Long-term effects of methylphenidate on the cardiovascular system in children with attention deficit hyperactivity disorder

IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309 an inventory for parents to estimate the capabilities of the EF. We found significant differences in EF deficits in children with ADHD and PBD. This study will allow to look for the necessary tools and appropriate intervention for children with these disorders display their EF in any context.

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ding and facial expression labelling but did not affect measures of trait empathy. Positive changes in empathic skills should be a focus of treatment in children with ADHD. http://dx.doi.org/10.1016/j.neurenf.2012.04.678

http://dx.doi.org/10.1016/j.neurenf.2012.04.676 We-P-3035 We-P-3033

Comparison of discontinuation risk in patients initiated on lisdexamfetamine dimesylate (LDX) vs. other medications for the treatment of attention deficit/hyperactivity disorder (ADHD): A retrospective claims analysis J. Setyawan a,∗ , P. Hodgkins a , A. Guerin b , G. Gauthier b , M. Cloutier b , E. Wu b , M.H. Erder a a Global Health Economics Outcomes Research, Shire Pharmaceuticals, Wayne, PA, USA b Analysis Group, Boston, USA ∗ Corresponding author. Objective.– To compare discontinuation rates in ADHD patients initiated on LDX vs. other ADHD FDA-approved medications. Methods.– ADHD patients initiated on a new ADHD medication were selected from a large US administrative claims database. Based on age and previous treatment status, patients were classified into treatment-naïve or previously treated children and adolescents, or adults, respectively. Furthermore, based on initiated treatment, patients were classified into 7 cohorts: LDX, atomoxetine (ATX), methylphenidate long acting HCL (OROS-MPH), generic methylphenidate/dexmethylphenidate HCL short acting (MPH SA) and long acting (MPH LA), and amphetamine short acting (AMPH SA) and long acting (AMPH LA). Discontinuation rates, defined as a treatment interruption of more or equal to 30 consecutive days, during a 12-month period were compared using multivariate Cox proportional-hazards models. Results.– Among 101,616 children and adolescents, 1-year discontinuation rates ranged between 74–96%. LDX patients had significantly lower (P < .05) discontinuation rates compared to all cohorts, except ATX (P = NS) and OROS-MPH (higher; P < .05) in treatment-naïve patients. Among 53,674 adults, 1-year discontinuation rates ranged between 76–93%. LDX patients had significantly lower discontinuation rates compared to each of the other cohorts, except AMPH LA (P = NS). Conclusion.– In majority of comparisons LDX-treatment was associated with similar or lower risk of discontinuation compared to other ADHD medications. http://dx.doi.org/10.1016/j.neurenf.2012.04.677 We-P-3034

Empathy and facial expression recognition in children with ADHD and non-ADHD: Effects of stimulant medication in the ADHD group F. Gumustas a , S.G. Imren b , Y. Yulaf b , O. Sabuncuoglu a,∗ Department of Child and Adolescent Psychiatry, Marmara University Faculty of Medicine, Istanbul, Turkey b Istanbul, Turkey ∗ Corresponding author.

a

The aims of the study were to explore trait and state empathy and facial expression recognition in 8- to 14-year-old children with AttentionDeficit/Hyperactivity Disorder (ADHD) and non-ADHD; and to assess the effects of methylphenidate (MPH) treatment on these measures in the ADHD group. In regard to trait empathy, although children with ADHD rated themselves as less empathic than the non-ADHD children, parent ratings did not indicate any significant difference between two groups. ADHD and healthy control group did not differ in their emotion labelling and empathic responding (state empathy) scores. A subgroup which consisted of ADHD children with comorbid oppositional defiant disorder showed significant deficits on measures of both trait and state empathy. MPH improved performance on measures of emphatic respon-

The effectiveness of clinic based social skills training for children with ADHD or ASD in Japan H. Iwasaka a,∗ , H. Takahashi b , H. Negoro a , S. Uemura a , R. Miyazaki a , Y. Miyazaki b , A. Honjyo b , T. Onishi a , J. Iida c a Center for Special Needs Education, Nara University of Education, Nara-shi, Japan b Psychiatry, Nara Rehabilitation Center, Nara, Japan c Faculty of Nursing, Nara Medical University, Kashihara, Nara, Japan ∗ Corresponding author. Objective.– We develop the SST which encountered Japanese culture and practice it to children with developmental disorder in a clinic and review the efficacy. Methods.– We took SST program arranged from UCLA’s program comprising a learning session, a play session and a session for parents and practiced it. SST of all ten times consists of skills to seem to be need to “Let’s play with friends happily”. For 85 children who participated in this SST from 2002 to 2010 in total, we reviewed a change of their social skills, behavior and self-efficacy on before/after SST and a half-year later. Results.– The hyperkinesis and the impulsiveness in ADHD-RS (parent evaluation) were improved, but the significant improvement was absent in target skills and self-efficacy (self-evaluation). It is considered we have to strength the cooperation with a school to develop self-efficacy. On the presentation day, we consider a more detailed result and report it. http://dx.doi.org/10.1016/j.neurenf.2012.04.679 We-P-3036

