title: Amitriptyline and methylphenidate treatment of behaviorally disordered children. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder. The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Effects of methylphenidate, desipramine, and l-dopa on attention and inhibition in children with Attention Deficit Hyperactivity Disorder Estimation of the association between desipramine and the risk for sudden death in 5- to 14-year-old children. A controlled study of nortriptyline in children and adolescents with attention deficit hyperactivity disorder. Outcomes of OROS® methylphenidate compared with atomoxetine in children with ADHD: A multicenter, randomized prospective study Treatment of childhood hyperactivity with desipramine: Plasma drug concentration, cardiovascular effects, plasma and urinary catecholamine levels, and clinical response Imipramine and methylphenidate treatments of hyperactive boys. A double-blind comparison. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Motor Performance in Hyperactive Children Treated with Imipramine Side effects of methylphenidate and desipramine alone and in combination in children. Design and rationale of controlled study of long-term methylphenidate and multimodal psychosocial treatment in children with ADHD. A double-blind placebo controlled study of desipramine in the treatment of ADD: I. Efficacy. A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder. The treatment of attention-deficit hyperactivity disorder in Tourette's syndrome: a double-blind placebo-controlled study with clonidine and desipramine. ADHD in a school sample of Brazilian adolescents: a study of prevalence, comorbid conditions, and impairments.
abstract: SUMMARY A controlled investigation was conducted to assess the relative effectiveness of amitriptyline and methylpheni date for treating hyperactive/aggressive behavior in children originally referred to a learning clinic .  Behavioral change was measured through parent and teacher ratings . Drug effects on attention , short term memory , and impulsivity were evaluated with laboratory tasks . It was found that both drugs were largely comparable in attenuating hyperactivity and aggression . Of the laboratory measures , only attention was improved by both drugs . However , neither medication interfered with functioning on the other laboratory tests . With the exception of and trip by line-induced sedation , side effects were of minor degree . Findings raised questions concerning measuring and improving attentiveness . Differences between results of this and other studies were discussed , as were issues regarding pharmacotherapy with amitriptyline in children BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes OBJECTIVE This study examined the efficacy and safety of clonidine hydrochloride extended-release tablets ( CLON-XR ) in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This 8-week , placebo-controlled , fixed-dose trial , including 3 weeks of dose escalation , of patients 6 to 17 years old with ADHD evaluated the efficacy and safety of CLON-XR 0.2 mg/day or CLON-XR 0.4 mg/day versus placebo in three separate treatment arms . Primary endpoint was mean change in ADHD Rating Scale-IV ( ADHD-RS-IV ) total score from baseline to week 5 versus placebo using a last observation carried forward method . Secondary endpoints were improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Severity , Clinical Global Impression of Improvement , and Parent Global Assessment from baseline to week 5 . RESULTS Patients ( N = 236 ) were r and omized to receive placebo ( n = 78 ) , CLON-XR 0.2 mg/day ( n = 78 ) , or CLON-XR 0.4 mg/day ( n = 80 ) . Improvement from baseline in ADHD-RS-IV total score was significantly greater in both CLON-XR groups versus placebo at week 5 . A significant improvement in ADHD-RS-IV total score occurred between groups as soon as week 2 and was maintained throughout the treatment period . In addition , improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Improvement , Clinical Global Impression of Severity , and Parent Global Assessment , occurred in both treatment groups versus placebo . The most common treatment-emergent adverse event was mild-to-moderate somnolence . Changes on electrocardiogram were minor and reflected the known pharmacology of clonidine . CONCLUSIONS Clonidine hydrochloride extended-release tablets were generally well tolerated by patients in the study and significantly improved ADHD symptoms in this pediatric population BACKGROUND Despite long-st and ing clinical concerns , relatively little is known about the comorbidity between attention-deficit/hyperactivity disorder ( ADHD ) and tic disorders . Therefore , we examined tic disorders in an ongoing prospect i ve follow-up study of male subjects with ADHD , a sample unselected for any comorbid disorder . METHODS One hundred twenty-eight male children and adolescents with ADHD and 110 male controls were comprehensively evaluated at baseline and 4 years later . We characterized tic disorders along with a wide range of neuropsychiatric correlates , including other comorbid disorders and indices of psychosocial function in multiple domains ( school , cognitive , social , and family ) . RESULTS Compared with controls , subjects with ADHD showed more tic disorders at baseline and more new onsets were reported at follow-up . Attention-deficit/hyperactivity disorder and tic disorders appeared to be independent in course : in contrast to low rates of ADHD remission , tic disorders mostly remitted . The age-adjusted rate of ADHD remission was 20 % and that of tic remission , 65 % . Tic disorders had little effect on the psychosocial functioning of subjects with ADHD . CONCLUSIONS These findings suggest that comorbidity with a tic disorder has a limited effect on ADHD outcome . However , because of the relatively small sample of subjects with tic disorders , our conclusions should be considered preliminary until confirmed in larger studies of medicated and unmedicated children with ADHD with and without tic disorders The objective of this study was to investigate the effects of methylpheni date ( MPH ) on attention and inhibition in children with Attention Deficit Hyperactivity Disorder ( ADHD ) and to establish what the relative contributions of the noradrenergic and dopaminergic systems to this effect were . In addition to MPH , two other drugs were administered in order to affect both transmitter systems more selectively , L-dopa ( dopamine ( DA ) agonist ) and desipramine ( DMI ) ( noradrenaline ( NA ) re-uptake inhibitor ) . Sixteen children with ADHD performed a stop-task , a laboratory task that measures the ability to inhibit an ongoing action , in a double-blind r and omized within-subjects design . Each child received an acute clinical dose of MPH , DMI , L-dopa , and placebo ;  measures of performance and plasma were determined . The results indicated that inhibition performance was improved under DMI but not under MPH or L-dopa . The response-time to the stop-signal was marginally shortened after intake of DMI . MPH decreased omission and choice-errors and caused faster reaction times to the trials without the stop-tone . No effects of L-dopa whatsoever were noted . Prolactin levels were increased and 5-HIAA levels were lowered under DMI relative to placebo . It is suggested that the effects of MPH on attention are due to a combination of noradrenergic and dopaminergic mechanisms . The improved inhibition under DMI could be serotonergically mediated BACKGROUND Four cases of  sudden death in children 12 years or younger during desipramine treatment were identified between 1986 and 1992 . We evaluated whether these events support the hypothesis that exposure to therapeutic doses of desipramine contributes to the risk for sudden death in otherwise healthy children . METHOD The National Center for Health Statistics provided the baseline number of sudden unexplained deaths in children 5 to 14 years old . Data from the National Disease and Therapeutic Index were used to estimate the exposure to desipramine in children in the same age group . Since two of the four deaths were identified by 1987 , we used the post-1987 experience as if it were a prospect i ve period in which a causal association could be examined . RESULTS The number of sudden deaths in  desipramine-exposed  children did not increase from 1986 to 1992 despite a marked increase in exposure . By using 4 to 6 months as the average lifetime of a desipramine prescription and a baseline rate of sudden death of 4.2 deaths/million/year in this population , the post-1987 period would account for 162,000 to 242,000 person-years of desipramine exposure . Although not statistically significant , this level of exposure corresponds to a relative risk of 2.1 ( 95 % CI = 0.5 to 15 ) to 3.1 ( 95 % CI = 0.8 to 22 ) . CONCLUSION Although , based on our estimates , the evidence for an association between desipramine and sudden death in children aged 5 to 14 years appears weak , replication of our findings is needed with a more precise numerator ( total number of deaths ) and denominator ( the appropriate conversion from drug appearance to actual exposure ) before a firm conclusion on this subject can be drawn . Until then , even if remote , the possibility of an association