Beneficios y riesgos de la discontinuación del tratamiento durante las vacaciones de verano en niños de edad escolar con trastorno por déficit de atención con hiperactividad

  1. Mariano Velilla Picazo 1
  2. Marta García Giral 2
  3. Pedro Martínez Jiménez 3
  4. Elena Zubillaga Marbán 3
  5. Iván Bernardo Fernández 3
  1. 1 Sección de Psiquiatría Infanto-Juvenil, Hospital Clí-nico Universitario Lozano Blesa, Zaragoza
  2. 2 Servicio de Psiquiatría Infanto-Juvenil del Hospital Clínic, Barcelona
  3. 3 Departamento Médico, Janssen-Cilag, Madrid
Revista:
Revista de Psiquiatría Infanto-Juvenil

ISSN: 2660-7271 1130-9512

Año de publicación: 2012

Volumen: 29

Número: 3

Páginas: 40-51

Tipo: Artículo

Otras publicaciones en: Revista de Psiquiatría Infanto-Juvenil

Resumen

En este estudio retrospectivo se evaluaron los benefi-cios y riesgos de la discontinuación del tratamiento far-macológico durante las vacaciones de verano (≥ 30 días) en 802 niños con trastorno por déficit de atención con hiperactividad (TDAH). En 440 de los pacientes (55%) se retiró el tratamiento durante el verano. El riesgo de mala adherencia (≤ 85%) fue más alto en los pacientes con vacaciones de tratamiento (odds ratio: 5,82). Com-parados con los pacientes que recibieron tratamiento, los pacientes que no lo recibieron durante el verano tenían cuatro veces mayor probabilidad de empeorar o de no mejorar en la Escala de Impresión Clínica Global de Gra-vedad del TDAH (ICG-G-TDAH) (odds ratio 4,20, P < 0,0001). Además, los pacientes del grupo de vacaciones de tratamiento tenían tres veces mayor probabilidad de tener una puntuación > 1,67 en la escala de valoración SNAP-IV (odds ratio 2,60, P < 0,0001), y era más proba-ble que sufrieran lesiones accidentales (odds ratio 1,49, P < 0,01), con un mayor número de lesiones por paciente (1,24 [DE = 3,67] frente a 0,8 [DE = 2,9], P = 0,05). Este análisis sugiere que las vacaciones del tratamiento en ni-ños con TDAH pueden asociarse con resultados clínicos adversos.

Referencias bibliográficas

  • American Academy of Pediatrics, Committee on Quality Improvement and Subcommittee on Attention- Deficit/Hyperactivity Disorder. Clinical Practice Guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033-1044
  • American Psychiatric Association. Diagnostic and Statistical Manual of mental Disorders: DSM-IVTR. Washington, DC: American Psychiatric Association; 2007.
  • Brehaut JC, Miller A, Raina P, McGrail KM. Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics 2003; 111: 262−269
  • Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, Pierce K, Wolraich ML and the Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder. Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics 2005; 115: e749−e757
  • Brown RT, Freeman WS, Perrin JM, Stein MT, Amler RW, Feldman HM, Pierce K, Wolraich ML. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics 2001; 107: E43
  • Daughton JM, Kratochvil CJ. Review of ADHD pharmacotherapies: advantages, disadvantages, and clinical pearls. J Am Acad Child Adolesc Psychiatry 2009; 48: 240−249
  • DuPaul GJ, Power TJ, Anastopoulos AD, Reid R, McGoey KE, Ikeda MJ. Teacher ratings on attention deficit hyperactivity disorder symptoms: factor structure and normative data. Psychol Assess 1997; 9: 436−444
  • Faraone SV, Spencer TJ, Montano CB, Biederman J. Attention-deficit/hyperactivity disorder in adults: a survey of current practice in psychiatry and primary care. Arch Intern Med 2004; 164: 1221−1226
  • Gau SS, Chen SJ, Chou WJ, Cheng H, Tang CS, Chang HL, Tzang RF, Wu YY, Huang YF, Chou MC, Liang HY, Hsu YC, Lu HH, Huang YS. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention- deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry 2008; 69: 131−140
  • Guy W. ECDEU Assessment Manual for Psychopharmacology, revised ed. Washington, DC: US Department of Health, Education, and Welfare; 1976
  • Hazell P. Pharmacological management of attention- deficit hyperactivity disorder in adolescence: special considerations. CNS Drugs 2007; 21: 37−46
  • Hugtenburg JG, Griekspoor JE, De Boer I, Heerdink ER, Tso YH, Egberts AC. Methylphenidate: use in daily practice. Pharm World Sci 2005; 27: 197−201
  • Karande S. Attention deficit hyperactivity disorder-- a review for family physicians. Indian J Med Sci 2005; 59: 546−555
  • Pastor PN, Reuben CA. Identified attention-deficit/ hyperactivity disorder and medically attended, nonfatal injuries: US school-age children, 1997- 2002. Ambul Pediatr 2006; 6: 38−44
  • Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2000; 9: 525−540
  • Servera M, Cardo E. ADHD Rating Scale-IV en una muestra escolar española: datos normativos y consistencia interna para maestros, padres y madres. Rev Neurol 2007; 45: 393−399
  • Spencer TJ, Faraone SV, Biederman J, Lerner M, Cooper KM, Zimmerman B. Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Child Adolesc Psychiatry 2006; 45: 527−537
  • Svanborg P, Thernlund G, Gustafsson PA, Hägglöf B, Schacht A, Kadesjö B. Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in Swedish children and adolescents. Eur Child Adolesc Psychiatry 2009; 18: 725−735
  • Swanson J. Compliance with stimulants for attention- deficit/hyperactivity disorder: Issues and approaches for improvement. CNS Drugs 2003; 17: 117−131
  • The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder. Arch Gen Psychiatry 1999; 56: 1073−1086.
  • Thiruchelvam D, Charach A, Schachar RJ. Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. J Am Acad Child Adolesc Psychiatry 2001; 40: 922−928
  • Vitiello B. Understanding the risk of using medications for ADHD with respect to physical growth and cardiovascular function. Child Adolesc Psychiatr Clin N Am 2008; 17: 459−471
  • Wernicke JF, Adler L, Spencer T, West SA, Allen AJ, Heiligenstein J, Milton D, Ruff D, Brown WJ, Kelsey D, Michelson D. Changes in symptoms and adverse events after discontinuation of atomoxetine in children and adults with attention deficit/hyperactivity disorder: a prospective, placebo-controlled assessment. J Clin Pharmacol 2004; 24: 30−35.
  • Wolraich M, Hannah JN, Baumgaertel A, Pinnock TY, Feurer I. Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a coun ty-wide sample. J Dev Behav Pediatr 1998; 19: 162−168
  • Wolraich ML, Wibbelsman CJ, Brown TE, Evans SW, Gotlieb EM, Knight JR, Ross EC, Shubiner HH, Wender EH, Wilens T. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics 2005; 115: 1734−1746.