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Sunday, November 06, 2005


ADHD Medication and children's emotional expression

New studies quantify effects of ADHD medication on children's
emotional expression


Common reasons behind a reluctance to employ drug therapy for
attention deficit hyperactivity disorder (ADHD) are that children will
be subjected to a 'chemical cosh' and 'turned into zombies' on one
hand, or made more excitable on the other. There are also concerns
that therapy might depress mood and provoke suicidal ideation. Now a
new 29-item assessment tool has been validated that allows parents and
care staff to study and quantify scientifically any effect, positive
or negative, that medication has on a child's emotional expression and
to monitor change over time.

The Expression and Emotion Scale for Children (EESC) can be used to
measure a child's usual level of emotional expression before
treatment. Any effects of medication on the child's emotional state
such as flattening or blunting of affect, emotional lability or
positive expression effects, can then be determined by comparison of
pre and post-treatment scores. Similarly, the scale can be used in
children stabilised on one medication to assess the effects of
switching to a new drug or adding in a further medication. And the
scale can be used to compare groups of children on different

Results of two studies involving the EESC were presented this month in
Toronto, Canada, during the annual meeting of the American Academy of
Child and Adolescent Psychiatry (AACAP). One compared how different
medications (atomoxetine (Stattera) or stimulants ) affected emotional
expression in children with a diagnosis of ADHD. The other was a
double-blind randomised placebo-controlled clinical trial comparing
the effects of atomoxetine and placebo on emotional expression in
children with ADHD aged between 6 and 12 years.

In the first study involving 179 children with a diagnosis of ADHD
(105 receiving stimulants and 74 receiving atomoxetine), parents
completed the EESC for the child's current and most recent prior
medications. In the second study parents of 208 children
participating, completed the EESC at baseline and at the end of a
six-week course of treatment.


In Study 1 there were no statistically significant differences in EESC
scores between treatment groups regarding their current medication.
For children who had switched from a stimulant medication to either a
different stimulant or to atomoxetine, there was a statistically
significant improvement in emotional expression. Patients switched to
atomoxetine showed a greater mean change in emotional expression than
those switched to another stimulant (p=0.008) with treatment
differences most apparent in assessment of 'blunting' or 'flattening'
of affect (p=0.001). Children who switched medications because of
adverse events had significantly higher EESC scores than those
switching because of a lack of efficacy.

In the double-blind trial both placebo-treated and atomoxetine-treated
patients showed statistically significant improvements in emotional
expression. Treatment differences were not significant for either
total scores or any subscale scores.

The studies' authors suggest that where there are problems regarding
emotional expression, this may be improved by selecting an alternative
medication. They added: "Patients who switched from stimulant
treatments improved more by switching to atomoxetine than to another
stimulant." The double-blind trial suggests that atomoxetine did not
significantly influence emotional expression in either a positive or
negative direction, they concluded.

Ref: AACAP 2005. Kratchovil CJ, Faries DE, Vaughan BS, et al.
Emotional expression during ADHD treatment: initial assessment of
treatment effects.

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