between desipramine and sudden death in children stresses the importance of assessing risks and benefits when desipramine is used in pediatric patients OBJECTIVES To study the efficacy and tolerability of nortriptyline ( NT ) in the treatment of pediatric attention deficit hyperactivity disorder ( ADHD ) . METHODOLOGY Subjects were outpatient children and adolescents with ADHD ascertained from clinical referrals . Subjects were enrolled in a 6-week open study in which NT was titrated to 2 mg/kg/day as tolerated over 2 weeks . Using either a 30 % reduction in the ADHD rating scale or a score of 1 or 2 on the Clinical Global Impression ( CGI ) scale for ADHD improvement , responders to treatment were then r and omized into a 3-week , controlled discontinuation phase . During this phase , subjects either continued on their current dose of NT or were tapered to placebo under double-blind conditions . Subjects were monitored for symptoms of ADHD , oppositionality , anxiety , and depression . RESULTS Of the 35 subjects enrolled in the study , 32 completed the open phase and 23 completed the discontinuation phase . The mean dose of NT was 80 mg ( 1.8 mg/kg/day ) , result ing in a serum level of 81 ng/ml . At the conclusion of the open 6-week study , NT was related to a significant reduction in ADHD ( p < 0.001 ) and oppositional symptoms ( p < 0.001 ) . At the conclusion of the discontinuation phase , the 12 subjects r and omized to NT had significantly lower scores on the DSM-IV ADHD symptom checklist than those 11 subjects r and omized to placebo ( 31 versus 21 ; t = 2.2 ; p < 0.04 ) . No significant adverse events were observed , and children were noted to have weight gain during the trial . CONCLUSIONS These data suggest that NT is effective in reducing symptoms not only of ADHD but also of oppositionality . This group of children and adolescents tolerated robust dosing of NT well , with few clinical or cardiovascular adverse events This community-based study was design ed to evaluate treatment outcomes with OROS ® methylpheni date ( MPH ) and atomoxetine in children with attentiondeficit/hyperactivity disorder ( ADHD ) , as assessed by physicians and parents in a setting that resembles clinical practice . In a multicenter , prospect i ve , open-label study , children 6 to 12 years of age with ADHD were r and omized ( 2:1 , respectively ) to 3 weeks of treatment with once-daily OROS MPH or atomoxetine . Investigatorrated measures of symptoms included the ADHD Rating Scale ( ADHD-RS ) and the Clinical Global Impression-Improvement of Illness scale ( CGI-I ) . Assessment s were made at baseline and during a telephone interview in week 1 , a clinic visit in week 2 , and a final clinic visit in week 3 . In total , 1323 patients received OROS MPH ( n=850 ) or atomoxetine ( n=473 ) . Significant reductions from baseline in investigator-evaluated ADHD-RS scores were observed among patients receiving OROS MPH and those receiving atomoxetine . At the end of the study , mean decreases from baseline ADHD-RS scores were 20.24 for OROS MPH and 16 for atomoxetine ( P < .001 ) . Between-treatment differences appeared to increase over time ( 2.77 , 3.44 , and 4.24 at weeks 1 , 2 , and 3 , respectively ; P < .001 ) . Treatment response ( ie , 25 % reduction from baseline ADHD-RS scores ) was significantly greater at each evaluation for patients taking OROS MPH than for those taking atomoxetine ( P < .001 ) . Similar percentages of patients taking OROS MPH ( 4.8 % ) and atomoxetine ( 5.5 % ) withdrew because of adverse events . Although community-based studies often lack the control of r and omized , placebo-controlled trials , these results nevertheless suggest greater ADHD symptom improvement  with OROS MPH compared with atomoxetine Twenty‐nine boys with attention deficit disorder/hyperactivity were r and omly assigned to receive desipramine ( DMI ; n = 17 ) or placebo ( n = 12 ) for 14 days in a noncrossover , double‐blind study . There was immediate behavioral improvement with DMI at day 3 that was sustained for 2 weeks ; behavioral improvement did not correlate with plasma concentrations of DMI , hydroxy‐DMI , or their sum at either days 3 or 14 . There were no untoward side effects ; there was a drug‐induced increase in pulse and diastolic blood pressure . During drug therapy , the urinary excretion of norepinephrine , vanillym and elic acid , and 3‐methoxy‐4‐hydroxyphenylglycol ( MHPG ) was decreased at both days 3 and 14 . The plasma MHPG level was decreased at days 3 and 14 and ( st and ing ) plasma NE levels increased at day 14 . The decreases in both urinary and plasma MHPG levels showed significant correlations