Pharmacological and Parenteral Therapies Q 16
A mother calls the clinic to report that her son has recently started medication to treat attention-deficit/hyperactivity disorder (ADHD). The mother fears her son is experiencing side effects of the medicine. Which of the following side effects are typically related to medications used for ADHD? Select all that apply.
A. Poor appetite
B. Insomnia
C. Sleepiness
D. Agitation
E. Decreased attention span
Correct Answer: A, B, D & E
ADHD in children is frequently treated with CNS stimulant medications, which increase focus and improve concentration. Children often experience insomnia, agitation, and decreased appetite. ADHD treatment commonly uses a combination of dextroamphetamine and levoamphetamine, as well as pure dextroamphetamine and lisdexamfetamine.
Option A: Loss of appetite is among the most common side effects of stimulants for ADHD. Across studies, approximately 20% of patients with ADHD who were treated with stimulants reported a loss of appetite. Weight loss is also quite common, as are digestive problems.
Option B: Insomnia or delayed SOL greater than 30 minutes is one of the most common adverse events associated with stimulant medications. This should be distinguished from bedtime resistance, which is when the child refuses to go to bed. Insomnia is a frequent side effect of all stimulant medications, based on parent report or side effects scales completed side effects scales by parents.
Option C: Sleepiness is not a side effect of stimulants. Efron et al. compared twice-daily, immediate-release MPH and dextroamphetamine in 125 ADHD youth in a crossover study. Using the parent-completed, Barkley Side Effect Scale, dextroamphetamine, but not MPH, was associated with higher ratings of severe insomnia relative to baseline.
Option D: The immediate psychological effects of stimulant administration include a heightened sense of well-being, euphoria, excitement, heightened alertness, and increases in motor activity. Stimulants also reduce food intake, reduce sleep time, and may increase socialization activities. Stimulants may also enhance performance of certain types of psychomotor tasks. High doses may result in restlessness and agitation, and excessive doses may produce stereotypic behaviors (repetitive and automatic acts).
Option E: In people with ADHD, stimulants produce a paradoxical calming effect. This results in a reduction in hyperactivity and an improvement in attention span in many patients.