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School-aged children show signs of ADHD in early morning despite treatment
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SAN FRANCISCO — Despite receiving stable doses of stimulant medications, children and adolescents with attention-deficit/hyperactivity disorder displayed inadequate symptom control and functional impairment related to the condition during their early morning routine before school, according to survey results presented at the 2016 AAP National Conference and Exhibition.
Floyd R. Sallee, MD, PhD, of Ironshore Pharmaceuticals and Development Inc. in Cincinnati, and colleagues administered an online questionnaire to primary caregivers (n = 201) of school-aged children with attention-deficit/hyperactivity disorder (ADHD) to assess inadequate ADHD symptom control and ADHD-related functional impairment, and identify the temporal period when symptoms and impairments occurred most often. The emotional effect on caregivers of children with the ADHD symptoms was also evaluated.
Respondents who indicated that their child had inadequately controlled ADHD symptoms (Likert severity rating of ≥2) during this the early morning temporal period, defined the period from wake-up time until leaving for school, continued the questionnaire to answer more specific questions regarding the early morning routine.
Caregivers rated inadequately controlled ADHD-related symptoms and functional impairments on scales ranging from 1 (no ADHD symptoms; mild impairment,) to 10 (significant ADHD symptoms; severe impairment).
Survey results revealed that the most severe uncontrolled symptoms occurred during the early morning routine and the evening homework period; each time was rated at 6.5. Overall early morning functional impairment was rated at an average of 6.1.
Most respondents reported moderate-to-severe ADHD symptoms (74%) and functional impairments (76%) during the early morning routine. The most frequently reported early morning ADHD symptoms included being easily distracted (74%), not listening (73%) and inattentiveness during tasks (66%). Caregivers identified impulsiveness (49%), failure to complete tasks (49%) and time awareness (44%) as the unwanted behaviors that occurred most often during early morning.
Inadequately controlled ADHD symptoms and functional impairment negatively impacted caregivers. They reported raising their voice more frequently (37%) and often feeling overwhelmed and exhausted (41%) and constantly stressed (30%). Most caregivers (79%) previously initiated discussions with their primary ADHD physician about their child’s early morning ADHD symptoms and functional impairments. To alleviate ADHD symptoms during the early morning routine, many parents (48%) reported waking up early to give ADHD medication to their child.
“The results strongly suggest that despite early morning administration of stimulants, caregivers of children and adolescents with ADHD report a high prevalence of inadequately controlled, early morning ADHD symptoms and related functional impairments,” Sallee and colleagues wrote. “Importantly, often the parent’s relationship with their child or adolescent with ADHD was negatively affected by these symptoms (42%). These results suggest that pharmacologic management of early morning functional impairments due to ADHD symptoms remains a significant unmet need in school-age children with ADHD.” – by Alaina Tedesco
Reference:
Sallee FR, et al. Abstract # 319912. Presented at: AAP National Conference and Exhibition; Oct. 22-25, 2016; San Francisco.
Disclosure: Infectious Diseases in Children was unable to confirm any relevant financial disclosures at the time of publication.