title: Sequential pharmacotherapy for children with comorbid attention-deficit/hyperactivity and anxiety disorders.
abstract: OBJECTIVE
  Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children.
  
  
  METHODS
  Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions-Improvement scores were also obtained.
  
  
  RESULTS
  Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global Impressions-Improvement-defined responder rate. Medications in both arms were well tolerated.
  
  
  CONCLUSIONS
  Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.
authors.affiliation: New York University Child Study Center, New York, NY 10016, USA. abikoh01@med.nyu.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Abikoff
authors.forename: James
authors.initials: J
authors.lastname: McGough
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.forename: James
authors.initials: J
authors.lastname: McCracken
authors.forename: Mark
authors.initials: M
authors.lastname: Davies
authors.forename: John
authors.initials: J
authors.lastname: Walkup
authors.forename: Mark
authors.initials: M
authors.lastname: Riddle
authors.forename: Melvin
authors.initials: M
authors.lastname: Oatis
authors.forename: Laurence
authors.initials: L
authors.lastname: Greenhill
authors.forename: Anne
authors.initials: A
authors.lastname: Skrobala
authors.forename: John
authors.initials: J
authors.lastname: March
authors.forename: Pat
authors.initials: P
authors.lastname: Gammon
authors.forename: James
authors.initials: J
authors.lastname: Robinson
authors.forename: Robert
authors.initials: R
authors.lastname: Lazell
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Louise
authors.initials: L
authors.lastname: Ritz
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D016666:Fluvoxamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000697:Central Nervous System Stimulants; D016666:Fluvoxamine; D008774:Methylphenidate; D017367:Selective Serotonin Reuptake Inhibitors