Evaluation of Medication Effects on Academic Performance, Sleep, and Core ADHD Symptoms in ... PDF
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WWeesstteerrnn MMiicchhiiggaann UUnniivveerrssiittyy SScchhoollaarrWWoorrkkss aatt WWMMUU Dissertations Graduate College 5-2010 EEvvaalluuaattiioonn ooff MMeeddiiccaattiioonn EEffffeeccttss oonn AAccaaddeemmiicc PPeerrffoorrmmaannccee,, SSlleeeepp,, aanndd CCoorree AADDHHDD SSyymmppttoommss iinn CChhiillddrreenn Tina K. Head Western Michigan University Follow this and additional works at: https://scholarworks.wmich.edu/dissertations Part of the Child Psychology Commons, Psychiatric and Mental Health Commons, and the Psychiatry and Psychology Commons RReeccoommmmeennddeedd CCiittaattiioonn Head, Tina K., "Evaluation of Medication Effects on Academic Performance, Sleep, and Core ADHD Symptoms in Children" (2010). Dissertations. 565. https://scholarworks.wmich.edu/dissertations/565 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. EVALUATION OF MEDICATION EFFECTS ON ACADEMIC PERFORMANCE, SLEEP, AND CORE ADHD SYMPTOMS IN CHILDREN by Tina K. Head A Dissertation Submitted to the Faculty of The Graduate College in partial fulfillment of the requirements for the Degree of Doctor of Philosophy Department of Psychology Advisor: Galen Alessi, Ph.D. Western Michigan University Kalamazoo, Michigan May 2010 EVALUATION OF MEDICATION EFFECTS ON ACADEMIC PERFORMANCE, SLEEP, AND CORE ADHD SYMPTOMS IN CHILDREN Tina K. Head, Ph.D. Western Michigan University, 2010 Idiosyncratic effects of Vyvanse™ (lisdexamfetamine dimesylate) and placebo were evaluated in a double-blind alternating treatments experimental design in this 4- week study. Direct, objective measures were combined with traditional behavior ratings to provide data sets to assess whether or not the prescribed stimulant medication showed detectable therapeutic effects for a child whose positive response to medication was not obvious via traditional subjective methods. Effects of medication on core ADHD symptoms, academic performance, and sleep in four children ages 10-12 with attention- deficit/hyperactivity disorder. Potential side effects were also measured. Daily measures included parent rating scales, side effects checklist, sleep journal and sleep questionnaires. Weekly data collection of objective measures included a computerized a continuous performance task, 1-minute reading and math tests, and youth self-report instruments. Brief daily school interval data and teacher ratings were collected for one child who was enrolled during the school year. A local pediatrician followed standard clinical practice to provide dose titration and clinical supervision. All children were referred for clarification of effects or dose titration of Vyvanse. Data sets provided copious and sometimes conflicting information between parent ratings and objective measures. The ability to conceptualize medication effects from both parent responses and direct measures enabled the physician to alter the child's course of treatment. Attention and motion data from the M-MAT offered information not otherwise available, allowed a behind-the-scene look at effects of less-obvious processes (e.g. processing speed, patterns of attendant responses, subtle hyperactivity), a process that supports clinical experience and judgment. Daily monitoring of side effects and weekly visits with a physician provided for closer monitoring for potential adverse events. Data plotted over time (parent ratings) or condition (objective measures) painted a different clinical picture for each child. Responses common to all participants included minimal side effects and no discernable effects on sleep. Medication effects were fairly straightforward for two participants, while a more enigmatic picture presented for the final two children. Copyright by Tina K. Head 2010 UMI Number: 3410404 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMT Dissertation Publishing UMI 3410404 Copyright 2010 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ACKNOWLEDGMENTS Acknowledgments and accolades for patience go to my committee for helping me navigate the convoluted river of research that eventually deposited me on the banks of graduation. Tina K. Head ii TABLE OF CONTENTS ACKNOWLEDGMENTS ii LIST OF TABLES xiii LIST OF FIGURES xv CHAPTER I. INTRODUCTION 1 Attention-Deficit/Hyperactivity Disorder 1 Associated Characteristics 1 Prevalence 1 Comorbidity 2 Lifetime of Symptoms 3 Pharmacological Treatment of ADHD Symptoms 3 Stimulants: Rates of use, efficacy 3 MTA Study 4 Stimulant Mechanism of Action 7 Posterior Attention System 8 Anterior Attention System 9 Prefrontal Cortex 9 Dopamine 10 Extended-Release Stimulants 11 Limitations and Adverse Effects of Stimulant Treatment 12 Effects of Stimulant Treatment on Academic Performance 15 iii Table of Contents — Continued CHAPTER Sleep in Children with ADHD 20 Sleep Problems 20 Objective Measures of Sleep 22 Polysomnography 22 Actigraphy 23 Alertness and Arousal 24 Restless Sleep 24 Stimulant Effects on Sleep 25 Stress Experienced by Parents of Children with ADHD 26 Effects of Child Stimulant Treatment on Parental Behavior 28 Medication Effects 29 Clinical Pharmacology of Lisdexamfetamine Dimesylate 30 Adverse Effects of Stimulant Medications 31 Side Effects for Stimulant Medications 33 Abuse Potential 34 Single-Subject Research 35 Single-Subject Analyses as a Clinical Instrument 35 Single-Subject Research Questions 38 Social Validity and Feasibility Questions 39 iv Table of Contents — Continued CHAPTER II. METHODS 40 Participants 40 Characteristics of Participant Population 40 Recruitment of Participants 40 Procedures 41 Protocol Development Background 41 Independent Variables and Experimental Design 41 Medication Blinding Protocol 42 Location of Data Collection 43 Consent, Assent, and Eligibility Sessions 43 Lab Sessions 46 Feedback Session 48 Protection/Safety Procedures 48 Dependent Variables.. 49 Parent Rating Scales 49 Conner's Rating Scales-Revised 49 Eyberg Child Behavior Inventory 50 Side Effects Questionnaire 50 Parent Stress Index 51 Daily Sleep Evaluation Questionnaire and Diary 51 v
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