Research article

Evaluating clonidine response in children and adolescents with attention-deficit/hyperactivity disorder

  • Received: 14 May 2018 Accepted: 10 October 2018 Published: 22 October 2018
  • Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, which is generally treated with stimulant and non-stimulant medications. However, 10–30% of patients in clinical setting do not present with adequate response to initial stimulant treatment. Thereby, clonidine may be considered for those patients who have failed to respond to psychostimulant/atomoxetine monotherapy or as an augmentation for inadequate response/comorbidity. This observational study evaluated its effectiveness as a single drug in ADHD cases unresponsive to previous treatment trials. Seventeen ADHD cases that were non-responders to stimulant, non-stimulant and combination therapy for the primary symptoms of ADHD were included in the study. Four cases dropped out before follow up, leaving thirteen cases who were administered immediate release clonidine treatment alone with a mean dose of 0.2 ± 0.05 mg/day at baseline. The trial lasted for 12 weeks, and treatment outcomes were evaluated by the Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S) and the Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scales. Mean age of the sample was 12.5 years (SD = 3.0) and eleven of the subjects had another comorbid psychopathology. Only two cases were evaluated as “very much improved”, while another patient was judged to be “minimally improved” after 12 weeks of clonidine treatment. Attrition during follow-up was associated with higher median scores on the hyperactivity and impulsivity subscales (Mann-Whitney U test, p = 0.02). According to the T-DSM-IV-S, CGI-S, and CGI-I scales, clonidine treatment by itself had minimal benefits in this sample of treatment of refractory cases with ADHD evaluated at the study center. Clonidine is not available in Turkey pharmaceutical marketing system and patients’ access to drug is limited. Our results provide first data regarding the use of clonidine in Turkish ADHD patients.

    Citation: Meryem Ozlem Kutuk, Gulen Guler, Ali Evren Tufan, Mehmet Ali Sungur, Zehra Topal, Ozgur Kutuk. Evaluating clonidine response in children and adolescents with attention-deficit/hyperactivity disorder[J]. AIMS Medical Science, 2018, 5(4): 348-356. doi: 10.3934/medsci.2018.4.348

    Related Papers:

  • Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, which is generally treated with stimulant and non-stimulant medications. However, 10–30% of patients in clinical setting do not present with adequate response to initial stimulant treatment. Thereby, clonidine may be considered for those patients who have failed to respond to psychostimulant/atomoxetine monotherapy or as an augmentation for inadequate response/comorbidity. This observational study evaluated its effectiveness as a single drug in ADHD cases unresponsive to previous treatment trials. Seventeen ADHD cases that were non-responders to stimulant, non-stimulant and combination therapy for the primary symptoms of ADHD were included in the study. Four cases dropped out before follow up, leaving thirteen cases who were administered immediate release clonidine treatment alone with a mean dose of 0.2 ± 0.05 mg/day at baseline. The trial lasted for 12 weeks, and treatment outcomes were evaluated by the Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S) and the Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scales. Mean age of the sample was 12.5 years (SD = 3.0) and eleven of the subjects had another comorbid psychopathology. Only two cases were evaluated as “very much improved”, while another patient was judged to be “minimally improved” after 12 weeks of clonidine treatment. Attrition during follow-up was associated with higher median scores on the hyperactivity and impulsivity subscales (Mann-Whitney U test, p = 0.02). According to the T-DSM-IV-S, CGI-S, and CGI-I scales, clonidine treatment by itself had minimal benefits in this sample of treatment of refractory cases with ADHD evaluated at the study center. Clonidine is not available in Turkey pharmaceutical marketing system and patients’ access to drug is limited. Our results provide first data regarding the use of clonidine in Turkish ADHD patients.


