WASHINGTON -- Kids' ADHD symptoms aren't well controlled in the morning, even when they take their early-morning dose of stimulants, researchers reported here.
In a survey of 201 parents and caregivers, 74% of children were easily distracted, 73% did not listen to caregivers, and 66% were unable to sustain attention to tasks during the early morning, even when they took their stimulants as directed, according to , chief medical officer of Ironshore Pharmaceuticals & Development, and a volunteer faculty member at the University of Cincinnati. Sallee was a professor of psychiatry at the university when the research was conducted.
He and colleagues reported the findings at the .
A sizeable portion of participants (42%) said the relationship with their child was negatively affected by these symptoms and the early morning routine resulted in a significant negative emotional burden on caregivers, with 41% reporting feeling often overwhelmed and exhausted, 37% saying they raise their voice more than they want, and 30% saying they feel constantly stressed, the researchers reported.
"There's quite a toll on parents and their self-perception of their parenting skills and their relationship with their child in that early morning period, despite the fact that they're 'adequately controlled' with medications," Sallee told 51˶. "Clearly there is an issue and an evening dose/morning available medication might help this early morning period."
For the study, a marketing research firm identified 201 parents and caregivers of children and adolescents with ADHD. All were responsible for a child between the ages of 6 and 17 who had been diagnosed with ADHD, were taking a stimulant medication as their primary ADHD medication, and had been on a stable dose of medication for at least 3 months prior to the survey.
Parents were asked to rate each of six daily time periods (Likert Severity Scale 1-10) when they saw the severity of any inadequately controlled ADHD symptoms: early morning routine, during the school day, afternoon homework time, dinner time, evening homework time, and bed time.
Caregivers who identified inadequately controlled symptoms during the early morning were asked additional questions about that time period. Early morning was defined as from the moment the child wakes until the time he or she leaves for school. The survey included severity ratings of morning functional activities such as getting out of bed, getting dressed, brushing teeth, sitting down for breakfast, and getting ready to leave the household.
Inadequately controlled ADHD symptoms were rated by parents and caregivers as most severe during the early morning routine (6.45 on the Likert) and the evening homework time (6.46).
The average level of functional impairment due to ADHD during early morning was rated as 6.09 on a 10-point scale, with a score of 10 indicating severe impairment. The majority of caregivers reported early morning ADHD symptoms (74%) and impairment of early morning routine (76%) as moderate to severe.
Being easily distracted, not listening, and being unable to sustain attention on tasks were the ADHD symptoms that appeared most frequently during the early morning routine, followed by difficulty organizing tasks (60%), not following instructions (56%) and being forgetful (53%), the researchers reported.
The unwanted behaviors that appeared most frequently during the early morning routine were being impulsive/acting without thinking (49%), failing to finish things (49%), and lacking time awareness/taking too long to complete tasks (44%).
A majority of respondents (79%) reported having previously discussed their child's early morning impairments with their primary ADHD physician, and 48% reported waking up early in order to administer ADHD medication to their child/adolescent in an attempt to help mitigate early morning ADHD symptoms.
In follow-up studies, Sallee said he plans to look at routines of children without ADHD and those with ADHD who are not well controlled as a comparison.
"My suspicion is it won't be very much different between treated and untreated children with ADHD with regard to early morning and evening homework times, because these are the times of day when stimulants really fall down," Sallee said.
Disclosures
The study was supported by AssureRx (a personalized medicine company) and the National Institute of Mental Health.
Sallee reported relationships with Ironshore, Otsuka Research and Development, Astra Zeneca, Supernus, P2D Bioscience, Pfizer, and Impax Labs.
Primary Source
American Professional Society of ADHD and Related Disorders
Sallee F "Early morning functioning in stimulant-treated children and adolescents with attention-deficit hyperactivity disorder and its impact on caregivers" APSARD 2016; Poster 20.