Raman Baweja1, Peter J Belin2, Hugh H Humphrey3, Lysett Babocsai2, Meaghan E Pariseau4, Daniel A Waschbusch1, Martin T Hoffman5, Opeolowa O Akinnusi6, Jenifer L Haak6, William E Pelham2, James G Waxmonsky1. 1. 1 Department of Psychiatry, Penn State University College of Medicine , Hershey, Pennsylvania. 2. 2 Center for Children and Families, Florida International University, Miami, Florida. 3. 3 Department of Psychiatry, Herbert Wertheim College of Medicine, Florida International University , Miami, Florida. 4. 4 Department of School and Counseling Psychology, SUNY Buffalo , Buffalo, New York. 5. 5 Department of Pediatrics, SUNY Buffalo School of Medicine , Buffalo, New York. 6. 6 Department of Psychiatry, SUNY Buffalo School of Medicine , Buffalo, New York.
Abstract
OBJECTIVE: This study examines the effectiveness and tolerability of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) and disruptive mood dysregulation disorder (DMDD). METHODS: To be eligible, participants had to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV) criteria for the combined subtype of ADHD and National Institute of Mental Health (NIMH) severe mood dysregulation criteria. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) DMDD criteria were retrospectively assessed after the study was completed. An open-label medication trial lasting up to 6 weeks was completed to optimize the central nervous system (CNS) stimulant dose. Measures of affective symptoms, ADHD symptoms and other disruptive behaviors, impairment, and structured side effect ratings were collected before and after the medication trial. RESULTS: Optimization of stimulant medication was associated with a significant decline in depressive symptoms on the Childhood Depression Rating Score-Revised Scale (p<0.05, Cohen's d=0.61) and Mood Severity Index score (p<0.05, Cohen's d=0.55), but not in manic-like symptoms on the Young Mania Rating Scale. There was a significant reduction in ADHD (p<0.05, Cohen's d=0.95), oppositional defiant disorder (ODD) (p<0.05, Cohen's d=0.5), and conduct disorder (CD) symptoms (p<0.05, Cohen's d=0.65) as rated by parents. There was also a significant reduction in teacher-rated ADHD (p<0.05, Cohen's d=0.33) but not in ODD symptoms. Medications were well tolerated and there was no increase in side effect ratings seen with dose optimization. Significant improvement in functioning was reported by clinicians and parents (all p's<0.05), but youth still manifested appreciable impairment at end-point. CONCLUSIONS: CNS simulants were well tolerated by children with ADHD comorbid with a diagnosis of DMDD. CNS stimulants were associated with clinically significant reductions in externalizing symptoms, along with smaller improvements in mood. However, most participants still exhibited significant impairment, suggesting that additional treatments may be needed to optimize functioning.
OBJECTIVE: This study examines the effectiveness and tolerability of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) and disruptive mood dysregulation disorder (DMDD). METHODS: To be eligible, participants had to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV) criteria for the combined subtype of ADHD and National Institute of Mental Health (NIMH) severe mood dysregulation criteria. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) DMDD criteria were retrospectively assessed after the study was completed. An open-label medication trial lasting up to 6 weeks was completed to optimize the central nervous system (CNS) stimulant dose. Measures of affective symptoms, ADHD symptoms and other disruptive behaviors, impairment, and structured side effect ratings were collected before and after the medication trial. RESULTS: Optimization of stimulant medication was associated with a significant decline in depressive symptoms on the Childhood Depression Rating Score-Revised Scale (p<0.05, Cohen's d=0.61) and Mood Severity Index score (p<0.05, Cohen's d=0.55), but not in manic-like symptoms on the Young Mania Rating Scale. There was a significant reduction in ADHD (p<0.05, Cohen's d=0.95), oppositional defiant disorder (ODD) (p<0.05, Cohen's d=0.5), and conduct disorder (CD) symptoms (p<0.05, Cohen's d=0.65) as rated by parents. There was also a significant reduction in teacher-rated ADHD (p<0.05, Cohen's d=0.33) but not in ODD symptoms. Medications were well tolerated and there was no increase in side effect ratings seen with dose optimization. Significant improvement in functioning was reported by clinicians and parents (all p's<0.05), but youth still manifested appreciable impairment at end-point. CONCLUSIONS: CNS simulants were well tolerated by children with ADHD comorbid with a diagnosis of DMDD. CNS stimulants were associated with clinically significant reductions in externalizing symptoms, along with smaller improvements in mood. However, most participants still exhibited significant impairment, suggesting that additional treatments may be needed to optimize functioning.
Authors: Kenneth D Gadow; L Eugene Arnold; Brooke S G Molina; Robert L Findling; Oscar G Bukstein; Nicole V Brown; Nora K McNamara; E Victoria Rundberg-Rivera; Xiaobai Li; Heidi L Kipp; Jayne Schneider; Cristan A Farmer; Jennifer L Baker; Joyce Sprafkin; Robert R Rice; Srihari S Bangalore; Eric M Butter; Kristin A Buchan-Page; Elizabeth A Hurt; Adrienne B Austin; Sabrina N Grondhuis; Michael G Aman Journal: J Am Acad Child Adolesc Psychiatry Date: 2014-06-12 Impact factor: 8.829
Authors: D A Brent; D J Kolko; B Birmaher; M Baugher; J Bridge; C Roth; D Holder Journal: J Am Acad Child Adolesc Psychiatry Date: 1998-09 Impact factor: 8.829
Authors: Gitta H Lubke; Bengt Muthén; Irma K Moilanen; James J McGough; Sandra K Loo; James M Swanson; May H Yang; Anja Taanila; Tuula Hurtig; Marjo-Riitta Järvelin; Susan L Smalley Journal: J Am Acad Child Adolesc Psychiatry Date: 2007-12 Impact factor: 8.829
Authors: Elizabeth B Owens; Stephen P Hinshaw; Helen C Kraemer; L Eugene Arnold; Howard B Abikoff; Dennis P Cantwell; C Keith Conners; Glen Elliott; Laurence L Greenhill; Lily Hechtman; Betsy Hoza; Peter S Jensen; John S March; Jeffrey H Newcorn; William E Pelham; Joanne B Severe; James M Swanson; Benedetto Vitiello; Karen C Wells; Timothy Wigal Journal: J Consult Clin Psychol Date: 2003-06
Authors: James G Waxmonsky; Daniel A Waschbusch; Peter Belin; Tan Li; Lysett Babocsai; Hugh Humphery; Meaghan E Pariseau; Dara E Babinski; Martin T Hoffman; Jenifer L Haak; Jessica R Mazzant; Gregory A Fabiano; Jeremy W Pettit; Negar Fallahazad; William E Pelham Journal: J Am Acad Child Adolesc Psychiatry Date: 2015-12-28 Impact factor: 8.829
Authors: Erica Ramstad; Ole Jakob Storebø; Trine Gerner; Helle B Krogh; Mathilde Holmskov; Frederik L Magnusson; Carlos R Moreira-Maia; Maria Skoog; Camilla Groth; Donna Gillies; Morris Zwi; Richard Kirubakaran; Christian Gluud; Erik Simonsen Journal: Scand J Child Adolesc Psychiatr Psychol Date: 2018-07-10
Authors: Rosanna Breaux; Nicholas C Dunn; Courtney S Swanson; Emma Larkin; James Waxmonsky; Raman Baweja Journal: Front Psychiatry Date: 2022-02-14 Impact factor: 5.435