March 6, 2021
Methylphenidate(MPH) is one of the most widely-prescribed medications for children. Given that ADHD frequently persists over a large part of an individual’s lifespan, any side effects of medication initiated during childhood may well be compounded over time. With funding from the European Union, a recently released review of the evidence looked for possible adverse neurological and psychiatric outcomes.
From the outset, the international team recognized a challenge: “ADHD severity may be an important potential confounder, as it may be associated with both the need for long-term MPH therapy and high levels of underlying neuropsychiatric comorbidity.” Their search found a higy heterogeneous evidence base, which made meta-analysis inadvisable. For example, only 25 of 39 groups studies reported the presence or absence of comorbid psychiatric conditions, and even among those, only one excluded participants with comorbidities. Moreover, in only 24 of 67 studies was the type of MPH used (immediate or extended-release)specified. The team, therefore, focused on laying out an “evidence map” to help determine priorities for further research.
The team found the following breakdown for specific types of adverse events:
· Low mood/depression. All three non-comparative studies found MPH safe. Two large cohort studies, one with over 2,300 participants, and the other with 142,000, favored MPH over the non-stimulant atomoxetine . But many other studies, including a randomized controlled trial(RCT), had unclear results. Conclusion: “the evidence base regarding mood outcomes from long-term MPH treatment is relatively strong, includes two well-powered comparative studies, and tends to favor MPH.”
· Anxiety. Here again, all three non-comparative studies found MPH safe. But only two of seven comparative studies favored MPH, with the other five having unclear results. Conclusion: “while the evidence about anxiety as an outcome of long-term MPH treatment tends to favor MPH, the evidence base is relatively weak.”
· Irritability/emotional reactivity. A large cohort study with over 2,300 participants favored MPH over atomoxetine . Conclusion: “the evidence base … is limited, although it includes one well-powered study that found in favor of MPH over atomoxetine.”
· Suicidal behavior/ideation. There were no non-comparative studies, but all five comparative studies favored MPH. That included three large cohort studies, with a combined total of over a hundred thousand participants, that favored MPH over atomoxetine. Conclusion: “the evidence base … is relatively strong, and tends to favor MPH.”
· Bipolar disorder. A very large cohort study, with well over a quarter-million participants, favored MPH over atomoxetine. A much smaller cohort study comparing MPH with atomoxetine , with less than a tenth the number of participants, pointed toward caution. Conclusion: “the evidence base … is limited and unclear, although it includes two well-powered studies.”
· Psychosis/psychotic-like symptoms. By far the largest study, with over 145,000 participants, compared MPH with no treatment, and pointed toward caution. A cohort study with over 2,300participants favored MPH over atomoxetine. Conclusion: “These findings indicate that more research is needed into the relationship between ADHD and psychosis, and into whether MPH moderates that risk, as well as research into individual risk factors for MPH-related psychosis in young people with ADHD.”
· Substance use disorders. A cohort study with over 20,000 participants favored MPH over anti-depressants, anti-psychotics, and no medication. Other studies looking at dosages and durations of treatment, age at treatment initiation, or comparing with no treatment or “alternative” treatment, all favored MPH except a single study with unclear results. Conclusion: “the evidence base … is relatively strong, includes one well-powered study that compared MPH with antipsychotic and antidepressant treatment, and tends to favor MPH.”
· Tics and other dyskinesias. Of four noncomparative studies, three favored MPH, the other, with the smallest sample size, urged caution. In studies comparing with dexamphetamine, pemoline, Adderall, or no active treatment, three had unclear results and two pointed towards caution. Conclusion: “more research is needed regarding the safety and management of long-term MPH in those with comorbid tics or a tic disorder.”
· Seizures or EEG abnormalities. With one exception, the studies had small sample sizes. The largest, with over 2,300 participants, compared MPH with atomoxetine, with inconclusive results. Two small studies found MPH safe, one had unclear results, and two others pointed towards caution. Conclusion: “While the evidence is limited and unclear, the studies do not indicate evidence for seizures as an AE of MPH treatment in children with no prior history … more research is needed into the safety of long-term MPH in children and young people at risk of seizures.”
· Sleep Disorders. All three noncomparative studies found MPH safe, but the largest cohort study, with over 2,300 participants, clearly favored atomoxetine. Conclusion: “more research is needed into the relationship between ADHD, sleep, and long-term MPH treatment.”
· Other notable psychiatric outcomes. Two noncomparative studies, with 118 and 289 participants, found MPH safe. A cohort study with over 700 participants compared with atomoxetine, with inconclusive results. Conclusion: “there is limited evidence regarding long-term MPH treatment and other neuropsychiatric outcomes, and that further research may be needed into the relationship between long-term MPH treatment and aggression/hostility.”
Although this landmark review points to several gaps in the evidence base, it mainly supports prior conclusions of the US Food and Drug Administration (FDA) and other regulatory agencies (based on short-term randomized controlled trials) that MPH is safe for the treatment of ADHD in children and adults. Given that MPH has been used for ADHD for over fifty years and that the FDA monitors the emergence of rare adverse events, patients, parents and prescribers can feel confident that the medication is safe when used as prescribed.
