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 Both stimulants and alternative medications can help reduce symptoms
such as restlessness, forgetfulness and lack of motivation, the
study found.
Psychotherapy that addresses issues like behavior, organization and
social skills may not always ease symptoms but can result in better
school performance, the study also found.
The trick is to figure out whether symptoms are severe enough to
warrant medication, said lead study author Dr. Eugenia Chan, a
researcher at Harvard Medical School and director of the ADHD
program at Boston Children’s Hospital.
A challenge unique to teens is that when they do need drugs, doctors
don’t always prescribe a high enough dose and these patients
sometimes fail to take what’s prescribed, Chan cautioned.
“Adherence to medication treatment is an especially important issue
for adolescents with ADHD,” Chan said.
“If they feel the medication is ineffective, causes significant side
effects, or makes them feel different from their peer group, they
are less likely to continue medication treatment as prescribed,”
Chan added by email.
Even though about 12 percent of U.S. youth aged 12 to 17 have ADHD,
much of the research so far has focused on younger kids, Chan and
colleagues note in JAMA.
To assess the effectiveness of treatments for adolescents in
particular, researchers analyzed data from 17 previously published
small studies of medication and psychotherapy with a combined 2,668
teenage participants.
Among the drugs approved in the U.S. to treat ADHD, there’s more
evidence to recommend extended-release versions of the stimulants
methylphenidate (Ritalin, Concerta) and amphetamine (Adderall) than
there is for other options, the review found. Two rigorous studies
found each of these drugs effective in teens.
Two alternatives – atomoxetine (Strattera) and extended-release
guanfacine (Tenex, Intuniv) – have one analysis apiece pointing to
effectiveness in adolescents. A third, clonidine (Kapvay), hasn’t
been tested in teens.
A limitation of the analysis is the dearth of high-quality studies
on medication and psychotherapy specifically for teens, the authors
note. The review also didn’t address stimulant addiction, which is a
particular concern for adolescent patients.
A separate study in JAMA looked just at methylphenidate (Ritalin),
the most commonly prescribed stimulant for ADHD.
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This review of 185 trials with a combined 12,245 children and teens
found the drug curbed ADHD symptoms but concluded there still isn’t
enough data to determine exactly how much it helps.
“We are less convinced of its benefits and believe that our analysis
highlights the low quality of studies underpinning the
methylphenidate evidence,” said lead study author Ole Jakob Storebo
of the psychiatric research unit, region Zealand in Denmark.
“The general perception of methylphenidate as an effective drug for
all children with ADHD seems out of step with the new evidence,”
Storebo added by email.
While the drug can improve a child’s quality of life, it also
carries side effects such as loss of appetite and sleeplessness, Dr.
Philip Shaw, an investigator at the U.S. National Human Genome
Research Institute, said by email.
Some children can outgrow ADHD during adolescence, though, and this
means teen patients on ADHD drugs require close monitoring to make
sure they need to continue treatment, said Shaw, author of an
editorial accompanying the study. Some children with attention
problems also may not have ADHD or need drugs.
“We should focus our efforts on children who are really struggling
at school at home and often with their peers,” Shaw added. “In these
children, problems with attention, impulsivity and hyperactivity are
having a major adverse impact on their development, preventing them
from reaching their potential.”
SOURCE: http://bit.ly/27aU2z1 JAMA, online May 10, 2016.
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