ADHD Clinical Update, October 28, 2011

Telephone-based treatments resulted in significant diagnosis decreases among children with disruptive behavior or anxiety compared with usual care, according to research published recently in The Journal of the American Academy of Child and Adolescent Psychiatry.

These kinds of interventions could increase access to mental health services, according to researchers from the IWK Health Centre and Dalhousie University in Halifax, Nova Scotia.

Because most children with mental health disorders do not receive timely care because of access barriers, the researchers conducted these initial trials to determine whether distance interventions provided by nonprofessionals could significantly decrease the proportion of children diagnosed with disruptive behavior or anxiety disorders.

In three randomized controlled trials, 243 children (80 with oppositional-defiant, 72 with attention-deficit/hyperactivity, and 91 with anxiety disorders) were stratified by DSM-IV diagnoses and randomized to receive the highest level of intervention or usual care (control).

“The intervention consisted of evidence-based participant materials (handbooks and videos) and weekly telephone coach sessions. The main outcome was mental health diagnosis change,” the authors wrote in the study abstract.

“Intention-to-treat analysis showed that for each diagnosis significant treatment effects were found at 240 and 365 days after randomization. Moreover, in the overall analysis significantly more children were not diagnosed as having disruptive behavior or anxiety disorders in the treatment group than the control group.”

Methylphenidate Dose-Response in ADHD: Pharmacogenetic Predictors

Certain genetic polymorphisms may be associated with individual variability in methylphenidate (MPH) dose-response in the treatment of attention-deficit/hyperactivity disorder, according to research published recently in The Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers at the University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center undertook the study because there is significant individual variability in ADHD medication response and increasing interest in identifying genetic predictors of treatment effects.

For the study, which examined the role of four catecholamine-related candidate genes in moderating MPH dose-response, 89 stimulant-naive children seven to 11 years old with ADHD participated in a randomized, double-blind, crossover trial of long-acting MPH.

“Children were genotyped for polymorphisms in the 3' untranslated region of dopamine transporter (DAT), exon 3 on dopamine receptor D(4) (DRD4), codon 158 on catechol-O-methyltransferase, and the adrenergic α(2A)-receptor promoter,” the researchers wrote in the study abstract.

“The most statistically significant gene-by-dose interactions were observed on hyperactive-impulsive symptoms for DRD4 and DAT polymorphisms, with participants lacking the DAT 10-repeat allele showing greater improvements in symptoms with increasing dose compared with 10-repeat carriers (p = .008) and those lacking the

DRD4 4-repeat allele showing less improvement across MPH doses compared with 4-repeat carriers (p = 0.02),” the authors concluded.

SourcesTelephone-based Mental Health Interventions for Child Disruptive Behavior or Anxiety Disorders: Randomized Trials and Overall Analysis [The Journal of the American Academy of Child and Adolescent Psychiatry]Pharmacogenetic Predictors of Methylphenidate Dose-response in Attention-deficit/Hyperactivity Disorder [The Journal of the American Academy of Child and Adolescent Psychiatry]