Benefits and risks of treatment discontinuation during summer holidays in school-aged children with attention deficit/hyperactivity disorder
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Published
2012-09-30
How to Cite
Velilla Picazo, M., García Giral, M., Martínez Jiménez, P., Zubillaga Marbán, E., & Fernández, I. B. (2012). Benefits and risks of treatment discontinuation during summer holidays in school-aged children with attention deficit/hyperactivity disorder. Revista De Psiquiatría Infanto-Juvenil, 29(3), 40–51. Retrieved from https://aepnya.eu/index.php/revistaaepnya/article/view/222
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Section
Orginial article
Keywords:
Attention deficit disorder with hyperactivity, stimulants, drug holidays, Clinical Global Impression- Severity, SNAP-IV scaleAbstract
This retrospective study assessed the benefits and risks of discontinuation of pharmacological treatment during summer holidays (? 30 days) in 802 school-aged children with attention deficit/hyperactivity disorder (ADHD). A total of 440 patients (55%) discontinued medical treatment during the summertime. The risk of poor adherence (? 85%) was higher for patients with drug holidays (odds ratio 5.82). As compared with children treated pharmacologically during the summertime, patients in the drug holiday group were four times more likely to have worsening or no improvement of their symptoms in the Clinical Global Impression ADHD Severity (GCIADHD- S) scale (odds ratio 4.20, P < 0.0001). Moreover, patients in the drug holiday group as compared with patients treated pharmacologically were almost three times more likely to score > 1.67 in the ADHD SNAP-IV rating scale (odds ratio 2.60, P < 0.0001), and more likely to suffer from accidental injuries (odds ratio 1.49, P < 0.01), with a higher mean number of injuries per patient (1.24 [SD = 3.67] vs. 0.8 [SD = 2.9], P = 0.05). This retrospective cohort analyses suggest that drug holidays during the summertime in children with ADHD may be associated with adverse clinical outcomes.
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References
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24. Wolraich M, Hannah JN, Baumgaertel A, Pinnock TY, Feurer I. Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a coun ty-wide sample. J Dev Behav Pediatr 1998; 19: 162?168
25. Wolraich ML, Wibbelsman CJ, Brown TE, Evans SW, Gotlieb EM, Knight JR, Ross EC, Shubiner HH, Wender EH, Wilens T. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics 2005; 115: 1734?1746.
2. American Psychiatric Association. Diagnostic and Statistical Manual of mental Disorders: DSM-IVTR. Washington, DC: American Psychiatric Association; 2007.
3. Brehaut JC, Miller A, Raina P, McGrail KM. Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics 2003; 111: 262?269
4. Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, Pierce K, Wolraich ML and the Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder. Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics 2005; 115: e749?e757
5. Brown RT, Freeman WS, Perrin JM, Stein MT, Amler RW, Feldman HM, Pierce K, Wolraich ML. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics 2001; 107: E43
6. Daughton JM, Kratochvil CJ. Review of ADHD pharmacotherapies: advantages, disadvantages, and clinical pearls. J Am Acad Child Adolesc Psychiatry 2009; 48: 240?249
7. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R, McGoey KE, Ikeda MJ. Teacher ratings on attention deficit hyperactivity disorder symptoms: factor structure and normative data. Psychol Assess 1997; 9: 436?444
8. Faraone SV, Spencer TJ, Montano CB, Biederman J. Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care. Arch Intern Med 2004; 164: 1221?1226
9. Gau SS, Chen SJ, Chou WJ, Cheng H, Tang CS, Chang HL, Tzang RF, Wu YY, Huang YF, Chou MC, Liang HY, Hsu YC, Lu HH, Huang YS. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention- deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry 2008; 69: 131?140
10. Guy W. ECDEU Assessment Manual for Psychopharmacology, revised ed. Washington, DC: US Department of Health, Education, and Welfare; 1976
11. Hazell P. Pharmacological management of attention- deficit hyperactivity disorder in adolescence: special considerations. CNS Drugs 2007; 21: 37?46
12. Hugtenburg JG, Griekspoor JE, De Boer I, Heerdink ER, Tso YH, Egberts AC. Methylphenidate: use in daily practice. Pharm World Sci 2005; 27: 197?201
13. Karande S. Attention deficit hyperactivity disorder-- a review for family physicians. Indian J Med Sci 2005; 59: 546?555
14. Pastor PN, Reuben CA. Identified attention-deficit/ hyperactivity disorder and medically attended, nonfatal injuries: US school-age children, 1997- 2002. Ambul Pediatr 2006; 6: 38?44
15. Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2000; 9: 525?540
16. Servera M, Cardo E. ADHD Rating Scale-IV en una muestra escolar española: datos normativos y consistencia interna para maestros, padres y madres. Rev Neurol 2007; 45: 393?399
17. Spencer TJ, Faraone SV, Biederman J, Lerner M, Cooper KM, Zimmerman B. Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Child Adolesc Psychiatry 2006; 45: 527?537
18. Svanborg P, Thernlund G, Gustafsson PA, Hägglöf B, Schacht A, Kadesjö B. Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in Swedish children and adolescents. Eur Child Adolesc Psychiatry 2009; 18: 725?735
19. Swanson J. Compliance with stimulants for attention- deficit/hyperactivity disorder: Issues and approaches for improvement. CNS Drugs 2003; 17: 117?131
20. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder. Arch Gen Psychiatry 1999; 56: 1073?1086.
21. Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry 2001; 40: 922?928
22. Vitiello B. Understanding the risk of using medications for ADHD with respect to physical growth and cardiovascular function. Child Adolesc Psychiatr Clin N Am 2008; 17: 459?471
23. Wernicke JF, Adler L, Spencer T, West SA, Allen AJ, Heiligenstein J, Milton D, Ruff D, Brown WJ, Kelsey D, Michelson D. Changes in symptoms and adverse events after discontinuation of atomoxetine in children and adults with attention deficit/hyperactivity disorder: a prospective, placebo-controlled assessment. J Clin Pharmacol 2004; 24: 30?35.
24. Wolraich M, Hannah JN, Baumgaertel A, Pinnock TY, Feurer I. Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a coun ty-wide sample. J Dev Behav Pediatr 1998; 19: 162?168
25. Wolraich ML, Wibbelsman CJ, Brown TE, Evans SW, Gotlieb EM, Knight JR, Ross EC, Shubiner HH, Wender EH, Wilens T. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics 2005; 115: 1734?1746.
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