Disclosures: Stein reports serving as an advisor/consultant to Akili Interactive, Cingulate Therapeutics, Genomind, NLS Pharma, Shire (a Takeda company), Supernus Pharmaceuticals and Tris Pharma. Stein and another study author report research support from the NIMH, Akili Interactive and Supernus. The other authors report no relevant financial disclosures.

September 23, 2020
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Lisdexamfetamine dimesylate, behavioral treatment combination effective for family ADHD

Disclosures: Stein reports serving as an advisor/consultant to Akili Interactive, Cingulate Therapeutics, Genomind, NLS Pharma, Shire (a Takeda company), Supernus Pharmaceuticals and Tris Pharma. Stein and another study author report research support from the NIMH, Akili Interactive and Supernus. The other authors report no relevant financial disclosures.

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A combination of medication and behavioral treatments may benefit multiplex families where both children and their mothers have ADHD, according to study results published in Journal of Clinical Psychiatry.

Mark A. Stein

“Young children with ADHD are among our most difficult patients to treat,” Mark A. Stein, PhD, of the department of psychiatry and behavioral medicine at Seattle Children’s Hospital, told Healio Psychiatry. “Medicines are less effective and more poorly tolerated, and families often prefer alternative approaches. Behavioral therapy is effective in targeting many associated problems with ADHD; however, when a parent has ADHD, standard behavioral therapy may be less effective, even if available.”

Results of a prior study suggested 25% to 50% of parents of children with ADHD may also have the disorder, which could compromise behavioral treatment for both parents and children. Previous efforts to address multiplex ADHD families did not compare behavioral parenting interventions with parent psychopharmacology without confounds of other treatments, according to Stein and colleagues.

In the current study, the investigators sought to compare parental treatment with lisdexamfetamine dimesylate (LDX; Vyvanse, Shire Development) with behavioral parent training (BPT) among 35 mothers who had untreated ADHD and who had young, stimulant-naive children aged 4 to 8 years (N = 35) with ADHD symptoms. The investigators randomly assigned the mothers to 8 weeks of LDX, starting at 20 mg/d and titrated to a maximum of 70 mg/d, or BPT. They used the Conners’ Adult ADHD Ratings Scales, Clinical Global Impressions-Severity of Illness (CGI-S) scale and CGI-Improvement scale to assess maternal ADHD outcomes; the Alabama Parenting Questionnaire (APQ) and Dyadic Parent-Child Interaction Coding System, Fourth Edition, to assess parenting; and Conners {aren’t Rating Scale Revised Short-Form and conners Early Childhood Scale to assess child ADHD outcomes.

Results showed improvement at 8 weeks related to both treatments, specifically in mothers’ functioning on the CGI and self-reported emotion regulation; however, only LDX was associated with improvement of mothers’ self-reported core ADHD symptoms. The medication was linked to improved parental perception of their own ADHD symptoms, as well as in corporal punishment on the APQ, which was consistent with results of prior studies. Although LDX did not improve observed parenting, BPT appeared to increase positive parenting during child-directed play and clean-up and decreased negative parenting during child-directed play. A total of 6% of children whose mothers were randomly assigned to LDX exhibited “much” or “very much” improvement on the CGI-I compared with 35% of those treated with BPT.

“It will also be important to examine longer-term effects of these approaches,” Stein and colleagues wrote. “Importantly, neither treatment was sufficient for most families, as most children remained impaired at 8 weeks. Combining medication and behavioral treatments, lengthening treatment duration and/or intervening earlier might be needed to alter the trajectory of child ADHD in multiplex families.”