Atomoxetine vs. Methylphenidate
Once-daily atomoxetine is just as effective as twice-daily methylphenidate in reducing symptoms of attention-deficit hyperactivity disorder in children, Dr. Yufeng Wang of Beijing Medical University reported in a poster at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.
However, the study, funded by Eli Lilly & Co., concluded that treatment-emergent adverse events, including anorexia, nausea, somnolence, dizziness, and vomiting, were significantly more common among those taking atomoxetine.
The study involved a total of 330 children aged 6–16 years from China, Mexico, and Korea who were randomized to either once-daily atomoxetine (0.8–1.8 mg/kg per day) or twice-daily methylphenidate (0.2–0.5 mg/kg per day).
Responders were those who experienced at least a 40% reduction from baseline symptom scores as measured by the parents' ADHD Rating Scale.
Response rates were 77% for atomoxetine and 81% for methylphenidate–not a statistically significant difference.
The total score changes on the parents' ADHD Rating Scale were similar for both atomoxetine and methylphenidate (38 vs. 37, respectively), as were the score changes on the inattention and hyperactivity subscales. Changes on the Connors Parent Rating Scale and the Clinical Global Impressions scale also were similar for both groups.
Sleep Disturbance and Headache
Twenty percent of children with episodic headaches have at least one symptom of sleep disturbance, according to a poster presented by Dr. Lenora M. Lehwald at a conference on sleep disorders in infancy and childhood, sponsored by the Annenberg Center for Health Sciences.
The incidence of sleep disturbance rises to 67% among children with chronic daily headache. These findings suggest that sleep disturbance should be considered in any child with headache, wrote Dr. Lehwald and her colleagues at the Mayo Clinic, Rochester, Minn.
In several cases, the investigators noted a close temporal relationship between the appearance of a sleep difficulty and the transformation of episodic migraine to chronic daily headache. This suggests that attention to sleep hygiene and early identification of sleep difficulties in children with episodic migraine may prevent that transformation.
The study involved a comprehensive chart review of 200 consecutive patients from a pediatric neurology practice who were diagnosed with chronic daily headache, migraine with aura, or migraine without aura.
The average age of the chronic daily headache patients was 14.6 years, and that of the migraine patients was 11.8 years, Dr. Lehwald reported.
After the investigators controlled for age and gender, patients with chronic daily headache were 6.4-fold more likely to have a sleep disturbance than were patients with episodic migraine.
This odds ratio was statistically significant.
Impact of Parents on Teens
Parents with social anxiety and depressive symptoms are more likely to have adolescents with social phobia diagnoses, according to data on 471 adolescents and their parents reported by psychology graduate student Emily R. Anderson and her colleagues at the University of Nebraska, Lincoln.
Parents with high levels of social anxiety may overreport anxiety in their adolescents, although the children themselves may not endorse such symptoms, the investigators wrote in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.
The study covered 223 boys and 248 girls aged 13–17 years living in the Midwest; 90% were white.
Investigators assessed the adolescents using several measures: the Brief Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Phobia and Anxiety Inventory, the Beck Depression Inventory, and the Anxiety Disorders Interview Schedule for DSM-IV.
The young people were then subdivided into three groups based on how they were diagnosed for social phobia: parental interviews, adolescent interviews, and both parent and adolescent interviews.
About 50 adolescents in the study met criteria for social phobia on each diagnostic scale based on parental interviews and parental/adolescent interviews, and about 25 met these criteria based on adolescent interviews only, according to Ms. Anderson.
Parents whose adolescents were diagnosed with social phobia based only on parent interviews, or on both parent and adolescent interviews, scored significantly higher on three scales, compared with parents whose adolescents were not diagnosed with social phobia or diagnosed based on adolescent interviews alone, the investigators found.