Posted by SalArmy4me on February 23, 2001, at 6:01:09
In reply to Adderall and Young Children, posted by TJD on February 21, 2001, at 11:54:29
From the Journal of the American Academy of Child and Adolescent Psychiatry 38 no5 500 May '99
To the Editor:
I was most interested to read of the apparent efficacy of Adderall(R) in the crossover study of children with attention-deficit hyperactivity disorder (ADHD) reported recently in the Journal (Swanson et al., 1998). As the authors suggest, if this preparation can be demonstrated to have a comparable efficacy and side effect profile to methylphenidate, with perhaps a more favorable biological and behavioral half-life, then it might be a useful addition to the psychostimulant armamentarium available to clinicians who treat children with ADHD.
In the "Discussion" section of this article (under the subheading "Clinical Implications"), the authors state that several studies have not demonstrated significant differences between dextroamphetamine and methylphenidate in overall efficacy or side effect profiles, referencing important papers published up to 1991. However, we recently conducted a double-blind, crossover, intrasubject comparative study of dextroamphetamine and methylphenidate in a sample of 125 children with ADHD. Dosages were standardized at 0.15 mg/kg per dose b.i.d. for dextroamphetamine and 0.3 mg/kg per dose b.i.d. for methylphenidate. Subjects had 2 weeks on each stimulant. Outcome measures included the Conners Parent Rating Scale-Revised (CPRS-R), Conners Teacher Rating Scale-Revised (CTRS-R), Continuous Performance Test (CPT), and Barkley Side Effects Rating Scale.
On the efficacy side, most subjects did well on both drugs, and the differences between the two were relatively minor, though consistently in favor of methylphenidate (Efron et al., 1997a). There were significant group mean improvements from baseline score on all measures for both stimulants. On the CTRS-R, response was greater on methylphenidate than dextroamphetamine on the Conduct Problems and Hyperactivity Factors, as well as the Hyperactivity Index (p < .01). On the CPRS-R, Anxiety was the only factor to differ significantly, in favor of methylphenidate (p = .02). No differences were found on the CPT.
The side effect data, however, revealed striking differences between the 2 stimulants (Efron et al., 1997b). Dextroamphetamine was associated with significantly (p < .01) more severe side effects than methylphenidate, particularly insomnia, irritability, proneness to crying, anxiousness, sadness/unhappiness, and nightmares. The insomnia is of course predictable from the known pharmacokinetics of dextroamphetamine. The negative emotional symptoms are commonly reported by parents of children taking dextroamphetamine and often result in the need to stop and try an alternative medication.
I agree with Swanson et al. (1998) that a high proportion of children who do not respond positively to the first stimulant tried will do well on the alternative stimulant. In fact, we found that depending on the measure of response examined, between 50% and 82% of nonresponders to dextroamphetamine responded to methylphenidate, and between 39% and 79% of nonresponders to methylphenidate responded to dextroamphetamine.
Despite the long-standing anecdotal impression and more recent research evidence of a less favorable side effect profile, dextroamphetamine is considerably less expensive than methylphenidate in Australia and has become the preferred first-line stimulant for children with ADHD in this country. It is therefore of particular interest to us to learn of a mixture of amphetamine salts which may prove to have a smoother, kinder effect.
poster:SalArmy4me
thread:54583
URL: http://www.dr-bob.org/babble/20010221/msgs/54658.html