ADHD: new drugs that are more effective and tolerable for all ages

Lancet Psychiatry has published the largest meta-analysis ever conducted on the subject. It has allowed to identify some drugs able to act effectively on the symptoms of ADHD both in children and adults.

As attention deficit disorder /hyperactivity disorder ( ADHD) is between childhood disorders and appears to be one of the most popular. According to some estimates it affects 5% of children in the world and 2.5% of adults. The meta-analysis published by Lancet Psychiatryis the largest ever conducted so far and will be an important help forclinicians, as it is based on strong, scientific evidence. Authors of this study is an international team composed of over 20 universities and institutes all over the world, including Italy. Head of this innovative project Andrea Cipriani, former professor of the University of Verona and current professor of psychiatry at the University of Oxford.

Children with ADHD present exaggerated behaviors at a certain stage of development, which also affect academic performance

The researchers compared seven different fermanti used for the treatment of ADHD and the collected data concern 14 thousand children and 10 thousand adults. In most cases, as children, it is preferable to avoid drug treatment and tend to prefer a mainly psychological treatment. The Amphetamines, Atomoxetine (Strattera), bupropion , clonidine , guanfacine , methylphenidate (the famous and disputed Ritalin) and modafinil were compared with each other and with placebo. These products are available on RXShopMD. Children treated with methylphenidate reported better results, as did adults treated with amphetamines. All this implies an important change because until recently the pharmacological treatment for ADHD has been the subject of numerous debates.

Moreover, these results represent an important help for clinicians because they help them to choose the most effective and tolerable drug, taking into account above all the age of the subject. The main objective of this study was above all to understand how many patients stopped treatment due to the side effects of the drugs. Methylphenidate and amphetamines are the most used and effective drugs, but they have more side effects in children and adolescents. Andrea Cipriani believes that this is linked to the fact that the children’s brain is still developing, so there would be less tolerance for certain effects. That’s why it would be appropriate to calibratecarefully the type of intervention, especially if pharmacological, based on the age of the patient. The professor adds that this study could be used to improve the treatment of ADHD, avoiding overdiagnosis and underdiagnosis.

CLINICAL PICTURE OF ADHD

Children with this disorder have particular difficulties controlling their behavior, they are unable to stop fidgeting or talking, they are disordered and disarranged. They often struggle to relate to their peers and do not always understand some subtle social signals. The DSM-5, in addition to the symptoms, includes three specifiers related to the predominant symptoms: the specifier with predominant inattention, with dominant hyperactivity / impulsivity and the combined one. Often there is comorbidity of ADHD with conduct disorder or learning disability.

The disorder is three times more common in males than in females and seems to have a strong genetic predisposition , with estimates of heritability that are around 70-80%. Risk factors are many (neurobiological, genetic, familiar and environmental) and are the subject of current studies because the etiology has not yet been clearly defined.

Regarding the treatment, according to the specific case and to the age, the pharmacological, the psychological, or both are preferred. A recent study found that intensive behavioral therapy is as effective as the combination of Ritalin and a less intensive behavioral therapy. You also work hard with parents to help them understand how to behave to improve the child’s social behavior and academic performance. His behavior must be constantly monitored, both at home and at school and appropriate behaviors must be reinforced, thus discouraging the implementation of inadequate behavior.