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Practitioner Review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents

Authors

  • Samuele Cortese,

    1. Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York, NY, USA
    2. UMR_S INSERMU 930, CNRS ERL 3106, François-Rabelais University, Child Psychiatry Centre, University Hospital, Tours, France
    3. Department of Life Sciences and Reproduction, Verona University, Italy
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    • The first two authors contributed equally to the manuscript.

  • Martin Holtmann,

    1. LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics of the Ruhr University Bochum, Hamm, Germany
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    • The first two authors contributed equally to the manuscript.

  • Tobias Banaschewski,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/ Heidelberg University, Mannheim, Germany
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  • Jan Buitelaar,

    1. Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
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  • David Coghill,

    1. Division of Neuroscience, Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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  • Marina Danckaerts,

    1. Department of Child and Adolescent Psychiatry, University Hospitals Leuven, KU Leuven, Belgium
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  • Ralf W. Dittmann,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/ Heidelberg University, Mannheim, Germany
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  • John Graham,

    1. Child and Adolescent Psychiatry, The Centre for Child Health, Dundee, UK
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  • Eric Taylor,

    1. Department of Child and Adolescent Psychiatry, Kings College London Institute of Psychiatry, UK
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  • Joseph Sergeant,

    1. Vrije Universiteit, Amsterdam, the Netherlands
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  • on behalf of the European ADHD Guidelines Group

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  • Conflicts of interest statement: See Acknowledgement section for author disclosures.

Abstract

Background:  Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD.

Methods:  For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system.

Results:  The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms.

Conclusion:  Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.

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