Taşkan Merve, Tufan Ali Evren, Öztürk Yusuf, Balta Kesikbaş Büşra, İmrek Yasemin, Akıncı Buse, Koçak Gökçe
Clinic of Child and Adolescent Psychiatry, Elbistan State Hospital, Kahramanmaraş, Türkiye.
Department of Child and Adolescent Psychiatry, Abant İzzet Baysal University Faculty of Medicine, Bolu, Türkiye.
Psychiatry Clin Psychopharmacol. 2024 Nov 28;34(4):285-293. doi: 10.5152/pcp.2024.24862.
In this study, we aimed to evaluate the effects of drug holidays during summer vacations on children with attention deficit/hyperactivity disorder (ADHD) treated with methylphenidate in terms of ADHD symptoms and emotion regulation (ER).
This single-center, naturalistic, prospective cohort study included pre-, post-, and post-drug holiday evaluations. All patients diagnosed with ADHD and included in our study were administered the Clinical Global Impression Scale, Affective Reactivity Index-parent and child, reading the mind in the eyes test (RMET), Faces test and Cognitive Emotion Regulation Questionnaire for Children 3 times. Fifty-six patients met the inclusion criteria and ten were lost to follow-up. Thirty-nine participants had complete evaluations at all time points.
Both parent and self-report ratings of child irritability were significantly reduced after methylphenidate (MPH) treatment (P=.003 and .002, respectively), although they returned to baseline after drug holidays (P=.618 and .974, respectively). The use of self-blame as a cognitive emotion regulation strategy increased significantly after treatment and remained significantly elevated even after drug holidays (P=.024 and .022, respectively). Children used planning as a cognitive strategy significantly more frequently during MPH treatment (P=.034), although this elevation was temporary and returned to baseline levels after the drug holidays (P=.890). Reading the mind in the eyes test performance was significantly improved after MPH treatment and did not change after drug holidays (P=.009 and .006, respectively), while there was a tendency for facial emotion recognition abilities to improve at the last visit (P=.051).
Our results suggest that MPH treatment improves child- and parent-reported irritability, clinician-rated disorder severity, RMET performance, and the use of planning as a cognitive ER strategy, although only improvement in RMET performance continued after drug holidays. Our results may support the importance of continuing treatment over the holidays for most children with ADHD unless necessitated by adverse events, growth problems, or development of tolerance.
在本研究中，我们旨在评估暑假期间药物假期对使用哌甲酯治疗的注意力缺陷多动障碍（ADHD）儿童的ADHD症状和情绪调节（ER）的影响。
这项单中心、自然主义、前瞻性队列研究包括药物假期前、后和假期后的评估。所有被诊断为ADHD并纳入我们研究的患者均接受了临床总体印象量表、情感反应指数（父母和儿童）、读心术测试（RMET）、面部表情测试和儿童认知情绪调节问卷3次。56名患者符合纳入标准，10名失访。39名参与者在所有时间点都有完整的评估。
哌甲酯（MPH）治疗后，父母和自我报告的儿童易怒评分均显著降低（分别为P = 0.003和0.002），尽管在药物假期后恢复到基线水平（分别为P = 0.618和0.974）。作为一种认知情绪调节策略，自责的使用在治疗后显著增加，即使在药物假期后仍显著升高（分别为P = 0.024和0.022）。在MPH治疗期间，儿童使用计划作为认知策略的频率显著更高（P = 0.034），尽管这种升高是暂时的，在药物假期后恢复到基线水平（P = 0.890）。MPH治疗后读心术测试表现显著改善，药物假期后无变化（分别为P = 0.009和0.006），而在最后一次访视时面部情绪识别能力有改善的趋势（P = 0.051）。
我们的结果表明，MPH治疗可改善儿童和父母报告的易怒、临床医生评定的疾病严重程度、RMET表现以及将计划作为一种认知ER策略的使用，尽管药物假期后仅RMET表现的改善持续存在。我们的结果可能支持对于大多数ADHD儿童在假期持续治疗的重要性，除非因不良事件、生长问题或耐受性发展而有必要停药。
