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Published on: June 12, 2020
Pre-school attention deficit hyperactivity disorder: 12 weeks prospective study
Sivapriya Vaidyanathan1, Tess Maria Rajan2, Venkatesh Chandrasekaran3
1Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
This study investigated Attention Deficit Hyperactivity Disorder (ADHD) interventions in Indian preschoolers, finding all treatments improved symptoms. Medication choice was influenced by cost and availability, highlighting the need for accessible ADHD pharmacotherapy in India.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Limited research exists on behavioral training and pharmacotherapy for Attention Deficit Hyperactivity Disorder (ADHD) in Indian preschool children.
- Effective, safe, and affordable early interventions are crucial due to potential adverse long-term outcomes.
- This study focuses on the short-term outcomes, safety, and tolerability of interventions for preschool ADHD in India.
Purpose of the Study:
- To evaluate the short-term outcomes of interventions for preschool ADHD in India.
- To assess the safety and tolerability of commonly prescribed medications.
- To inform the development of accessible and affordable early interventions.
Main Methods:
- Prospective study of children aged 2.5-6 years diagnosed with ADHD.
- Assessment using Conner's abbreviated rating scale and Clinical Global Impression-Severity scale.
- Exclusion of children with Autism Spectrum Disorder or social quotient below 50; statistical analysis included descriptive statistics and Repeated Measures ANOVA.
Main Results:
- Out of 56 children, 33.93% received behavioral interventions alone, and 66.07% received a combination of medication and behavioral intervention.
- Clonidine was the most prescribed drug (44.64%), followed by risperidone (28.7%). Sedation was noted in 24% of children on clonidine.
- All children demonstrated significant improvement at 12 weeks (p < 0.001), regardless of the intervention type.
Conclusions:
- Intervention choices in India are primarily driven by medication affordability and availability.
- There is a critical need for structured, parent-focused behavioral training programs suitable for low-resource settings.
- Anti-ADHD medications should be integrated into national health programs to prevent over-prescription of antipsychotics in preschool ADHD.
Introduction:
Extant literature lack studies on behavioural training or pharmacotherapy in Indian preschool children. With adverse long term outcomes, effective, safe and affordable early interventions for ADHD are a priority. Aim of this prospective study is to report on short term outcome of preschool ADHD with specific focus on safety and tolerability of medications.
Methods:
Children with ADHD aged 2.5-6 years were assessed for severity and adverse events at baseline and follow-up using Conner's abbreviated rating scale and Clinical Global Impression-Severity scale. Children with Autism spectrum disorder and those with social quotient less than 50 were excluded. Statistical Analysis included descriptive statistics and Repeated measures ANOVA.
Results:
Of 56 children recruited, 33.93 %(N = 19) were on behavioural interventions alone, 66.07 %(N = 37) were on a combination of medication and behavioural intervention. All children received treatment according to standard care. The most prescribed drug was clonidine (44.64%), then risperidone (28.7%), methylphenidate (10.7%) and atomoxetine (10.7%). Medication choice was determined by affordability, availability and comorbidity profile. Sedation occurred in 24 % of children on clonidine. Atomoxetine was not well tolerated in 2 children. Methylphenidate was well tolerated. Irrespective of medication choice, all children showed significant improvement at 12 weeks (p < 0.001).
Conclusions:
Choice of interventions is largely determined by availability and affordability. There is a need for structured parent behavioural training program deliverable in low resource setting. Anti-ADHD medications should be made available under the NMHP, RBSK program and all government settings in India, to address over-prescription of antipsychotics in preschool ADHD.
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