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Psychostimulants may reduce risk for anxiety in children with ADHD

Results from a meta-analysis show a reduced risk for anxiety among children with attention-deficit/hyperactivity disorder receiving psychostimulant treatment compared with those receiving placebo.

“Epidemiologic studies have demonstrated that 25% to 50% of children with [attention-deficit/hyperactivity disorder (ADHD)] also have a comorbid anxiety disorder. Anxiety has also been identified as a potential moderator of short-term treatment response in children with ADHD. Previous trial data have suggested that children with ADHD who have comorbid anxiety may exhibit a decreased response to methylphenidate (MPH) and experience more side effects than children with ADHD without anxiety,” Catherine G. Coughlin, BS, of Yale Child Study Center, Yale University School of Medicine, and colleagues wrote.

Researchers searched PubMed to identify all double blind, randomized, placebo-controlled trials examining the efficacy of psychostimulants to treat ADHD among children. They then conducted a meta-analysis of 23 studies including 2,959 children with ADHD.

Risk for anxiety associated with psychostimulant treatment was significantly lower compared with placebo (RR = 0.86; 95% CI, 0.77-0.95; P < .05).

Further, higher doses of psychostimulants were associated with a reduced risk for anxiety when compared with placebo (P = .019).

“These results do not rule out the possibility that some children experience increased anxiety when treated with psychostimulants, but suggests that those risks are outweighed by children who experience improvement in anxiety symptoms (possibly as a secondary effect of improved control of ADHD symptoms),” Coughlin and colleagues wrote. “As reports of worsening anxiety were common in placebo arms of randomized controlled trials in children with ADHD (24% in this meta-analysis), clinicians should further consider rechallenging children with ADHD who report new-onset or worsening anxiety with psychostimulants but significant improvement in ADHD symptoms, as worsening anxiety symptoms are much more likely to be coincidental rather than caused by psychostimulants.” – by Amanda Oldt

Disclosure: The study was funded by the National Institutes of Health, the Tourette Association of America, Brain and Behavior Research Foundation, the Rembrandt Foundation, and the National Center for Research Resources, a component of the NIH, and NIH roadmap for Medical Research. Coughlin and colleagues report no relevant financial disclosures.