The Impact of Persistent Irritability on the Medication Treatment of Paediatric Attention Deficit Hyperactivity Disorder

Raman Baweja, Daniel A Waschbusch, William E Pelham 3rd, William E Pelham Jr, James G Waxmonsky, Raman Baweja, Daniel A Waschbusch, William E Pelham 3rd, William E Pelham Jr, James G Waxmonsky

Abstract

This study compares the efficacy and tolerability of central nervous system (CNS) stimulants in children with attention deficit hyperactivity disorder (ADHD) with and without prominent irritability (IRR) over the course of 30 months. This is a secondary analysis of a study examining growth patterns in medication naïve children with ADHD subsequently treated with CNS stimulants (predominantly OROS-Methylphenidate, up to 54 mg per day) for 30 months. Participants had to meet full diagnostic criteria for ADHD and been treated with CNS stimulants for under 30 days. Children were classified as IRR if they were rated as pretty much or very much on either of the "often angry" or easily annoyed" items plus "lose temper," items of the Disruptive Behavior Disorders Rating Scale (DBDRS). Structured ratings of ADHD symptoms, impairment, side effects, and symptoms of oppositional defiant disorder (ODD) were collected every 2-12 weeks for the duration of the study. Medication use was measured by pill count and parent report. The IRR group comprised 28% of all participants. The IRR group had significantly higher levels of ADHD and ODD symptoms, impairment, and side effects ratings at baseline. In the IRR group, ODD symptoms, emotional lability, and impairment significantly decreased for participants with higher medication use. Total side effects increased for non-IRR participants with higher medication use. Emotional side effects decreased for IRR participants with higher medication use. Central nervous system stimulants were a tolerable and efficacious treatment in treatment naïve youth with ADHD with irritability. Clinical Trials Registration: NCT01109849.

Keywords: ADHD; CNS stimulant; children; irritability; medication.

Conflict of interest statement

JW has received research funding from the National Institutes of Health, Supernus, and Pfizer in the past 3 years. WP (4th author) has received funding from NIMH, NIAAA, NIDA, and the Institute of Education Sciences. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Baweja, Waschbusch, Pelham, Pelham and Waxmonsky.

Figures

Figure 1
Figure 1
Illustration of the Time*Med*IRR interaction from the IOWA scale.
Figure 2
Figure 2
Illustration of the Time*Med*IRR interaction from the Score from the impairment rating scale.

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