1) Placebo-Controlled Study of the Effects of Atomoxetine on Bladder Control in Children With Nocturnal Enuresis

Calvin R. Sumner, Kory J. Schuh, Virginia K. Sutton, Robert Lipetz, Douglas K. Kelsey

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 6:699-711.

PURPOSE: Introduction: Nocturnal enuresis is a condition in which children at least 5 years of age are incontinent of urine at night. Atomoxetine, a potent inhibitor of the presynaptic norepinephrine transporter, is used to treat attention-deficit/hyperactivity disorder (ADHD). This study tested the hypothesis that atomoxetine will provide significant therapeutic benefit for nocturnal enuresis in patients with the diagnosis of nocturnal enuresis.

METHODS: Atomoxetine's efficacy for improving nocturnal enuresis was studied in 87 pediatric subjects using an outpatient, multicenter, randomized, double-blind, parallel, placebo-controlled study. Efficacy was determined by measuring the mean number of dry nights per week using an intent-to-treat analysis of the primary outcome measure, the Dry Night Log-Parent Report (DNL-PR), a daily parent diary.

RESULTS: Baseline and end point DNL-PR data were available from 42 atomoxetine-treated and 41 placebo-treated subjects. Atomoxetine increased the average number of dry nights per week by 1.47 compared with .60 for placebo (F = 7.06; df = (1, 75); p = 0.01). Fifteen atomoxetine-treated subjects (35.7%) had an increase of at least 2 dry nights per week compared with only 6 (14.6%) placebo-treated subjects (Fisher's exact test; p = 0.042). There were no significant differences in adverse events between the groups.

CONCLUSION: Compared with placebo, atomoxetine treatment was associated with a significant increase in dry nights in children with nocturnal enuresis.

2) Attention-Deficit Hyperactivity Disorder Symptoms in a Clinic Sample of Children and Adolescents with Pervasive Developmental Disorders

Douglas O. Lee, Opal Y. Ousley

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 6:737-746.

OBJECTIVES: The aims of this systematic chart review were to determine the frequency of attention-deficit/hyperactivity disorder (ADHD) in a clinic sample of children and adolescents with autism spectrum disorders (ASD), to compare ADHD symptoms in children with Autistic Disorder, Asperger's Disorder, and pervasive developmental disorders–not otherwise specified (PDD-NOS), to compare ADHD symptoms in individuals with and without ADHD-related chief complaints, and to determine the correlation between ADHD Rating Scale (ADHD RS) scores and age.

METHOD: This systematic chart review examined data from children and adolescents who were consecutively referred to a university-based autism psychopharmacology program. All individuals were diagnosed by semistructured interview for ASD and ADHD, and ADHD symptoms were assessed using ADHD RS scores.

RESULTS: Of 83 children, 78% fulfilled Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for ADHD and exceeded the 93rd percentile norm for the ADHD RS. Hyperactivity-impulsivity scores were significantly greater in individuals with autism than those with other ASDs. DSM-IV ADHD diagnosis was represented equally in individuals with and without ADHD as their chief complaints. ADHD RS hyperactivity-impulsivity and total scores were negatively correlated with age.

CONCLUSION: ADHD symptoms are pervasive in clinically referred children and adolescents with ASD.

3) Atomoxetine Treatment in Children and Adolescents with Attention-Deficit Hyperactivity Disorder: What Are the Long-Term Health-Related Quality-of-Life Outcomes?

Amy R. Perwien, Christopher J. Kratochvil, Douglas E. Faries, Brigette S. Vaughan, Thomas Spencer, Ronald T. Brown

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 6:713-724.

OBJECTIVE: Numerous investigations have examined the efficacy of pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) in children. However, relatively few studies have addressed the impact of treatment on long-term subjective, psychosocial outcomes, such as health-related quality of life (HRQL). This study examines the long-term effects of pharmacological treatment with atomoxetine on HRQL in children and adolescents with ADHD.

METHODS: Participants included 6- to 17-year-old children and adolescents (n = 912) with ADHD enrolled in a 24-month, multicenter, open-label trial of atomoxetine. Outcomes included clinician ratings of ADHD, parent ratings of ADHD, and a widely used measure of HRQL (The Child Health Questionnaire (CHQ)). Treatment response rates were calculated based on a CHQ improvement of at least 1 standard error of measurement.

RESULTS: Significant improvements in HRQL were found following both acute and long-term treatment for psychosocial but not physical health. Of participants who completed treatment (n = 312 or 34.2% of those enrolled), 81% responded to acute treatment and 78% responded to long-term treatment. Improvements noted after acute treatment were maintained during long-term treatment with the majority of participants (86%) continuing to respond to treatment.

CONCLUSIONS: Atomoxetine is associated with improvements in HRQL, and the improvements are generally stable over time.

4) What is the Social Impact of ADHD in Girls? A Multi-Method Assessment.

Ohan JL, Johnston C.

Psychology Department, Unit 4, Barber School of Arts & Sciences, University of British Columbia-Okanagan, 3333 University Way, Kelowna, British Columbia, Canada, jeneva.ohan@ubc.ca.

J Abnorm Child Psychol. 2006 Dec 30; [Epub ahead of print]

This study explores the social impact of ADHD, with and without opposition-defiant behaviour (ADHD+ODD (n= 22) and ADHD-only (n= 18)), in 9- to 12- year old girls compared to girls without ADHD (n= 40). Girls played a computer game involving simulated players, and mothers and teachers completed rating scales. In general, mothers and teachers saw girls with ADHD+ODD as more overtly and relationally aggressive and less prosocial than girls with ADHD-only, who were seen as more overtly and relationally aggressive and less prosocial than control girls. On the computer game, girls with ADHD+ODD were more overtly aggressive, more directly relationally aggressive, and showed less skilled behaviour than the other groups. Girls with ADHD-only showed less covert, indirect relational aggression and more socially awkward interactions than girls in the control group on the computer game. In all, the results indicate that girls with ADHD, with and without ODD behaviour, engage in socially detrimental behaviours.

The Influence of Risperidone on Attentional Functions in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Co-Morbid Disruptive Behavior Disorder

Thomas Gunther, Beate Herpertz-Dahlmann, Jellemer Jolles, Kerstin Konrad

Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 6:725-735.

This study aims to examine the influence of risperidone on various attentional functions, including intensity and selectivity aspects of attention plus inhibitory control in children with attention deficit/hyperactivity disorder (ADHD) with co-morbid Disruptive Behavior Disorders (DBD) and normal IQ. Children with ADHD and DBD, aged 8–15 years, were treated with risperidone (mean daily dose: 1.5 mg; n = 23) and examined with three attentional paradigms before and after a 4-week treatment period. Age- and IQ-matched normal controls (n = 23) were also tested without medication on the same two occasions. No influence of the medication could be detected for any neuropsychological variable, neither as a positive enhancement nor as adverse side effects. However, clinical symptoms of ADHD and DBD assessed on the IOWA Conners Scale significantly improved after the 4-week treatment period. Divergent behavioral and cognitive effects of risperidone on ADHD symptoms were observed, with a significant reduction in behavioral symptoms, whereas no positive treatment effects were found on laboratory tasks of impulsivity. Thus, the cognitive effects of risperidone seem to differ from the cognitive effects of stimulant treatments in children with ADHD + DBD. However, no negative impact of risperidone was observed on attentional functions either, i.e., there was no slowing of cognitive speed.