Helga Krinzinger,Charlotte L Hall, Madeleine J Groom, Mohammed T Ansari, Tobias Banaschewski,Jan K Buitelaar, Sara Carucci, David Coghill, Marina Danckaerts, Ralf W Dittmann, Bruno Falissard, Peter Garas, Sarah K Inglis, Hanna Kovshoff, Puja Kochhar, Suzanne McCarthy, Peter Nagy, Antje Neubert, Samantha Roberts, Kapil Sayal, Edmund Sonuga-Barke , Ian C K Wong , Jun Xia, Alexander Zuddas, ChrisHollis, Kerstin Konrad,
A recent study published in Alpha Psychiatry sheds light on the connection between ADHD, empathy, and narcissistic traits. Researchers aimed to evaluate how pharmacological treatments—specifically psychostimulants—affect empathy deficits and pathological narcissism in adults with ADHD. These findings could have important implications for enhancing treatment outcomes and improving social functioning.
Study Overview
The study involved 75 adult ADHD patients who were treated with either methylphenidate or atomoxetine. Researchers assessed levels of narcissistic traits and empathy using validated tools such as the Pathological Narcissism Inventory (PNI) and the Empathy Quotient (EQ). Measurements were taken before treatment and after three months of therapy.
Key Findings
Why It Matters
Adults with ADHD often struggle with social interactions, partly due to empathy deficits and personality traits like narcissism. By addressing these challenges through psychostimulant treatment, patients may experience better social and emotional well-being. This study underscores the importance of viewing ADHD treatment as not just a way to manage symptoms but also a means to improve overall quality of life.Takeaway
Effective ADHD treatment goes beyond managing attention and hyperactivity. By improving empathy and reducing narcissistic traits, psychostimulants can foster healthier relationships and enhance social functioning. This research highlights the need for comprehensive care that considers the broader psychological and interpersonal effects of ADHD.
According to Fosco et al. (2019), “Inhibitory control has long been considered a central neurocognitive process in ADHD, with ADHD groups typically showing medium-sized impairments relative to their typically-developing peers on common inhibition paradigms.”
Learning to play a musical instrument requires effective coordination of physical movements and sound signals to produce music. Musical training involves repetitive practice, perfecting connections between perceptions, muscular actions, and cognition.
Noting that listening to music activates the brain’s reward circuits in both children and adults, that “Being internally motivated during learning experiences increases learning capacity and efficiency, and this greater engagement is reflected in increased electrical brain activity following musical training,” and that “Training music in a social environment increases positive feelings of bonding through shared emotions and group synchrony,” a Montreal-based research team carried out a systematic review and meta-analysis of the peer-reviewed medical literature from 1980 to 2023 to learn what effect music training might have on inhibition control.
Outcomes:
The team found eight randomized controlled trials (RCTs) and 14 other longitudinal studies that met search criteria, including:
Meta-analysis of all 22 longitudinal studies with a combined total of 1,734 participants yielded a small-to-medium effect size improvement in inhibitory control. Variation (heterogeneity) in outcomes between individual studies was small, and there was no sign of publication bias. Restricting the analysis to the eight RCTs with a combined total of 641 participants, however, yielded a medium-to-large effect size improvement, with negligible heterogeneity, meaning the outcome was consistent across RCTs.
The Take-Away: The team concluded, “Music training plays a privileged role compared to other activities (sports, visual arts, drama) in improving children’s executive functioning, with a particular effect on inhibition control.” I cannot, however, recommend this as a therapy for ADHD until RCTs show it reduces symptoms of ADHD and/or real world impairments associated with the disorder.
Organic farming aims to protect biodiversity, promote animal welfare, and avoid using pesticides and fertilizers made from petrochemicals. Some pesticides are designed to target insects’ nervous systems but can also affect brain development and health in larger animals, including humans.
Many people believe organic food is healthier than conventionally produced food, which might be true for certain foods and health factors. But does eating organic food during pregnancy impact the chances of a child developing ADHD or autism spectrum disorder (ASD)?
In Norway, researchers can use detailed national health records to study these connections on a population-wide level, thanks to the country’s single-payer healthcare system and national registries.
The Norwegian Mother, Father, and Child Cohort Study (MoBa) invites parents to participate voluntarily and has a 41% participation rate. The study includes:
For this research, a team tracked 40,707 mother-child pairs from children born between 2002 and 2009. They used questionnaires to measure how much organic food mothers consumed during pregnancy. ADHD and ASD symptoms in children were assessed using validated rating scales.
The final analysis included:
The researchers adjusted for factors like maternal age, education, previous pregnancies, BMI before pregnancy, smoking and alcohol use during pregnancy, birth year and season, and the child’s sex.
The researchers concluded that eating organic food during pregnancy has no meaningful effect on the likelihood of a child developing ADHD or ASD. They stated, “The results do not indicate any clinically significant protective or harmful effects of eating organic food during pregnancy on symptoms of ADHD and ASD in the offspring. Based on these findings, we do not recommend any specific advice regarding intake of organic food during pregnancy.”
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