The children’s attention project: A community-based study of ADHD symptoms in 6- to 7-year-old Australian children E. Sciberras a,∗ , D. Efron b , E. Schilpzand a , V. Anderson a , B. Jongeling c , P. Hazell d , O. Ukoumunne e , J. Nicholson f a Murdoch Childrens Research Institute, Parkville, Australia b Royal Children’s Hospital, Parkville, Australia c Joondalup Child Development Centre, Perth, WA, Australia d University of Sydney, Sydney, Australia e University of Exeter, Exeter, UK f Parenting Research Centre, East Melbourne, Australia ∗ Corresponding author. This study aimed to investigate the relationship between ADHD symptoms and family background and comorbid mental health problems, in a community-based sample of 6 to 7-year-old Australian children. In 2011 and 2012, approximately 5300 children attending 41 schools are being screened for ADHD, using the Conners’ 3 ADHD index (parent and teacher report). Children screening positive for ADHD, and a matched sample screening negative, are invited to participate in the longitudinal study. The first wave of screening has been completed (n = 2731). Based on pilot data (n = 345), we anticipate that compared to controls, children screened positive for ADHD will be more likely to have younger parents, less well educated parents and to be from single parent families. We anticipate that children with ADHD will have higher rates of comorbid mental health problems than controls. These data will provide the foundation for the first Australian longitudinal study of ADHD. http://dx.doi.org/10.1016/j.neurenf.2012.04.680 We-P-3037

Long-term effects of methylphenidate on the cardiovascular system in children with attention deficit hyperactivity disorder

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IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S254–S309

J. Popp a,∗ , R. Kleinrahm b , F. Keller c , K. Böckmann a , M. Allroggen b , U.M.E. Schulze b , J.M. Fegert c , A.G. Ludolph c a Ulm, Germany b Child And Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany c Department Of Child And Adolescent Psychiatry, University of Ulm, Ulm, Germany ∗ Corresponding author. Objective.– To examine the effects of methylphenidate (MPH) on the cardiovascular system. Study design.– A retrospective chart review was conducted analysing ECG, blood pressure (BP) and heart rate (HR) recordings of 104 children and adolescents (mean age 10 years, range 6–16), during treatment with MPH (up to 5,5 years). Results.– The overall results showed a non-significant reduction in ECG parameters and an increase in HR (mean 5 bpm). Already before MPH treatment, ADHD patients as a group showed a statistically significant elevated mean BP. Furthermore, a statistically significant increase was observed over time. We identified 15 patients with at least 3 BP measurements above the 95th percentile. Four patients showed these prior to medication, 11 developed hypertension during MPH treatment. Conclusions.– The observed elevated HR in addition to the changed ECG parameters presumably results from the sympathomimetic potential of MPH. Regarding the hypertension in adolescents, partly prior to treatment, further studies are recommended to assure the safety of MPH. http://dx.doi.org/10.1016/j.neurenf.2012.04.681 We-P-3038

Expert consensus for the diagnosis and treatment of ADHD in Japan 1st step: Diagnosis and assessment M. Aoshima a,∗ , C. Katumi b , K. Makino b , Y. Iwadare b , M. Usami b , M. Kodaira b , K. Watanabe b , K. Saito b a Division of Neuropsychiatry, department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan b Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global health and Medicine, Ichikawa, Japan ∗ Corresponding author. Aims.– The objective of this study was to revise the present guideline for diagnosis and treatment of ADHD in Japan to be more adaptable to present clinical situation by investigating the specialists’ recommendations and creating expert consensus. This is the 1st step of all three compositions. Method.– Eighty-four clinicians were selected as the expert and they replied to 67 items of questionnaire. Delphi method was applied to obtain the consensus. Result.– Eighty-three experts completed two rounds of the questionnaire along Delphi method. Eight of 67 items corresponded to the primary recommendation ICD-10 and DSM-IV-TR for “Diagnostic criteria”, Semi-structured Clinical Interview Form for ADHD and the usual unstructured interview for “Diagnostic interview form”, ADHD-RS- IV for “Action evaluation index”, WAIS-III and WISC-III for “Intelligence scale and Cognitive functioning scale”, EEG for “Neuro-physiological examination”. Conclusion.– The result of this study offers standards for diagnostic and assessment system of ADHD to Japanese clinicians. http://dx.doi.org/10.1016/j.neurenf.2012.04.682 We-P-3039

