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Attention-deficit/hyperactive disorder (ADHD) is a common neurodevelopmental disorder among children. According to Hervas et al. (2014), the global prevalence rate of this condition in individuals under the age of 18 years is estimated at 5.3 percent. These numbers underline the need to have comprehensive medication regimes to ensure that the affected children are treated effectively for improved quality of life. The commonly used drugs to treat ADHD in children are stimulants, especially amphetamine-based medications and methylphenidate, but their effectiveness might be affected by several factors including inadequate response and severe side effects. Therefore, non-stimulant medications have been developed as an alternative to stimulants for individuals not getting the desired efficacy from stimulant-based drugs. However, these drugs also have some side effects, which hinder their efficacy. This paper discusses two empirical articles investigating the use of guanfacine extended-release (GXR) (a non-stimulant medication) to treat ADHD in children.
Hervas et al. (2014)
The objective of this study was to assess the efficacy, in terms of symptoms and function, and safety of “once-daily dose-optimized GXR compared with placebo in the treatment of children and adolescents aged 6–17 years with a diagnosis of ADHD as measured by the ADHD Rating Scale version IV (ADHD-RS-IV) in Europe, the USA and Canada” (Hervas et al., 2014, p. 1862). The study sample included children and adolescents (both male and female) aged between 6 and 17 years randomly selected for this study (n=114 for the intervention group and n=111 for the control group). For a participant to qualify, he or she had to have been diagnosed with ADHD of at least moderate severity.
The selected participants were required to take GXR medication once every morning for four weeks, for those aged under 13 years, and for seven weeks, for those aged between 13 and 17 years, as part of double-blind dose optimization. A six-week maintenance period followed, whereby the participants continued taking the medication, and then a 2-week tapering period. A follow-up visit was conducted one week after the last dose. The results showed that GXR has robust efficacy by improving the core symptoms of ADHD among the participants. The researchers recommended GXR up to 7 mg (0.05-0.12 mg/kg/day) as an effective dosage for treating ADHD among children and adolescents. The study was limited in its scope of population because individuals with co-morbid conditions were excluded from the study. However, in the real world, people with ADHD have co-morbid conditions, thus these results may not be generalizable in other population set-ups.
Stein et al. (2015)
The objective of this study was to “determine whether once-daily GXR (1–4 mg/day) monotherapy, administered in the morning or evening in children aged 6–12 years, impacts overall functional impairment, as measured by the WFIRS-P” (Stein et al., 2015, p. 955). Participants were randomly selected children aged between 6 years and 12 years with ADHD diagnosis. For a participant to be included in the study he or she was required to have “ADHD-RS-IV Total score ≥ 28 and a CGI–Severity of Illness score ≥ 4 at baseline” (Stein et al., 2015, p. 955).
One group of participants (n=107) was given GXR in the morning and a placebo in the evening, while the other one (n=111) was given a placebo in the morning and GXR in the evening. The control group (n=109) was given a placebo in the morning and the evening. The dose optimization period took 5 weeks followed by 3 weeks of maintenance and 9 days of tapering. The results showed that GXR alleviates symptoms of ADHD significantly regardless of the time of administration. This study had several limitations – first, the ADHD symptoms measures were based on parents’ reports, hence subject to bias. Second, the participants had varying ADHD severity ranging from moderate to severe, which might affect the generalizability of the results in other populations.
Advice to Parents and Professionals
These two studies have shown the efficacy of using GXR as an alternative non-stimulant medication for ADHD in children and teenagers. Therefore, professionals should be comfortable prescribing this drug, especially for children with unfavorable outcomes when treated with stimulant-based drugs. Parents should know that the drug works well despite the time of administration (whether in the morning or the evening). However, these studies did not highlight possible side effects associated with GXR, thus professionals and parents should consult other sources to understand the issue comprehensively for their children’s safety.
Conclusion
The global prevalence of ADHD among children is high and it keeps increasing with changing human lifestyles that contribute to childhood developmental disorders. The commonly used medications for children with ADHD are stimulant-based. However, some children experience adverse effects after taking these drugs, hence the need for an alternative. GXR is a non-stimulant drug that can be used in the treatment of this condition. The two articles used in this study have shown that GXR has high efficacy in alleviating ADHD symptoms among children and teenagers. Therefore, professionals should be comfortable when prescribing GXR to their patients. However, parents and clinicians should be careful to understand the side effects of these drugs.
References
Hervas, A., Huss, M., Johnson, M., McNicholas, F., van Stralen, J., Sreckovic, S., … Robertson, B. (2014). Efficacy and safety of extended-release guanfacine hydrochloride in children and adolescents with attention-deficit/hyperactivity disorder: A randomized, controlled, Phase III trial. European Neuropsychopharmacology, 24(12), 1861-1872. Web.
Stein, M. A., Sikirica, V., Weiss, M. D., Robertson, B., Lyne, A., & Newcorn, J. H. (2015). Does guanfacine extended-release impact functional impairment in children with attention-deficit/hyperactivity disorder? Results from a randomized controlled trial. CNS Drugs, 29(11), 953-962. Web.
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