Tuesday, May 21, 2013
Attention Deficit Hyperactivity Disorder
Anxiety, ADHD, and stimulant effect...
After a little online research, I have learned that the so-called paradoxical effect of stimulants does not exist.
What I don`t understand is why, if this effect does not exist, my child`s anxiety is relieved by the use of Adderall. He tells he feels calmer and less irritable when using this medication. Does the general population without ADHD also experience this effect? Is this effect easily explained?
Many things can relieve anxiety, including reassurance, being taken care of, and placebo effect. The multimodal treatment study of children with ADHD (the MTA) found a significant benefit on anxiety as rated by parents but not as rated by the child. It may be that what parents perceive as child anxiety is actually the restlessness of ADHD or irritability. Specific ratings of irritability improve with a stimulant as rated by both parents and teachers. Anyone can attain improved focus with an individually correct dose of a stimulant, and focusing on a task allows one to forget anxiety and appear calmer. Finally, one may have secondary anxiety about performance when past experience has been failure at tasks that require sustained attention. Then when one is able to perform well, the anxiety is resolved.
Although the effects of a stimulant are not paradoxical in the sense of being specific to ADHD, they do vary from person to person such that only about 2/3 of patients benefit significantly from a given stimulant; but then 2/3 of the remainder benefit from a different stimulant. Ultimately, about 10% of those with ADHD do not benefit from a stimulant and a few even get worse. Many investigators are working on understanding the genetic and other differences among people that contribute to so much individual variation in drug response.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University