Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders
Abstract Background Appetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorde...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-12-01
|
| Series: | Journal of Eating Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40337-023-00954-1 |
| _version_ | 1797377240430804992 |
|---|---|
| author | Daphna M. Finn Jessie E. Menzel Emily Gray Terry Schwartz |
| author_facet | Daphna M. Finn Jessie E. Menzel Emily Gray Terry Schwartz |
| author_sort | Daphna M. Finn |
| collection | DOAJ |
| description | Abstract Background Appetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment. Case presentations Consecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case. Conclusions These findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed. |
| first_indexed | 2024-03-08T19:50:51Z |
| format | Article |
| id | doaj.art-fca855cd2dd24a8d957a702abfb658ef |
| institution | Directory Open Access Journal |
| issn | 2050-2974 |
| language | English |
| last_indexed | 2024-03-08T19:50:51Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj.art-fca855cd2dd24a8d957a702abfb658ef2023-12-24T12:07:33ZengBMCJournal of Eating Disorders2050-29742023-12-0111111210.1186/s40337-023-00954-1Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disordersDaphna M. Finn0Jessie E. Menzel1Emily Gray2Terry Schwartz3UCSD Eating Disorder Center for Treatment and Research, University of CaliforniaEquip HealthOhana at the Community Hospital of the Monterey PeninsulaUCSD Eating Disorder Center for Treatment and Research, University of CaliforniaAbstract Background Appetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment. Case presentations Consecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case. Conclusions These findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed.https://doi.org/10.1186/s40337-023-00954-1Attention deficit hyperactivity disorderAvoidant restrictive food intake disorderStimulant medicationChildrenCase series |
| spellingShingle | Daphna M. Finn Jessie E. Menzel Emily Gray Terry Schwartz Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders Journal of Eating Disorders Attention deficit hyperactivity disorder Avoidant restrictive food intake disorder Stimulant medication Children Case series |
| title | Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| title_full | Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| title_fullStr | Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| title_full_unstemmed | Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| title_short | Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| title_sort | pharmacotherapy for attention deficit hyperactivity disorder in youth with avoidant restrictive food intake disorder a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders |
| topic | Attention deficit hyperactivity disorder Avoidant restrictive food intake disorder Stimulant medication Children Case series |
| url | https://doi.org/10.1186/s40337-023-00954-1 |
| work_keys_str_mv | AT daphnamfinn pharmacotherapyforattentiondeficithyperactivitydisorderinyouthwithavoidantrestrictivefoodintakedisorderacaseseriesofpatientsprescribedstimulantmedicationinapartialhospitalizationprogramforeatingdisorders AT jessieemenzel pharmacotherapyforattentiondeficithyperactivitydisorderinyouthwithavoidantrestrictivefoodintakedisorderacaseseriesofpatientsprescribedstimulantmedicationinapartialhospitalizationprogramforeatingdisorders AT emilygray pharmacotherapyforattentiondeficithyperactivitydisorderinyouthwithavoidantrestrictivefoodintakedisorderacaseseriesofpatientsprescribedstimulantmedicationinapartialhospitalizationprogramforeatingdisorders AT terryschwartz pharmacotherapyforattentiondeficithyperactivitydisorderinyouthwithavoidantrestrictivefoodintakedisorderacaseseriesofpatientsprescribedstimulantmedicationinapartialhospitalizationprogramforeatingdisorders |