Intervention Review

Amfetamine for attention deficit hyperactivity disorder in people with intellectual disabilities

  1. Alex Thomson1,*,
  2. Stefanos Maltezos1,
  3. Elena Paliokosta1,
  4. Kiriakos Xenitidis2

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 12 MAY 2010

Assessed as up-to-date: 9 AUG 2007

DOI: 10.1002/14651858.CD007009.pub2

Database Title

Additional Information

How to Cite

Thomson A, Maltezos S, Paliokosta E, Xenitidis K. Amfetamine for attention deficit hyperactivity disorder in people with intellectual disabilities. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007009. DOI: 10.1002/14651858.CD007009.pub2.

Author Information

  1. 1

    Kings College London, Institute of Psychiatry, Section of Brain Maturation (P050), London, UK

  2. 2

    Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Mental Impairment Evaluation and Treatment Services, Beckenham, Kent, UK

*Alex Thomson, Section of Brain Maturation (P050), Kings College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK. alex.thomson@kcl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 12 MAY 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Attention-deficit hyperactivity disorder (ADHD) is increasingly recognised as occurring in people with intellectual disability (ID), although treatment of ADHD in this population has not been tested widely. Amfetamine has been used to treat ADHD in people with and without ID, although the evidence for its efficacy in people with ID is unclear.

Objectives

To examine the effectiveness of amfetamine for the treatment of attention deficit hyperactivity disorder in people with intellectual disabilities.

Search methods

MEDLINE, PsycINFO, EMBASE, AMED, ISI Web of Science and WorldCat Dissertations were searched using an extensive list of synonyms for ADHD and ID. CENTRAL, Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register, clinicaltrials.gov were searched in August 2007. Pharmaceutical companies and experts in the field were contacted. Reference lists of review articles were examined and citation searches were performed in ISI Web of Knowledge.

Selection criteria

All randomised controlled studies, both published and unpublished, in any language, in which children or adults with ADHD and ID were treated with amfetamine.

Data collection and analysis

Data were extracted independently by two reviewers using a standardised extraction sheet. Risk of bias was assessed by two authors using a standardised framework. Meta-analyses were planned but were not performed due to a lack of suitable studies.

Main results

Only one study was suitable for inclusion. This was a cross-over study in 15 children with ADHD, ID and Fragile X syndrome. Duration of treatment was only one week. No significant difference was reported between amfetamine and placebo for any of the ADHD measures, but significantly more side effects were reported while taking amfetamine, mainly mood lability and irritability.

Authors' conclusions

There is very little evidence for the effectiveness of amfetamine for ADHD in people with ID . Prescribing in this population is based on extrapolation of research in people without ID. More research into effectiveness and tolerability is urgently needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Amfetamine for ADHD in people with intellectual disabilities

Some people with intellectual disability (ID; also known as mental retardation) may also have attention-deficit hyperactivity disorder (ADHD). Most of the research into treatment of ADHD with amfetamine has been performed in people who do not have ID. The objective of this review was to assess whether amfetamine is effective in treating ADHD in people who also have an intellectual disability. We found only one study, which examined this question in a small group of participants. This did not find an effect, but we do not think this is enough evidence to draw conclusions about whether or not amfetamine is effective. More research in this area is urgently needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於有智能障礙合併注意力不集中過動症，amfetamine的治療

注意力不集中過動症在智能障礙患者中有較高發生率，然而關於注意力不集中過動症的治療，在這個族群中尚未被廣泛的檢驗。Amfetamine被用來治療注意力不集中過動症，不論患者是否有智能障礙；然而對於智能障礙族群的治療效果，證據尚不明確。

目標

檢驗amfetamine對有智能障礙的注意力不集中過動症患者，其治療效果。

搜尋策略

使用 ‘注意力不集中過動症’ 和 ‘智能障礙’ 或廣義同類辭，搜尋包括MEDLINE，PsycINFO，EMBASE，AMED，ISI Web of Science and WorldCat Dissertations等資料庫。CENTRAL，Current Controlled Trials metaregister (mRCT) ，CenterWatch，NHS National Research Register，clinicaltrials.gov搜尋範圍到2007年8月。另外聯絡藥廠和這個領域的專家。檢視相關回顧文章的參考文獻，使用ISI Web of Knowledge作引用方面的搜尋。

選擇標準

針對Amfetamine對患有注意力不集中過動證和智能障礙的孩童與成人之治療，所有的隨機分布試驗，不論語言種類，出版與否。

資料收集與分析

資料由兩個回顧者利用標準化的摘錄表，獨立摘錄出來。兩位作者使用標準化流程來評估偏差的風險性。因為缺乏適合的試驗，所以進行統合分析 (metaanalysis) 的計畫並沒有實行。

主要結論

只有一個試驗符合選擇標準。這是一個針對15名患有注意力不集中過動症兒童、智能障礙及X染色體脆折症 (Fragile X syndrome) 的交叉試驗 (crossover study) 。治療期間只有一星期。使用amfetamine和安慰劑比較起來，在任何注意力不集中過動的量測因素方面沒有顯著差異，但是使用amphetamine的有比較多副作用，主要為情緒波動起伏及煩躁，且達到顯著意義。

作者結論

對於有智能障礙的注意力不集中過動症患者，使用amfetamine的治療效果只有非常少的證據。在這個族群開立處方是根據那些針對沒有智能障礙的患者的研究結果來推斷。更多相關治療效果和耐受性的試驗是迫切需要的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

對於有智能障礙的注意力不集中過動症患者，amfetamine的治療：某些有智能障礙的個案也患有注意力不集中過動症。大多數對於注意力不集中過動症使用amfetamine治療的相關試驗都是針對沒有智能障礙的患者。這篇回顧的目的，在評估那些亦同時患有智能障礙的注意力不集中過動症患者，amfetamine的治療是否有效。我們發現，只有一篇包含少數參與者的試驗，檢視這個問題。並未發現效果。但我們並不認為這樣的結果擁有足夠證據，得到amfetamine治療是否有效的結論。這個領域還迫切需要更多的試驗。

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