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  • Print publication year: 2014
  • Online publication date: January 2018

6 - Pharmacology for attention-deficit hyperactivity disorder, Tourette syndrome and autism spectrum disorder

    • By David Coghill, Reader in Child and Adolescent Psychiatry, Division of Neuroscience, Medical Research Institute, University of Dundee, UK, Eugenia Sinita, Head of Research and Development & Consultant in Adult Psychiatry, Department of Research and Development, National Centre of Mental Health, Clinical Psychiatric Hospital, Chisinau, Republic of Moldova
  • Edited by Sarah Huline-Dickens
  • Publisher: Royal College of Psychiatrists
  • pp 74-93

Summary

Historically, paediatric pharmacology in general and paediatric psychopharmacology in particular have received much less research interest and funding than their adult counterparts. As a consequence, relatively few drugs are licensed for use in child and adolescent populations.

One of the greatest obstacles to evidence-based clinical practice is the time taken to translate research findings into treatment recommendations that are effective and usable in a general out-patient setting. Unfortunately, there are also several clear examples of changes in clinical practice outstripping the available evidence. In this chapter and the next, we describe some of the recent advances and current controversies in child and adolescent psychopharmacology. With the exception of attentiondeficit hyperactivity disorder (ADHD) in this chapter, they are organised by disorder rather than drug class. The section on ADHD is organised by class of drug as this best reflects the ways in which clinical decisions are made about individual patients.

Attention-deficit hyperactivity disorder

There has been more research into the use of medication for the treatment of ADHD than any other area of child and adolescent psychopharmacology, and most clinicians are now comfortable with the idea of using medications as a part of their treatment of ADHD. There have, however, been key advances in knowledge and several new treatment options introduced over the past few years. In addition, more basic science studies have helped clarify the relationship between the pharmacokinetics and misuse potential of stimulant medications (Volkow et al, 1995) and raised interesting questions about the relationship between core ADHD symptoms and cognition (Coghill et al, 2007). Clinical studies have started to address the similarities and differences between different medications as well as their effect on non-core aspects of functioning and quality of life (Coghill, 2010). In view of the quantity of trial data and the fact that most clinicians are used to working with these drugs, we focus here on newer medications and current controversies.

Evidence-based treatment and the MTA study

The end of 1999 saw the publication of the primary findings from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) multisite study, which was funded by the US National Institute of Mental Health. These findings, and the ensuing commentaries and criticisms of the study, marked a milestone in child and adolescent psychiatry research.