Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders

Howard Abikoff*, James McGough, Benedetto Vitiello, James McCracken, Mark Davies, John Walkup, Mark Riddle, Melvin Oatis, Laurence Greenhill, Anne Skrobala, John March, Pat Gammon, James Robinson, Robert Lazell, Donald J. McMahon, Louise Ritz

*Corresponding author for this work

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-naïve children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

Original languageEnglish (US)
Pages (from-to)418-427
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume44
Issue number5
DOIs
StatePublished - Jan 1 2005

Fingerprint

Attention Deficit Disorder with Hyperactivity
Anxiety Disorders
Drug Therapy
Fluvoxamine
Methylphenidate
Anxiety
Placebos
Pediatrics
Diagnostic and Statistical Manual of Mental Disorders

Keywords

  • Anxiety
  • Attention-deficit/hyperactivity
  • Combination pharmacotherapy
  • Comorbidity

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Abikoff, Howard ; McGough, James ; Vitiello, Benedetto ; McCracken, James ; Davies, Mark ; Walkup, John ; Riddle, Mark ; Oatis, Melvin ; Greenhill, Laurence ; Skrobala, Anne ; March, John ; Gammon, Pat ; Robinson, James ; Lazell, Robert ; McMahon, Donald J. ; Ritz, Louise. / Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2005 ; Vol. 44, No. 5. pp. 418-427.
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abstract = "Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-na{\"i}ve children openly treated with methylphenidate, 26 (81{\%}) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.",
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Abikoff, H, McGough, J, Vitiello, B, McCracken, J, Davies, M, Walkup, J, Riddle, M, Oatis, M, Greenhill, L, Skrobala, A, March, J, Gammon, P, Robinson, J, Lazell, R, McMahon, DJ & Ritz, L 2005, 'Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 44, no. 5, pp. 418-427. https://doi.org/10.1097/01.chi.0000155320.52322.37

Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders. / Abikoff, Howard; McGough, James; Vitiello, Benedetto; McCracken, James; Davies, Mark; Walkup, John; Riddle, Mark; Oatis, Melvin; Greenhill, Laurence; Skrobala, Anne; March, John; Gammon, Pat; Robinson, James; Lazell, Robert; McMahon, Donald J.; Ritz, Louise.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 44, No. 5, 01.01.2005, p. 418-427.

Research output: Contribution to journalArticle

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T1 - Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders

AU - Abikoff, Howard

AU - McGough, James

AU - Vitiello, Benedetto

AU - McCracken, James

AU - Davies, Mark

AU - Walkup, John

AU - Riddle, Mark

AU - Oatis, Melvin

AU - Greenhill, Laurence

AU - Skrobala, Anne

AU - March, John

AU - Gammon, Pat

AU - Robinson, James

AU - Lazell, Robert

AU - McMahon, Donald J.

AU - Ritz, Louise

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-naïve children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

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KW - Anxiety

KW - Attention-deficit/hyperactivity

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KW - Comorbidity

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