Atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children with ADHD and dyslexia

Calvin R Sumner, Susan Gathercole, Michael Greenbaum, Richard Rubin, David Williams, Millie Hollandbeck, Linda Wietecha, Calvin R Sumner, Susan Gathercole, Michael Greenbaum, Richard Rubin, David Williams, Millie Hollandbeck, Linda Wietecha

Abstract

Background: The objective of this study was to assess the effects of atomoxetine on treating attention-deficit/hyperactivity disorder (ADHD), on reading performance, and on neurocognitive function in youth with ADHD and dyslexia (ADHD+D).

Methods: Patients with ADHD (n = 20) or ADHD+D (n = 36), aged 10-16 years, received open-label atomoxetine for 16 weeks. Data from the ADHD Rating Scale-IV (ADHDRS-IV), Kaufman Test of Educational Achievement (K-TEA), Working Memory Test Battery for Children (WMTB-C), and Life Participation Scale for ADHD-Child Version (LPS-C) were assessed.

Results: Atomoxetine demonstrated significant improvement for both groups on the ADHDRS-IV, LPS-C, and K-TEA reading comprehension standard and composite scores. K-TEA spelling subtest improvement was significant for the ADHD group, whereas the ADHD+D group showed significant reading decoding improvements. Substantial K-TEA reading and spelling subtest age equivalence gains (in months) were achieved for both groups. The WMTB-C central executive score change was significantly greater for the ADHD group. Conversely, the ADHD+D group showed significant phonological loop score enhancement by visit over the ADHD group. Atomoxetine was well tolerated, and commonly reported adverse events were similar to those previously reported.

Conclusions: Atomoxetine reduced ADHD symptoms and improved reading scores in both groups. Conversely, different patterns and magnitude of improvement in working memory component scores existed between ADHD and ADHD+D patients. Though limited by small sample size, group differences in relation to the comparable changes in improvement in ADHD symptoms could suggest that brain systems related to the therapeutic benefit of atomoxetine in reducing ADHD symptoms may be different in individuals with ADHD+D and ADHD without dyslexia.

Clinical trial registry: ClinicalTrials.gov: NCT00191048.

Figures

Figure 1
Figure 1
Disposition of Patients. Abbreviations: ADHD = attention-deficit/hyperactivity disorder; ADHD+D = ADHD with dyslexia; ATX = atomoxetine.
Figure 2
Figure 2
ADHDRS-IV Total Scores Over 16 Weeks of Treatment. Abbreviations: ADHD = attention deficit-hyperactivity disorder; ADHD+D = ADHD with dyslexia; ADHDRS-IV = ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored. * p < .001 for within-group change.
Figure 3
Figure 3
WMTB-C Component Scores Over 16 Weeks of Treatment. Abbreviations: WMTB-C = Working Memory Test Battery for Children; ADHD = attention deficit-hyperactivity disorder; ADHD+D = ADHD with dyslexia; PL = phonological loop; CE = central executive; VSP = visuo-spatial sketchpad. * p-value statistically significant.