with behavioral improvement during the second week . These data corroborate previous findings on sympathomimetic effects of tricyclic antidepressants in children and support a noradrenergic mechanism in the mediation of drug effects on attention deficit disorder/hyperactivity A double-blind outpatient study is reported comparing imipramine hydrochloride , methylpheni date hydrochloride , and placebo treatments of 76 hyperactive grade -school boys . In addition , the predrug behavioral evaluation is examined in detail to provide guidelines for clinics examining these children . Base line clinic evaluations showed the usefulness of the psychologist 's global estimates of attention and behavior disorder , as these ratings predicted teacher rating of classroom behavior better than did psychiatric playroom observations . Parent four-day diaries of activity and family interaction also predicted teacher ratings and reflected response to stimulant medication . Although the global judgments of psychiatrists , psychologist , and the pediatrician indicated the superiority of both drugs to a placebo , all measures favored the stimulant drug . The significance of these findings may be limited , however , by the dose of imipramine hydrochloride ( 80 mg ) that was lower than in use elsewhere OBJECTIVE In the Multimodal Treatment Study of ADHD ( MTA ) , the effects of medication management ( MedMgt ) and behavior modification therapy ( Beh ) and their combination ( Comb ) and usual community comparison ( CC ) in the treatment of attention-deficit/hyperactivity disorder ( ADHD ) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy ( Comb or MedMgt ) over Beh and CC and modest additional benefits of Comb over MedMgt alone . Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention . METHODS Of 579 children who entered the study , 540 ( 93 % ) participated in the first follow-up 10 months after the end of treatment . Mixed-effects regression models explored possible persisting effects of the MTA medication strategy , the incremental benefits of Comb over MedMgt alone , and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains . RESULTS The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months , although not as great as at 14 months . Significant additional benefits of Comb over MedMgt and of Beh over CC were not found . The groups differed significantly in mean dose ( methylpheni date equivalents 30.4 , 37.5 , 25.7 , and 24.0 mg/day , respectively ) . Continuing medication use partly mediated the persisting superiority of Comb and MedMgt . CONCLUSION The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time The effects of the tricyclic antidepressant imipramine were evaluated in a study of 9 children with Attention Deficit-Hyperactivity Disorder . The study was double-blind , placebo-controlled , with three drug conditions , low , medium , and high doses . The focus was on neuropsychological drug effects .  Imipramine exerted negative dose-response effects on motor performance ( motor speed , motor pursuit ) , while it improved hyperactive behavior and attention and raised the heart rate slightly OBJECTIVE To investigate side effects of methylpheni date and desipramine alone and in combination in hospitalized children with symptoms of attention-deficit hyperactivity disorder and depression . METHOD A double-blind placebo controlled crossover design was used to investigate each medication alone and in combination .  Side effect ratings and EKGs were done weekly . Pulse and blood pressure were monitored daily . RESULTS Nausea , dry mouth , and tremor were present in at least twice as many children on combined methylpheni date and desipramine compared with any other condition . Nausea/vomiting , headaches , other aches , refusal of food , and feeling " tired " were significantly more frequent during the combined methylpheni date plus desipramine condition when compared with either methylpheni date alone or with baseline . Significantly higher ventricular heart rate was found on combined methylpheni date plus desipramine compared with desipramine alone , methylpheni date alone , and baseline . Prolonged PR interval and significantly higher heart rate occurred during desipramine alone compared with baseline . CONCLUSIONS During the several-month duration of the study , there were more frequent side effects during combined methylpheni date plus desipramine treatment than with either medication alone . Clinical ly , side effects present during combined medication appeared to be similar to and no more serious than those associated with desipramine alone OBJECTIVE To describe the rationale , methodology , and sample characteristics of a dual-site treatment study ( New York and Montreal ) of children with attention-deficit/hyperactivity disorder ( ADHD ) conducted between 1990 and 1995 . The hypotheses were that ( 1 ) methylpheni date combined with comprehensive multimodal psychosocial treatment was superior to methylpheni date alone in improving multiple functions and ( 2 ) the efficacy of the psychosocial intervention result ed from its specific components and not from nonspecific treatment effects . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to methylpheni date , were r and omized for 2 years to ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date combined with multimodal psychosocial treatment that included parent training and counseling , academic assistance , psychotherapy , and social skills training ; or ( 3 ) methylpheni date plus attention control treatment that excluded specific aspects of the psychosocial intervention . Children were switched to single-blind placebo after 12 months ; methylpheni date was reinstituted when clinical ly indicated . Assessment s included ratings by parents , teachers , children , and psychiatrists ; school observations in academic and gym classes ; and academic performance tests . Almost 80 % of families completed the 2-year study . Companion papers present treatment effects . CONCLUSIONS A comprehensive 2-year psychosocial treatment was delivered successfully to children with ADHD and their families The tricyclic antidepressant drug desipramine ( DMI ) was evaluated in the treatment of young patients with attention deficit disorder with hyperactivity ( ADDH ) in an unselected sample of 62 clinical ly referred patients , 43 ( 69 % ) of whom previously responded poorly to psychostimulant treatment . The 42 children and 20 adolescents were assigned r and omly to receive DMI ( N = 31 ) or placebo ( N = 31 ) for up to 6 weeks in a parallel groups , double-blind study . Clinical ly and statistically significant differences in behavioral improvement were found for DMI over placebo , at an average ( + /- SEM ) maximal daily dose of 4.6 + /- 0.2 mg/kg ; 68 % of DMI-treated patients were considered very much or much improved , compared with only 10 % of placebo patients ( p less than 0.001 ) . DMI was well tolerated , even at the relatively high doses used . These findings suggest that DMI can be an effective treatment in the management of pediatric patients with ADDH , including patients who failed to respond to stimulants BACKGROUND Currently , there is no consensus on the best therapeutic approach to chronic tic disorders and comorbid attention-deficit/hyperactivity disorder ( ADHD ) . To address this issue , we evaluated the tolerability and efficacy of the noradrenergic tricyclic antidepressant desipramine hydrochloride in the treatment of children and adolescents with chronic tic disorders and comorbid ADHD . METHODS Forty-one children and adolescents with chronic tic disorders , including Tourette disorder and comorbid ADHD , were studied in a 6-week , double-blind , placebo-controlled , parallel trial . Desipramine was titrated weekly up to 3.5 mg/kg per day . We rated ADHD and tic symptoms weekly and monitored adverse effects , laboratory findings , and cardiovascular parameters . RESULTS Treatment with desipramine ( mean total daily dose , 3.4 mg/kg per day ) was well tolerated without meaningful adverse effects . Desipramine significantly reduced core symptoms of ADHD ( ADHD Rating Scale ; 42 % decrease from baseline relative to placebo , P<.001 ) , with equal response in inattentive symptoms and hyperactive/impulsive symptoms ( P<.001 for both ) . The ADHD response rate was robust ( 71 % vs 0 % ; desipramine vs placebo , P<.001 ) . Likewise , desipramine significantly reduced tic symptoms ( Yale Global Tic Severity Scale ; 30 % decrease from baseline relative to placebo , P<.001 ) , with equal response in motor and phonic tic symptoms ( P<.01 for both ) . The tic response rate was substantial ( 58 % vs 5 % ; desipramine vs placebo , P<.001 ) . There were small but statistically significant differences between desipramine and placebo in heart rate and blood pressure . CONCLUSIONS Treatment with desipramine was well tolerated and was associated with robust clinical ly significant reductions in tic and ADHD symptoms in children and adolescents with chronic tic disorders and ADHD diagnoses OBJECTIVES Because psychostimulants can exacerbate preexisting motor/phonic tics in individuals with Tourette 's syndrome ( TS ) , a clinical trial was performed to examine the ability of clonidine and desipramine to modify attention-deficit hyperactivity