The family impact in children and adolescent with ADHD after the switch of treatment from immediate-release MPH to OROS-MPH W.J. Chou a,∗ , L.J. Wang b , C.H. Lin c Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan b Psychiatric Department, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan a

c

Department Of Psychiatry, Chimei Medical Center, Tainan, Taiwan author.

∗ Corresponding

Objectives.– To explore the impact on the parents and families as well as clinical symptoms, school performance, and social change of familial relationships and psychological status of patients as well as ADHD symptoms of children adjustment in children and adolescents with ADHD after switching from IR-MPH to OROS-MPH. Methods.– This is a prospective, single-arm, open-label, 8-week, multi-center study. After obtaining informed consent, baseline characteristics will be attained. Psychological status measure of subjects’ parents with the Chinese Health Questionnaire (CHQ), familial relationships measure with the Family Adaptation, Partnership, Growth, Affection, and Resolve (Family APGAR), school performance and social adjustment measure with the Social Adjustment Inventory for Children and Adolescents (SAICA), and ADHD symptoms measure with SNAPIV and CGI-ADHD-S will be assessed and recorded by parents/caregivers and investigators of subjects. After etering the treatment phase, OROS-MPH will be administered to replace IR-MPH. The dosage of OROS-MPH is flexible. Clinicians should adjust the dosage of each subject according to subject’s clinical responses and/or side effects. During the study period, subjects will be assessed on week-2, week-4, and week-8. Scores of CHQ, Family APGAR-C, SAICA, and SNAP-IV will be assessed. Reports of adverse events will also be recorded. Results.– A total of 296 subjects who met the initial requirement were enrolled in this study. The ITT (intent-to-treatment) population were comprised of 247 male subjects (83.4%) and 49 female subjects (16.6%), with average age of 9.5 years old ranging from 6.0 to 17.0 years old. The majority of the subjects were studying in the elementary school (n = 241, 81.4%). The major subtype of ADHD was the combined one (n = 201, 67.9%), followed by subtype of inattentive (n = 90, 30.4%) and hyperactive (n = 3, 1.0%). From the results of SNAP-IV (parents), it showed that subjects’ parents subjectively perceived their kids’ ADHD behaviour symptoms had significant improvement at all of three dimensions (Inattention, Hyperactivity, and Oppositional symptoms) from baseline to the three follow-up visits (P < 0.0001 for all of three visits to baseline) after switched their medication from IR MPH to OROS-MPH. The CHQ results collected from patients’ mothers showed that mothers’ psychological status had significant improvement as compared with baseline at visit 3 (P = 0.000) and visit 4 (P = 0.003). However, patients’ fathers had no significant change on their psychological status (P = 0.587 and P = 0.581 for visit 3 and visit 4 comparing to baseline, respectively) during the study. Family APGAR-C showed that there was no significant difference on the family support. The SAICA assessment was used to evaluate the change on patients’ social adjustment. Conclusion.– Comparing with the baseline, OROS-MPH had been demonstrated that it could significantly improved subjects’ ADHD behavioral symptoms and their social adjustment at school and at home. In addition, subjects’ mothers (major caregivers) significantly reduced the mental stress on caring their kids after the subjects switched their medication from IR MPH to OROS-MPH. However, these results were contributed by the compliance improvement or by the more stable medication concentration should be further investigated. http://dx.doi.org/10.1016/j.neurenf.2012.04.683 We-P-3040

ADHD subtypes in attention and visual memory L. Huang a,∗ , C. Shang b , S.S. Gau c Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan b Department of Psychiatry, Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan c Department of Psychiatry, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan ∗ Corresponding author. a

This study tested the hypothesis of significant differences in attention performance and visual memory among the three ADHD subtypes as comparing to healthy controls. The sample consisted of 478 youth with ADHD [male, 80.7%; 11.8 ± 1.6 years old; 242 ADHD combined-type (ADHD-C), 193 ADHD inattentive-type (ADHD-I), and 43 ADHD hyperactive-impulsive-type (ADHD-HI)] and 229 non-ADHD controls. They were assessed by Rapid Visual