Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
For children with ADHD who do not respond to stimulants (10 to
30 percent) or cannot tolerate the side effects, there are other useful
medications. The antidepressant bupropion has been found to be superior to
placebo, although the response is not as strong as that found with stimulants
(Cantwell, 1998). Bupropion can also be used as an adjunct to augment stimulant
treatment. Well-controlled trials have shown tricyclic antidepressants to be
superior to placebo but less effective than stimulants (Elia et al., 1991; Elia
& Rapoport, 1991). Reports of sudden death of a few children in the early 1990s
on the tricyclic compound desipramine led to great caution with the use of
tricyclics in children (Riddle et al., 1991).
Considerable controversy surrounds the use of central alpha-adrenergic blocking drugs, such as clonidine and guanfacine, to treat ADHD. There is some evidence that clonidine is effective for ADHD when it occurs with a tic disorder (Hunt, 1987; Hunt et al., 1990, 1995). Caution is warranted in view of the four cases of sudden death that have been reported in children taking methylphenidate and clonidine together and of a number of reports of nonfatal cardiac side effects in children taking clonidine alone or in combination (Swanson et al., 1995a).
Neuroleptics have been found to be occasionally effective (Green, 1995), yet the risk of movements disorders, such as tardive dyskinesia, makes their use problematic. Lithium, fenfluramine, or benzodiazapines have not been found to be effective treatments for ADHD (Cantwell, 1996a; Green, 1995), nor have SSRIs, such as fluoxetine (Goldman et al., 1998). Furthermore, more than 20 studies have shown that dietary manipulation (e.g., the Feingold diet) is not efficacious (Mattes & Gittelman, 1981), and controlled studies failed to demonstrate that sugar exacerbates the symptoms of children with ADHD (Milich & Pelham, 1986).