disorder ( ADHD ) behaviors in children with TS + ADHD . METHODS A double-blind , placebo-controlled protocol was used in which each subject served as his or her own control and received , in a r and omly assigned fashion , 6-week medication cycles with clonidine ( 0.05 mg four times daily ) , desipramine ( 25 mg four times daily ) , and placebo . RESULTS Thirty-seven children with TS+ADHD between the ages 7 to 13 years and of normal intellect were recruited , and 34 ( 31 males , 3 females ) completed the entire protocol . Outcome measures for ADHD included Parent and Teacher Child Behavior Checklists ( CBCL ) , continuous performance tests , and neuropsychologic tests of executive function . Several markers for ADHD were shown to improve significantly ( P < .05 ) after treatment with desipramine  ( parent linear analogue rating , parent CBCL " hyperactivity " subscale , and teacher CBCL subscales " nervous/overactive , " " anxious , " and " unpopular " ) . Improvement with desipramine was always superior to that noted with clonidine .  Clinical improvement did not correlate with drug blood levels . On measures of tic severity , neither drug made tics worse .  Desipramine showed a statistically significant improvement on a global linear analogue scale , but not on the Hopkins Motor/Vocal Tic Severity Scale , the Tourette Syndrome Severity Scale , or the Yale Global Tic Severity Scale .  Clonidine did not significantly alter tic severity on any measure . CONCLUSION The results of this study suggest that desipramine may be a useful alternative for the treatment of symptoms of ADHD in children with TS OBJECTIVE To evaluate the prevalence , comorbid conditions , and impairments of attention-deficit/hyperactivity disorder ( ADHD ) among young adolescents in Porto Alegre , Brazil . METHOD 1,013 students aged 12 to 14 years were evaluated at 64 state schools , using a screening instrument based on the 18 DSM-IV ADHD symptoms . All positive screened students ( n = 99 ) and a r and om subset of negative screened subjects ( n = 92 ) had a psychiatric evaluation carried out within a hospital setting or at home . RESULTS The prevalence of ADHD was estimated to be 5.8 % ( 95 % confidence interval = 3.2 - 10.6 ) , and the comorbidity with other disruptive behavior disorders was high ( 47.8 % ) . Youths with ADHD ( n = 23 ) had significantly higher rates of school repetitions , suspensions , and expulsions ( p < .01 ) than controls ( n = 168 ) . No association was identified between ADHD and alcohol , marijuana , and inhalant use . CONCLUSION The results extend to adolescents well-documented findings in children , indicating that ADHD is quite prevalent in early adolescence and affected youths are at high risk for impairment and dysfunction in multiple domains
target: Desipramine appeared more efficacious than clonidine in reducing ADHD symptoms as rated by parents ( SMD -0.90 , 95 % CI -1.40 to -0.40 , 1 trial , 68 participants , very low quality evidence ) in participants with ADHD and comorbid tics or Tourette syndrome .
  Although this Cochrane Review did not identify serious adverse effects in patients taking TCAs , it did identify mild increases in diastolic blood pressure and pulse rates .
  Also , patients treated with desipramine had significantly higher rates of appetite suppression compared to placebo whilst nortriptyline result ed in weight gain .
  Other reported adverse effects included headache , confusion , sedation , tiredness , blurred vision , diaphoresis , dry mouth , abdominal discomfort , constipation , and urinary retention .
  AUTHORS ' CONCLUSIONS Most evidence on TCAs relates to desipramine .
  Findings suggest that , in the short term , desipramine improves the core symptoms of ADHD , but its effect on the cardiovascular system remains an important clinical concern .
background: BACKGROUND Attention deficit hyperactivity disorder ( ADHD ) is a chronic neurodevelopmental disorder of childhood onset , which may persist into adulthood .
  ADHD has a significant impact on a child 's daily life , affecting relationships and academic performance .
  Its core symptoms include developmentally inappropriate levels of inattention , hyperactivity , and impulsive behaviour .
  Tricyclic antidepressants ( TCAs ) are sometimes used as second line of treatment in the reduction of ADHD symptoms in children and adolescents with ADHD .
  However , their efficacy is not yet known .
  OBJECTIVES To assess the efficacy of TCAs in the reduction of ADHD symptoms within the broad categories of hyperactivity , impulsivity , and inattentiveness in young people aged 6 to 18 years with established diagnoses of ADHD .