Harinder S. Ghuman

Psychostimulants in Preschool Children With Attention-Deficit/Hyperactivity Disorder: Clinical Evidence From a Developmental Disorders Institution

OBJECTIVE To examine psychostimulant response in preschool children with attention-deficit/hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic (housed within a developmental disorders institution) over 3, 12, and 24 months of treatment. METHOD A systematic retrospective chart review was conducted for 27 preschool children with ADHD who were started on psychostimulants between the ages of 3 and 5 years, inclusive. Two child and adolescent psychiatrists reviewed each chart independently, using the Clinical Global Impressions (CGI) scale to rate the severity of illness and global improvement and the Side Effects Rating Form to rate side effects. RESULTS Over 24 months, psychostimulants were stopped in three children (11%) because of side effects and concomitant psychotropic medications were added in seven children (26%). The CGI severity-of-illness ratings showed a significant effect of time over 3, 12, and 24 months of psychostimulant treatment (all p values < .0001). Rate of response was 74% at 3 months and 70% at 12 and 24 months. Side effects were mostly mild and occurred in 63% of the children at 3 months, 41% at 12 months, and 29% at 24 months. CONCLUSIONS The findings suggest that preschool children with developmental disorders respond to psychostimulants but need close monitoring because of frequent side effects. Inasmuch as the study participants were recruited from a child psychiatry clinic housed within a developmental disorders institution and had a high rate of developmental disorders, the findings may not generalize to other preschool children with ADHD.

Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies.

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that can result in significant functional impairment, and if not adequately treated can lead to impaired quality of life. Pharmacotherapy is considered the first-line treatment for ADHD in children and adolescents. We review both recent literature and seminal studies regarding the pharmacological treatment of ADHD in children and adolescents. There is ample evidence for the efficacy and safety of both stimulants and non-stimulants in the treatment of ADHD. We review important aspects of evaluation and assessment and discuss first-line pharmacological treatments and as well as when to consider using alternative pharmacological agents. Treatment approaches to manage frequently seen comorbid disorders with ADHD are also covered.

Review of Social Interaction Measures in Infants and Preschool Children.

This review of the literature is presented to familiarize the reader with the available measures as they relate to assessing the basic capacity for social interaction in infants and preschool children. A review of the literature revealed that broad concepts of social interaction that overlap with other aspects of social development have been included in the assessment of social interaction. Only those measures that included assessment of the basic capacity for social interaction, either as the main goal or as part of assessing different aspects of social development, were considered. The identified measures are grouped in this review by the main area of social development for which they were established. Brief descriptions of the measures are provided in a table format.

Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review

Attention-deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental health disorders and is associated with higher incidence of comorbid oppositional or conduct, mood, anxiety, pervasive developmental, and substance-use disorders. Comorbid mental health conditions may alter the presence of symptoms and treatment of ADHD. Atomoxetine (ATX), a nonstimulant medication for the treatment of ADHD, may be prescribed for individuals with ADHD and comorbid conditions despite some risk for certain undesirable side effects and lower effectiveness for the treatment of ADHD than stimulants. In this paper, we review studies utilizing randomized, placebo-controlled trials (RCTs) as well as within-subject designs to determine the effectiveness of ATX in the treatment of children and adults with ADHD and comorbid conditions. The current review uses an expanded methodology beyond systematic review of randomized controlled trials in order to improve generalizability of results to real-world practice. A total of 24 articles published from 2007 to 2015 were reviewed, including 14 RCTs: n = 1348 ATX, and n = 832 placebo. The majority of studies show that ATX is effective in the treatment of ADHD symptoms for individuals with ADHD and comorbid disorders. Cohen’s d effect sizes (ES) for improvement in ADHD symptoms and behaviors range from 0.47 to 2.21. The effectiveness of ATX to improve symptoms specific to comorbidity varied by type but appeared to be most effective for diminishing the presence of symptoms for those with comorbid anxiety, ES range of 0.40 to 1.51, and oppositional defiant disorder, ES range of 0.52 to 1.10. There are mixed or limited results for individuals with ADHD and comorbid substance-use disorders, autism spectrum disorders, dyslexia or reading disorder, depression, bipolar disorder, and Tourette syndrome. Results from this review suggest that ATX is effective in the treatment of some youth and adults with ADHD and comorbid disorders, and may be a treatment option in these patients.

Why I Like Being an Academic Psychiatrist

ment and implementation. Acad Psychiatry 2003; 27:149–153 25. Ende J: Feedback in clinical medical education. JAMA 1983; 250:777–781 26. Wolverton SE, Bosworth MF: A survey of resident perceptions of effective teaching behaviors. Fam Med 1985; 17:106–108 27. Milan FB, Parish SJ, Reichgott MJ: A model for educational feedback based on clinical communication skills strategies: beyond the “feedback sandwich.” Teach Learn Med 2006; 18: 42–47 28. Sloan TB, Kaye CI, Allen WR, et al: Implementing a simpler approach to mission-based planning in a medical school. Acad Med 2005; 80:994–1004 29. Vanderveen K, Chen M, Scherer L: Effects of resident dutyhours restrictions on surgical and nonsurgical teaching faculty. Arch Surg 2007; 142:759–764, discussion 764–766