Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE)

• Changes in growth [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • Proportion height < 2nd centile, 0.4th centile (according to best available country specific norms)
  • Weight (z-scores according to best available country specific norms)
  • Proportion weight < 2nd centile, 0.4th centile (according to best available country specific norms)
  • BMI (z-scores according to best available country specific norms)
  • Proportion BMI < 2nd centile, 0.4th centile (according to best available country specific norms)
  • Pubertal stage (Tanner stage)
  • Bone age (selected sample from Italian cohort)
• Changes to the cardiovascular system [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • Heart rate
  • Proportion heart rate > 120 bpm
  • Diastolic blood pressure
  • Proportion diastolic blood pressure > 90 mm/hg
  • Systolic blood pressure
  • Proportion systolic blood pressure > 95th centile
• Effects on Psychiatric state [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • SNAP-IV mean scores
  • Clinical Global Impressions score(CGI; severity, improvement)
  • Children's Global Assessment Scale score (CGAS)
  • Strengths and Difficulties questionnaire (SDQ)
  • Mood and Feelings Scale (parent and child ratings)
  • Developmental and Wellbeing Assessment
  • DAWBA Rapidly changing mood section (proportion > cut off)
  • DAWBA tics section (proportion > cut off)
  • Columbia - Suicide Severity Rating Scale
  • Psychosis-like symptoms
  • Substance Use Questionnaire
• Changes in neurological state [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  • Child's Sleep Habits Questionnaire (CSHQ; total score and subscale scores, proportion > cut offs)
  • Abnormal Involuntary Movement Scale (AIMS; total score, Q8 score)

The aim of the ADDUCE project is to investigate any adverse effects of methylphenidate (trade name ritalin) on growth, neurological system, psychiatric states and cardiovascular system over a two year period in children and adults.

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, affecting approximately 5% children in Europe. Methylphenidate (MPH, trade name ritalin) is the most-commonly prescribed medication for ADHD children; it is also increasingly used in ADHD adults. In 2007, the European Commission requested a referral to the Committee for Medicinal Products for Human Use (CHMP) under Article 31 of Directive 2001/83/EC, as amended, for MPH because of safety concerns. The CHMP concluded that study of the long-term effects of MPH on growth, sexual development, neurological system, psychiatric states and cardiovascular system is needed. In response to the CHMP s concerns, the ADDUCE (Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects) research team has been formed by a consortium of experts in the fields of ADHD, drug safety, neuro-psychopharmacology and cardiovascular research.

The ADDUCE project aims to investigate the long-term adverse effects of MPH on growth, neurological system, psychiatric states and cardiovascular system in children and adults.

Furthermore the ADDUCE team will develop research tools for the evaluation of adverse effects of MPH on cognition and motivation.

Attention Deficit Disorder clinic

• ADHD medicated
  Children aged 6-17 years with clinical diagnosis of ADHD and not previously treated with methylphenidate who have an agreement with their physician to begin treatment with methylphenidate.
• ADHD unmedicated controls
  Children aged between 6-17 years with clinical diagnosis and not previously treated with methylphenidate who have an agreement with their physician NOT to treat with methylphenidate
• Non-ADHD siblings controls
  Siblings of a child in either the ADHD-medicated or ADHD-unmedicated control group who are 6-17 years old and living in the same family as the child with ADHD. These children must have a low rating (<1.5) on the clinician-rated Swanson Nolan and Pelham IV Rating scale (SNAP IV) and not be medicated with with either dexamfetamine or atomoxetine.

Inclusion Criteria:

ADHD-treated group:

• Clinical diagnosis of ADHD
• Aged between 6 and 17 years.
• Not previously treated with methylphenidate
• Agreement between clinician, patient and their family to commence on methylphenidate (baseline measures will be taken before first prescription of methylphenidate is issued).
• Any co-medication other than dexamfetamine or atomoxetine will be allowed.
• All psychiatric and physical illness comorbidities will be allowed

ADHD-unmedicated controls:

• Clinical diagnosis of ADHD not previously treated with medication.
• Aged between 6 and 17 years.
• Agreement between clinician, patient and their family not to treat with methylphenidate.
• Any medication other than dexamfetamine or atomoxetine will be allowed.
• All comorbidities will be allowed.

Non-ADHD siblings controls:

• Sibling of a member of the two ADHD groups (medicated or unmedicated).
• Living in the same family as the proband.
• Aged between 6 and 17 years.
• Mean total clinician rated Swanson Nolan and Pelham IV Rating scale (SNAP IV) score (ADHD items) < 1.5
• Parent rated Strengths and Difficulties Questionnaire (SDQ) Hyperactivity Score within normal range for country (e.g. < 6 for UK)
• Any current medication other than dexamfetamine or atomoxetine will be allowed.
• Any other mental health or physical illness diagnoses will be allowed.

Exclusion Criteria:

All Groups:

• Current or past treatment with dexamfetamine or atomoxetine.

Un-medicated ADHD controls:

• Previous or current treatment with methylphenidate.

Non-ADHD Siblings controls:

• Previous or current treatment with methylphenidate.
• Clinician rated SNAP score ≥ 1.5. Parent rated SDQ Hyperactivity Score in Borderline or Abnormal range.
• Living in a different home to index case.

• Zentralinstitut fuer Seelische Gesundheit
• Universita degli Studi di Cagliari
• Vadaskert Child and Adolescent Psychiatry Clinic