Do Psychostimulants Cause Inadequate Early Morning ADHD Symptoms Management?

In online surveys, primary caregivers for children and adolescents on psychostimulant pharmacotherapy for ADHD reported that early morning hours were a time of inadequate symptom control, functional impairment, and parental stress.

SAN ANTONIO, TX—Poor early morning psychostimulant symptoms management for children and adolescents with attention deficit/hyperactivity disorder (ADHD) can involve functional impairment for the patients and emotional impacts for parents and caregivers, according to findings from a pair of online questionnaire studies presented at the U.S. Psychiatric & Mental Health Congress.

“These concordant findings suggest that inadequate ADHD symptom control during the EMR [early morning routine] is a clinically significant and highly unmet need in school-age children with ADHD currently treated with stimulant medications,” reported Frank A. López, MD, of the Children’s Development Center in Winter Park, FL, and F. Randy Sallee, MD, PhD, of Ironshore Pharmaceuticals & Development, Inc., in Grand Cayman, the Cayman Islands.

ADHD is the most common childhood-onset neurobehavioral disorder diagnosis. Long-acting psychostimulants are a first-line pharmacotherapy for ADHD.

Treatment focus for ADHD has recently shifted from symptoms management in the classroom to symptoms control at home, the coauthors stated.

Psychostimulant formulations can control symptoms for up to 12 hours but have an onset latency as long as two hours, they noted. That might leave patients with untreated symptoms during the early morning hours—a “critical time period during which school-age children are required to quickly and efficiently complete multiple morning activities” like eating breakfast, brushing teeth, dressing themselves, and gathering books or homework for school, the authors asserted.

Such examples of early morning functional impairment can impact the child and parents alike, according to the authors.

“While it is becoming apparent that many home-based difficulties for children and adolescents with ADHD may occur during the early-morning routine, very little is known about the specific nature (prevalence, frequency, and severity) of inadequately controlled ADHD symptoms and related early morning functional impairments in stimulant-treated children and adolescents with ADHD, or the impact of these impairments on caregivers,” they reported.

They therefore examined the frequency and severity of inadequate ADHD symptoms management, functional impairment for children and adolescents, and impacts on their parents or caregivers, during early mornings, school day, after-school afternoon hours, dinner time, and bed time, using two nearly-identical online, caregiver-completed questionnaires. (The Study 1 survey also included questions about evening homework time.)

Eligibility criteria included caring for children aged 6 to 17 who are currently taking psychostimulants for ADHD. No control group of caregivers for non-ADHD-diagnosed children or adolescents was included in the study.

A total of 201 primary caregivers participated in the first survey; 300 participated in the second one.Respondents in the two surveys “reported a concordantly high prevalence and severity of early morning functional impairment in their stimulant-treated children [and] adolescents with ADHD, which had a prevalent, negative emotional impact on caregivers,” the coauthors reported.

More than half of respondents in both surveys reported that during early morning routines, they often or sometimes felt overwhelmed or exhausted, felt constantly stressed, and felt inadequate as a parent. They also reported punishing their child more and praising their child less frequently, as a result.

Improving early morning functional impairments “could be a significant first step to further optimizing clinical outcomes with ADHD pharmacologic treatment,” they concluded.

The authors reported support from Impax, Ironshore Pharmaceuticals & Development, Pfizer, and past AstraZeneca advisory-board membership.