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Text Revision. 4. Washington, DC: APA; 2000.
    1. Shaywitz SE, Shaywitz BE. In: Pediatric Neurology: Principles and Practice. Swaiman KF, editor. II. St. Louis: Mosby; 1994. Learning disabilities and attention disorders; pp. 1119–1151.
    1. Shaywitz SE. Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level. New York: Alfred A Knopf Publisher; 2003.
    1. Brown TE. Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington, DC: American Psychiatric Press; 2000.
    1. Willcutt EG, Pennington BF, Olson RK, DeFries JC. Understanding comorbidity: a twin study of reading disability and attention-deficit/hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet. 2007;144B:709–14. doi: 10.1002/ajmg.b.30310.
    1. Aaron PG, Joshi RM, Palmer H, Smith N, Kirby E. Separating genuine cases of reading disability from reading deficits caused by predominantly inattentive ADHD behaviors. J Learn Disabil. 2002;35:425–435. doi: 10.1177/00222194020350050301.
    1. Martinussen R, Tannock R. Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. J Clin Exp Neuropsychol. 2006;28:1073–1094. doi: 10.1080/13803390500205700.
    1. Gathercole SE, Alloway TP, Willis C, Adams A. Working memory in children with reading disabilities. J Exp Child Psychol. 2006;93:265–281. doi: 10.1016/j.jecp.2005.08.003.
    1. Pickering S. In: Working Memory in Dyslexia. Alloway TP, Gathercole SE, editor. Hove (UK): Psychology Press; 2006. Working memory and neurodevelopmental disorders; pp. 7–40.
    1. Baddeley A. The episodic buffer: a new component of working memory? Trends Cogn Sci. 2000;4:417–423. doi: 10.1016/S1364-6613(00)01538-2.
    1. Baddeley AD, Hitch G. In: The Psychology of Learning and Motivation. Bower G, editor. New York: Academic Press; 1974. Working memory; pp. 47–90. full_text.
    1. Michelson D, Allen AJ, Busner J, Casat C, Dunn D, Kratochvil C, Newcorn J, Sallee FR, Sangal RB, Saylor K, West S, Kelsey D, Wernicke J, Trapp NJ, Harder D. Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Am J Psychiatry. 2002;159:1896–1901. doi: 10.1176/appi.ajp.159.11.1896.
    1. Michelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, Spencer T. Atomoxetine ADHD Study Group. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics. 2001;108:E83. doi: 10.1542/peds.108.5.e83.
    1. Wernicke JF, Fouche DS, Spencer T, Dunn D, Faries DE, Kelsey DK, Heiligenstein JH, Michelson D. Safety of atomoxetine in pediatric patients treated for ADHD. Eur Neuropsychopharmacol. 2001;11(Suppl 3):S319. doi: 10.1016/S0924-977X(01)80449-1.
    1. Pickering S, Gathercole S. Working Memory Test Battery for Children (WMTB-C) manual. London: The Psychological Corporation; 2001.
    1. Shaywitz SE. Dyslexia. N Engl J Med. 1998;338:307–312. doi: 10.1056/NEJM199801293380507.
    1. Kaufman J, Birmaher B, Brent D, Rao U, Ryan N. Kiddie Schedule of Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version. 1996.
    1. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV: Checklists, norms, and clinical interpretations. New York: Guilford Press; 1998.
    1. Kaufman AS, Kaufman NL. Kaufman Brief Intelligence Test (K-BIT) manual. Circle Pines: American Guidance Service, Inc; 1990.
    1. Kaufman AS, Kaufman NL. Kaufman Test of Educational Achievement (K-TEA) Comprehensive Form manual. Circle Pines: American Guidance Service, Inc; 1998.
    1. Saylor K, Buermeyer C, Sutton V, Faries D, Khan S, Schuh K. The Life Participation Scale for Attention-Deficit/Hyperactivity Disorder--Child Version: psychometric properties of an adaptive change instrument. J Child Adolesc Psychopharmacol. 2007;17:831–42. doi: 10.1089/cap.2007.0030.
    1. Keulers EH, Hendriksen JG, Feron FJ, Wassenberg R, Wuisman-Frerker MG, Jolles J, Vles JS. Methylphenidate improves reading performance in children with attention deficit hyperactivity disorder and comorbid dyslexia: an unblinded clinical trial. Eur J Paediatric Neurol. 2007;11:21–28. doi: 10.1016/j.ejpn.2006.10.002.
    1. Grizenko N, Bhat M, Schwartz G, Ter-Stephanian M, Joober R. Efficacy of methylphenidate in children with attention-deficit hyperactivity disorder and learning disabilities: a randomized crossover trial. J Psychiatry Neurosci. 2006;31:46–51.
    1. Michelson D, Faries DE, Wernicke JF, Spencer T. Atomoxetine in the treatment of children with ADHD: a randomized, placebo-controlled dose-response study. Eur Neuropsychopharmacol. 2001;11(Suppl 3):319–320. doi: 10.1016/S0924-977X(01)80450-8.

Source: PubMed

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