Prescribed stimulant use for ADHD continues to rise steadily
September 29, 2011
Science Daily/NIH/National Institute of Mental Health
The prescribed use of stimulant medications to treat attention deficit hyperactivity disorder (ADHD) rose slowly but steadily from 1996 to 2008, according to a new study.
ADHD is one of the most common childhood disorders, and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). The condition is frequently treated with stimulants such as methylphenidate (e.g., Ritalin), amphetamines (e.g., Adderall) or other types of medications. Behavioral therapies can also be effective.
During the 1990s, stimulant prescription use increased significantly, going from a prevalence rate among youth of 0.6 percent in 1987 to 2.7 percent in 1997, with the rate stabilizing around 2.9 percent in 2002. Recent reports, however, suggest that the prescribed use of these medications and the diagnosis of ADHD have continued to rise. Based on the Health Resources and Services Administration's National Survey of Children's Health, the percentage of children age 4-17 years diagnosed with ADHD increased from 7.8 percent in 2003 to 9.5 percent in 2007.
Overall, prescription use among 6-12-year-olds was highest, going from 4.2 percent in 1996 to 5.1 percent in 2008. But the fastest growth of prescribed use occurred among 13-18-year-olds, going from 2.3 percent in 1996 to 4.9 percent in 2008. "This continuous increase among teens likely reflects a recent realization that ADHD often persists as children age. They do not always grow out of their symptoms," said Dr. Vitiello.
Prescription use among preschoolers remained very low at 0.1 percent from 2004 onward and decreased between 2002 and 2008, suggesting that stimulant use among very young children continues to be disfavored. Boys continued to be three times more likely to be prescribed a stimulant than girls, and use among white children continued to be higher than among black or Hispanic children (4.4 percent in 2008 among whites, compared to 2.9 percent in blacks and 2.1 percent in Hispanics).
However, prescribed stimulant use is increasing among racial and ethnic minorities, likely suggesting more recognition of ADHD and acceptance of psychopharmacological treatment among these groups, according to the authors.
In addition, rates were substantially lower in Western states compared to other regions of the nation, with no increase in recent years, a finding consistent with other studies. In comparison, rates in the Northeast increased from 2.7 percent in 2002 to 4.6 percent in 2008.
"These persistent differences in prescribed stimulant use related to age, racial and ethnic background, and geographical location indicate substantial variability in how families and doctors approach ADHD treatment throughout the United States," said Dr. Zuvekas.
http://www.sciencedaily.com/releases/2011/09/110928105714.htm
Children who take ADHD medicines have trouble sleeping
Study addresses decades of conflicting evidence of meds' effect on sleep
November 23, 2015
Science Daily/University of Nebraska-Lincoln
Children given ADHD stimulant medications take significantly longer to fall asleep, have poorer quality sleep and sleep for shorter periods, shows new research.
The study addresses decades of conflicting opinions and evidence about the medications' effect on sleep.
In what's known as a "meta-analysis," researchers from the UNL Department of Psychology combined and analyzed the results from past studies of how ADHD medications affect sleep.
In a study published online by the journal Pediatrics, the Nebraska researchers found children given the medicines take significantly longer to fall asleep, have poorer quality sleep, and sleep for shorter periods.
"We would recommend that pediatricians frequently monitor children with ADHD who are prescribed stimulants for potential adverse effects on sleep," said Katie Kidwell, a psychology doctoral student who served as the study's lead author.
About 1 in 14 children and adolescents in the U.S. are diagnosed with ADHD, a chronic condition that includes attention difficulty, hyperactivity and impulsiveness. In the most common form of ADHD treatment, about 3.5 million are prescribed stimulant medications such as Ritalin and Adderall.
Many research articles have been written in the past 30 years on whether ADHD medications harm the ability to sleep. Some researchers have found that the drugs do interfere with sleep, particularly if taken later in the day. Others maintain the medications improve patients with ADHD's ability to sleep, by relieving symptoms and reducing resistance to bedtime. Indeed, some suggest that sleep problems are caused by the medication wearing off near bedtime, creating withdrawal symptoms.
"One reason we did the study is that researchers have hypothesized different effects, and there are some conflicting findings in the literature," said Timothy Nelson, an associate professor of psychology involved in the study. "This is when a meta-analysis is most useful. By aggregating and previous research in a rigorous and statistical way, we can identify the main findings that we see across all these studies. It's essentially a study of studies."
After screening nearly 10,000 articles, Kidwell and her colleagues reviewed 167 full texts before selecting nine studies of sufficient rigor for their analysis. Tori Van Dyk and Alyssa Lundahl, also psychology doctoral students, assisted in the effort.
Studies chosen for the analysis were peer-reviewed, randomized experiments. The studies did not rely on parental reports of their children's sleeping patterns, instead requiring objective measures obtained through clinical sleep studies or wristband monitors used at home.
The researchers found that both methylphenidate medications like Ritalin and amphetamines like Adderall cause sleep problems, without identifying differences between the two. Although they were unable to determine whether varying dosage amounts changed the effect on sleep, they found that more frequent dosages made it harder for children to fall asleep.
They found that drugs tend to cause more sleep problems for boys. The problems dissipate, but never completely go away, the longer children continue to take the medication.
"Sleep impairment is related to many cognitive, emotional and behavioral consequences, such as inattention, irritability and defiance," Kidwell said. "Sleep adverse effects could undermine the benefits of stimulant medications in some cases. Pediatricians should carefully consider dosage amounts, standard versus extended release, and dosage frequencies to minimize sleep problems while effectively treating ADHD symptoms."
She also recommended considering behavioral treatments, such as parental training and changes to classroom procedures and homework assignments, to reduce ADHD's negative consequences.
"We're not saying don't use stimulant medications to treat ADHD," Nelson said. "They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants."
http://www.sciencedaily.com/releases/2015/11/151123202819.htm