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 medications.


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.


Results


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.


Olwen Glynn Owen