    加载中
    [1] Polanczyk G, Lima MD, Horta B, et al. (2007) The worldwide prevalence of ADHD: A systematic review and Metaregression analysis. Am J Psychiatry 164: 942–948. doi: 10.1176/ajp.2007.164.6.942
    [2] Ramtekkar UP, Reiersen AM, Todorov AA, et al. (2010) Sex and age differences in attention-deficit/Hyperactivity disorder symptoms and diagnoses: Implications for DSM-V and ICD-11. J Am Acad Child Psy 49: 217–228.
    [3] Wolraich M, Brown L, Brown R, et al. (2011) Subcommittee on attention- deficit/hyperactivity disorder; steering committee on quality improvement and management. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children. Pediatrics 128: 1007–1022.
    [4] Willens T, Spencer T (2000) The stimulants revisited. Child Adolesc Psychiatr Clin N Am 9: 573–603. doi: 10.1016/S1056-4993(18)30108-1
    [5] Golmirzaei J, Mahboobi H, Yazdanparast M, et al. (2016) Psychopharmacology of attention-deficit Hyperactivity disorder: Effects and side effects. Curr Pharm Design 22: 590–594. doi: 10.2174/1381612822666151124235816
    [6] Pliszka S (2007) Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/Hyperactivity disorder. J Am Acad Child Psy 46: 894–921. doi: 10.1097/chi.0b013e318054e724
    [7] Briars L, Todd T (2016) A review of pharmacological management of attention-deficit/Hyperactivity disorder. J Pediatr Pharmacol Ther 21: 192–206.
    [8] Barbaresi WJ, Katusic SK, Colligan RC, et al. (2006) Long-term stimulant medication treatment of attention-deficit/Hyperactivity disorder. J Dev Behav Pediatr 27: 1–10. doi: 10.1097/00004703-200602000-00001
    [9] Connor DF, Barkley RA, Davis HT (2000) A pilot study of Methyiphenidate, Clonidine, or the combination in ADHD Comorbid with aggressive Oppositional defiant or conduct disorder. Clinical Pediatrics 39: 15–25. doi: 10.1177/000992280003900102
    [10] Palumbo DR, Sallee FR, Pelham WE, et al. (2008) Clonidine for attention-deficit/Hyperactivity disorder: I. Efficacy and Tolerability outcomes. J Am Acad Child Psy 47: 180–188. doi: 10.1097/chi.0b013e31815d9af7
    [11] Leckman JF (1991) Clonidine treatment of Gilles de la Tourette's syndrome. Arch Gen Psychiatry 48: 324. doi: 10.1001/archpsyc.1991.01810280040006
    [12] Turgay A (1994) Disruptive behavior disorders child and adolescent screening and rating scales for children, adolescents, parents and teachers. West Bloomfield (Michigan): Integrative Therapy Institute Publication.
    [13] Hunt RD, Minderaa RB, Cohen DJ, et al. (1985) Clonidine benefits children with attention deficit disorder and Hyperactivity: Report of a double-blind placebo-crossover therapeutic trial. J Am Acad Child Psy 24: 617–629. doi: 10.1016/S0002-7138(09)60065-0
    [14] Agarwal V, Sitholey P, Kumar S, et al. (2001) Double-blind, placebo-controlled trial of Clonidine in hyperactive children with mental retardation. Ment Retard 39: 259–267. doi: 10.1352/0047-6765(2001)039<0259:DBPCTO>2.0.CO;2
    [15] Hazell PL, Stuart JE (2003) A Randomized controlled trial of Clonidine added to Psychostimulant medication for hyperactive and aggressive children. J Am Acad Child Psy 42: 886–894. doi: 10.1097/01.CHI.0000046908.27264.00
    [16] Connor DF, Fletcher KE, Swanson JM (1999) A Meta-Analysis of Clonidine for symptoms of attention-deficit Hyperactivity disorder. J Am Acad Child Psy 38: 1551–1559. doi: 10.1097/00004583-199912000-00017
    [17] Martinez-Raga J, Knech C, Szerman N, et al. (2012) Risk of serious cardiovascular problems with medications for attention-deficit hyperactivity disorder. CNS Drugs 27: 15–30.
    [18] Borison RL, Ang L, Hamilton WJ, et al. (1983) Treatment approaches in Gilles de la Tourette syndrome. Brain Res Bull 11: 205–208.
    [19] Gaffney GR, Perry PJ, Lund BC, et al. (2002) Risperidone versus Clonidine in the treatment of children and adolescents with Tourette's syndrome. J Am Acad Child Psy 41: 330–336. doi: 10.1097/00004583-200203000-00013
    [20] Schvehla TJ, Mandoki MW, Sumner GS (1994) Clonidine therapy for Comorbid attention-deficit Hyperactivity disorder and conduct disorder: Preliminary findings in a Children's inpatient unit. South Med J 87: 692–695. doi: 10.1097/00007611-199407000-00004
    [21] Spencer TJ, Kratochvil CJ, Sangal RB, et al. (2007) Effects of Atomoxetine on growth in children with attention-deficit/Hyperactivity disorder following up to five years of treatment. J Am Acad Child Psy 17: 689–699.
    [22] Hirota T, Schwartz S, Correll CU (2014) Alpha-2 Agonists for attention-deficit/Hyperactivity disorder in youth: A systematic review and Meta-Analysis of Monotherapy and add-on trials to stimulant therapy. J Am Acad Child Psy 53: 153–173. doi: 10.1016/j.jaac.2013.11.009
    [23] Jain R, Segal S, Kollins SH, et al. (2011) Clonidine extended-release tablets for pediatric patients with attention-deficit/Hyperactivity disorder. J Am Acad Child Psy 50: 171–179. doi: 10.1016/j.jaac.2010.11.005
    [24] Sallee FR, Eaton K (2010) β-Guanfacine extended-release for attention-deficit/hyperactivity disorder (ADHD). Expert Opin Pharmacother 11: 2549–2556.
    [25] Froehlich TE, McGough JJ, Stein MA (2010) Progress and promise of attention-deficit hyperactivity disorder pharmacogenetics. CNS Drugs 24: 99–117. doi: 10.2165/11530290-000000000-00000
    [26] Tan-Kam T, Suthisisang C, Pavasuthipaisit C, et al. (2013) Importance of pharmacogenetics in the treatment of children with attention deficit hyperactive disorder: A case report. Pharmacogenomics Pers Med 6: 3–7.
    [27] Danckaerts M, Sonuga-Barke EJS, Banaschewski T, et al. (2009) The quality of life of children with attention deficit/hyperactivity disorder: A systematic review. Eur Child Adolesc Psychiatry 19: 83–105.
    [28] Gau SSF, Shen HY, Chou MC, et al. (2006) Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Am Acad Child Psy 16: 286–297.
    [29] Charach A, Ickowicz A, Schachar R (2004) Stimulant treatment over five years: Adherence, effectiveness, and adverse effects. J Am Acad Child Psy 43: 559–567. doi: 10.1097/00004583-200405000-00009
  • Reader Comments
  • © 2018 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(8021) PDF downloads(764) Cited by(1)

Article outline

Figures and Tables

Tables(4)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog