1,721,429 research outputs found
Sleep-associated adverse events during the methylphenidate treatment of attention-deficit/hyperactivity disorder: A meta-analysis
No full textObjective: Sleep disturbances are a feature of attention deficit/hyperactivity disorder (ADHD) and an adverse event (AE) of methylphenidate (MPH) treatment. We sought to clarify MPH-associated sleep problems and how studies are affected by confounding factors. Data Sources: Published studies in English collected via online databases and unpublished data from www.clinicaltrials.gov and FDA websites. Sources were searched from inception to August 2017. Study Selection: We included blinded placebo-controlled studies of youth with ADHD conducted in naturalistic settings. This led to 35 studies yielding 75 observations of sleep-related AEs. These studies comprised 3079 drug-exposed and 2606 placebo-treated patients. Data Extraction: Two PhD reviewers reviewed each study for inclusion. Four PhD/PharmD reviewers extracted data in duplicate. Discrepancies were resolved by discussion or, if needed, by the senior author. Results: We found increased pooled relative risks (RRs) for MPH-associated sleep-related AEs for insomnia, initial insomnia, middle insomnia, combined insomnia, and sleep disorder. Several sample or study design features were significantly associated with the RR for sleep-related AEs and the MPH formulation studied. After correcting for confounding, we found significant differences among drugs. We show that the RR, and its interpretation, is constrained by the placebo AE rate. Conclusions: Several types of insomnia and sleep problems are associated with MPH treatment. Study design and sample features influence the RR statistic. By showing that the rate of placebo AEs impacts the RR, we provide the field with a useful covariate for adjusting RR statistics
A 4-year follow-up of attention-deficit/hyperactivity disorder in a population sample
No full textBackground: Prior follow-up studies of attention-deficit/hyperactivity disorder (ADHD) ascertained ADHD cases in clinical samples mostly from North America but rarely from European countries. They have provided a good deal of information about the persistence of ADHD and its impairments, but the degree to which these results generalize to population samples and to other countries is not certain. Prior studies have also not assessed predictors of new-onset ADHD in youth without ADHD.Method: At baseline, 7,912 of 18 million telephone numbers were randomly selected from throughout France from October 2, 2008, through December 11, 2008. Among 4,186 eligible families, 1,012 (24.2%) were successfully recruited at baseline, when a telephone interview was administered to all families about a child in the 6- to 12-year age range. Four years later, we attempted to recruit the entire sample to assess the persistence of ADHD and its impairments and the emergence of new associated conditions.Results: 86.5% of the families assessed at baseline were followed-up (N = 875). Participants who were and were not interviewed at follow-up did not differ on any clinical or demographic features. At follow-up, the prevalence of full or subthreshold ADHD was 65.8% for ADHD participants and 9.8% for those not having ADHD at baseline. Among the children who were not diagnosed with ADHD at baseline, 3.4% were diagnosed with ADHD at follow-up. Both the persistence of ADHD and new onsets of ADHD were significantly predicted by several baseline clinical features and by having a family history of ADHD (all P values < .05).Conclusions: We replicated prior predictors of ADHD’s persistence and provide new data about predictors of new ADHD onsets in the population. Our data about subthreshold ADHD support a dimensional conceptualization of the disorder and address the potential clinical utility of a subthreshold diagnostic category.<br/
What should be said to the lay public regarding ADHD etiology based on unbiased systematic quantitative empirical evidence
No full textAMUpstate Medical UniversityPsychiatryN/
Placebo and nocebo responses in randomised, controlled trials of medications for ADHD: a systematic review and meta-analysis
Get PDFThe nature and magnitude of placebo and nocebo responses to ADHD medications and the extent to which response to active medications and placebo are inter-correlated is unclear. To assess the magnitude of placebo and nocebo responses to ADHD and their association with active treatment response. We searched literature until June 26, 2019, for published/unpublished double-blind, randomised placebo-controlled trials (RCTs) of ADHD medication. Authors were contacted for additional data. We assessed placebo effects on efficacy and nocebo effects on tolerability using random effects meta-analysis. We assessed the association of study design and patient features with placebo/nocebo response. We analysed 128 RCTs (10,578 children/adolescents and 9175 adults) and found significant and heterogenous placebo effects for all efficacy outcomes, with no publication bias. The placebo effect was greatest for clinician compared with other raters. We found nocebo effects on tolerability outcomes. Efficacy outcomes from most raters showed significant positive correlations between the baseline to endpoint placebo effects and the baseline to endpoint drug effects. Placebo and nocebo effects did not differ among drugs. Baseline severity and type of rating scale influenced the findings. Shared non-specific factors influence response to both placebo and active medication. Although ADHD medications are superior to placebo, and placebo treatment in clinical practice is not feasible, clinicians should attempt to incorporate factors associated with placebo effects into clinical care. Future studies should explore how such effects influence response to medication treatment. Upon publication, data will be available in Mendeley Data: PROSPERO (CRD42019130292).</p
WHO Essential Medicines List and methylphenidate for ADHD in children and adolescents - Authors' reply
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Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies
No full textObjective: to perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using poly-somnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.Method: we searched for subjective and objective sleep studies (1987–2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.Results: sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p < .001), more sleep onset difficulties (z = 9.38, p < .001), night awakenings (z = 2.15, p = .031), difficulties with morning awakenings (z = 5.19, p < .001), sleep disordered breathing (z = 2.05, p = .040), and daytime sleepiness (z = 1.96, p = .050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p = .001; z = 2.43, p = .015; z = 3.47, p = .001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p = .024), true sleep time on actigraphy (z = 2.85, p = .004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p < .001) than the controls.Conclusions: the children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADH
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