title: Early Morning Functional Impairments in Stimulant-Treated Children with Attention-Deficit/Hyperactivity Disorder Versus Controls: Impact on the Family.
abstract: OBJECTIVE
  Children with attention-deficit/hyperactivity disorder (ADHD) frequently manifest early morning functional (EMF) impairments before school. We conducted a quantitative research survey to assess the impact of these EMF impairments on the family unit (caregiver, spouse/partner, and siblings).
  
  
  METHODS
  We developed an online survey questionnaire to collect data from 300 primary caregivers of children with ADHD and 50 primary caregivers of children who did not have ADHD.
  
  
  RESULTS
  Although the ADHD children we surveyed were currently treated with stable doses of stimulants as their primary ADHD medication for at least 3 months, their parents reported high levels of EMF impairments in the child, which had a substantial negative effect on the emotional well-being of parents, on parents' functioning during the early morning routine, and on the level of conflict with siblings. The impact of EMF impairments on family functioning was mediated by the severity of the index child's impairments.
  
  
  CONCLUSIONS
  EMF impairments exert a pervasive and significantly negative emotional and functional burden on not only the primary caregiver but also on the spouse/partner and siblings. This work suggests that adequate ADHD symptom control during the early morning period may be an unmet need for school-age children with ADHD being treated with stimulants. More work is needed to confirm this finding and determine the degree to which symptom control at other times of day is also an unmet need.
authors.affiliation: 1 Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: 2 Department of Psychiatry and Research Institute, The Hospital for Sick Children, University of Toronto , Toronto, Canada .
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Schachar
authors.affiliation: 3 Department of Psychiatry, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: Russell A
authors.initials: RA
authors.lastname: Barkley
authors.affiliation: 4 Ironshore Pharmaceuticals & Development, Inc. , Camana Bay, Grand Cayman, Cayman Islands .
authors.forename: Rick
authors.initials: R
authors.lastname: Nullmeier
authors.affiliation: 4 Ironshore Pharmaceuticals & Development, Inc. , Camana Bay, Grand Cayman, Cayman Islands .
authors.forename: F Randy
authors.initials: FR
authors.lastname: Sallee
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D017028:Caregivers / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants
keywords: ADHD; family; functioning; morning; parents; siblings