences have yet to be fully studied. Since 1978 there have been 7 articles identifying electroencephalogram (EEG) abnormalities, particularly epileptiform discharges in children with attention deficit hyperactivity disorder (ADHD). Many have studied the prevalence of these discharges in this population with varying results. An article published in 2011 suggests that EEG technology should be considered prior to prescribing stimulants to children diagnosed with ADHD due to a high prevalence of epileptiform discharges. The 2011 study found a higher prevalence (26%) of epileptiform discharges when using 23-hour and sleep-deprived EEGs in comparison with other methods of activation (hyperventilation or photostimulation) and conventional EEG. We sought to replicate the 2011 results using conventional EEG with the added qEEG technologies of automatic spike detection and low-resolution electromagnetic tomography analysis (LORETA) brain mapping. Our results showed 32% prevalence of epileptiform discharges, which suggests that an EEG should be considered prior to prescribing stimulant medications.
View Full Paper →Neurofeedback is the Best Available First-Line Treatment for ADHD: What is the Evidence for this Claim?
Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic syndrome characterized by deficits in executive functions and attentional processes. Persons diagnosed with ADHD have significant deficits in self-regulation evidenced by difficulty staying focused, controlling impulsive behaviors, and for many, restraining hyperactive motor activity. These symptoms typically create problems in academic, social, and familial contexts as well as in the planning and organization skills needed for daily functioning. Additionally, comorbid syndromes that can mimic the symptoms of ADHD and confound differential diagnosis are commonly present (e.g., anxiety, depression, learning disorders). ADHD is the most frequently diagnosed pediatric disorder with 11% of American school-aged children (and nearly 20% of teenage boys) having been medically diagnosed with ADHD according to the latest report from the Centers for Disease Control (Schwarz & Cohen, 2013). Stimulant medication (SM) and behavior therapy (BT) are the two most widely accepted treatments for ADHD, with approximately 70% of those diagnosed prescribed medication (Schwarz, 2013). Although both interventions are considered to meet the highest standards for the evidence-based treatment of ADHD, and have been recognized as such by the American Academy of Child and Adolescent Psychiatry (AACAP) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the leading ADHD advocacy group, the actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them and, therefore, do not warrant being the first option for treating ADHD
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