Hallucinations Are Rare Side Effects of ADHD Medications

(HealthDay News) -- Children who take medications for attention-deficit hyperactivity disorder (ADHD) may rarely experience some disturbing side effects, such as hallucinations.

U.S. government experts reviewed clinical trials and post-marketing reports of side effects from the commonly prescribed ADHD stimulant medications, such as Concerta, Ritalin and Strattera. They found that out of every 100 "person-years" of treatment, one or two children will experience serious side effects, such as hallucinations of bugs or snakes.

"Patients and physicians should be aware that psychosis or mania arising during drug treatment of attention-deficit hyperactivity disorder may represent adverse drug reactions, the study's authors wrote in the February issue Pediatrics.

"These reactions are very rare," said Dr. Roy Boorady, director of the psychopharmacology service at the New York University Child Study Center in New York City.

"We see a lot of children on medications here, and I would say maybe one a year or once every two years, we might hear about a child with tactile hallucinations, where kids feel like they have bugs on them. It's usually really young kids who are on medications, and once they back off or stop the medications, the sensation is gone," he said.

Almost 8 percent of children in the Unite States -- about 4.5 million -- have ever received a diagnosis of ADHD, according to background information in the article. And, it's estimated that 4.3 percent of American children are taking medications to treat ADHD. The main signs of ADHD are inattention, hyperactivity, and impulsiveness.

Concern about potential psychiatric side effects from these medications led to the current study.

The FDA experts reviewed the results of 49 randomized, placebo-controlled trials and asked drug manufacturers to analyze their post-marketing surveillance databases.

They found that 11 psychosis or mania episodes occurred for every 743 person-years of treatment. No episodes of psychosis or mania occurred in children taking placebo treatments. For every 100 person-years, the rate of psychosis or mania was 1.48, according to the study.

The post-marketing reports found more than 800 incidences of psychosis or mania. In about 90 percent of cases, there was no previous history of a similar psychiatric condition, the study found.

The most common hallucinations were visual or tactile sensations of insects, snakes or worms.

"Any medication has side effects, some of which are very, very rare," said Dr. William Cohen, a developmental-behavioral pediatrician in the Child Development Unit at Children's Hospital of Pittsburgh. "Whenever your child is taking any new medication, if something new starts, consider it a side effect and call your doctor. With these medications, it's safe to stop them and call your doctor."

Boorady said that sleep problems and a loss of appetite tend to be more common side effects of these types of medications. And he doesn't think parents should be overly concerned about the possibility of psychiatric symptoms, because they are so uncommon.

More information
The Nemours Foundation has more on ADHD medications and their side effects.

St. John's Wort Doesn't Work for ADHD

(HealthDay News) -- St. John's wort isn't effective for treating Attention-deficit hyperactivity disorder (ADHD) in children, a new study finds.

Published in the June 11 issue of the Journal of the American Medical Association, the study compared St. John's wort to a placebo in children aged 6 to 17 and found the herb wasn't any more effective than the placebo.

"To my knowledge, this is the first placebo-controlled study of St. John's wort for ADHD. We believed that some parents were using it to treat their children, and there was a potentially plausible biological mechanism, so we went into the study not knowing what we were going to find," said study author Wendy Weber, a research associate professor in the School of Naturopathic Medicine at Bastyr University in Kenmore, Wash.

But, said Weber, "in our study, a pretty standard dose of St. John's wort didn't provide benefit."

She added that most herbal supplements, and especially St. John's wort, have the potential to interact with other medications, which is why it's important to consult your child's doctor before trying anything new. In the case of St. John's wort, said Weber, it increases the metabolism of other drugs.

Previous studies of St. John's wort in children with depression have had mixed results, according to the study. The herb has been found to affect the metabolism of the brain chemicals serotonin, norepinephrine and dopamine. A medication (buproprion hydrochloride) sometimes used to treat ADHD, though not FDA-approved for that purpose, acts in a similar manner on these chemicals.

Because there appeared to be a potential biological explanation for the use of St. John's wort in ADHD, and because the authors suspected that parents were already using the drug for that purpose, they designed a small randomized, double-blind placebo-controlled trial of St. John's wort.

Fifty-four children between the ages of 6 and 17 who met the diagnostic criteria for ADHD were recruited for the study. During the first week, all of the children were given a placebo, and none were allowed to take ADHD medications. Those who had been taking prescription medications underwent a "washout" period before the start of the study to make sure they had no medication left in their bodies.

After the initial placebo period, half of the group was given 300 milligrams of St. John's wort or a placebo three times daily for eight weeks.

The researchers found no statistically significant differences between the groups.

Funding for the study was provided by the National Center for Complementary and Alternative Medicine (NCCAM).

"This was an extraordinarily good study that highlights the need for parents to be as critical of complementary and alternative medicines as they are about conventional medicines," said the author of an accompanying editorial in the same issue of the journal, Dr. Eugenia Chan, director of the ADHD Program at the Developmental Medicine Center at Children's Hospital Boston.

"Parents are typically very leery of stimulant medications, whereas with some of the herbs and dietary supplements, which we don't necessarily know what the side effects are, parents have a harder time being critical. It may be that because they're herbs or supplements, they're not equated with medication or that they seem natural, and natural must mean safer," Chan said.

"The evidence is definitely lagging far behind the interest," said Chan, who added that may be why some physicians are leery of alternative therapies, because without studies, it's difficult for them to weigh the risks and benefits of a treatment.

Chan said that it's important to keep your child's physician well-informed about any therapies they're using because of the potential for adverse interactions.

"If a family is very interested in using alternative and complementary medicine, it's very important to find a physician who will work with them," Chan advised.

More information
To learn more about attention-deficit hyperactivity disorder, visit the National Institute of Mental Health.

Children as Young as 4 Can Develop OCD

(HealthDay News) -- Children as young as 4 can develop obsessive-compulsive disorder (OCD), a new study says.

The study, published online by the Journal of Psychopathology and Behavioral Assessment, found many parallels between young children with OCD and their older peers with the anxiety disorder. For example, both groups had similar obsessions and compulsions, multiple psychiatric diagnoses, and high rates of obsessive-compulsive disorder in their family history. However, the younger children were less likely to have depression than the older children.

"Our findings offer the first glimpse at the features and variables that emerge during early childhood-onset OCD, and will hopefully lead to further studies focusing on assessment and treatment of this age group," study author Abbe Garcia, director of the Bradley Hasbro Children's Research Center Pediatric Anxiety Research Clinic in Rhode Island, said in a clinic news release.

Obsessive-compulsive disorder causes a person to have recurring, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). These compulsions -- such as hand washing, counting, checking or cleaning -- are often performed in hope of preventing obsessive thoughts or making them go away. Performing them brings only temporary relief and not performing them markedly increases anxiety.

Up to one in 200 children and adolescents may have obsessive-compulsive disorder, according to the American Academy of Child & Adolescent Psychiatry.

In their study of 58 children with OCD, aged 4 to 8, a fifth had an immediate family member with a history of the disorder. Roughly a fifth of the children also were diagnosed with attention-deficit hyperactivity disorder (ADHD) or generalized anxiety disorder (GAD).

Seventy-five percent of those studied reported having multiple obsessions, the most common being fear of contamination and catastrophic fears that involved death or harm to themselves or loved ones. Nearly all had multiple compulsive behaviors with an average of four per child. Washing, checking and repeating were the most common.

Garcia noted the importance of the study, saying, "early diagnosis and intervention are critical to reducing the severity of symptoms and improving quality of life."

More information
The National Institute of Mental Health has more about obsessive-compulsive disorder.