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ADHD medication may help childhood cancer survivors.

Children who develop problems with memory, attention, and behavior after cancer treatment may gain some long-term benefit from a medication commonly used for attention-deficit hyperactivity disorder (ADHD), according to a small clinical study. The drug, methylphenidate, improved long-term problems with thinking, memory, and attention span, as well as behavior and school performance. These problems are usually seen in children who undergo radiation and chemotherapy that target the central nervous system.

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The study included 122 children who had developed attention and learning problems after successful treatment for brain cancer or acute lymphoblastic leukemia. The children who were given methylphenidate for a year showed greater improvement in attention, behavioral problems, and social skills than those who did not take the medication, as measured by a series of performance tests and parent, teacher, and self-questionnaires. In terms of academics, the researchers found that children on the ADHD drug showed no greater improvement in tests of reading, spelling, and math skills than those in the control group. The evidence suggests that methylphenidate improves attention, behavioral problems, and social skills in about half of the child cancer survivors who take it.

The researchers point out that the medication would typically be one element in a strategy that includes school accommodation (e.g., seating the child in the front of the classroom, giving him or her shorter homework assignments) and teaching children tactics for making schoolwork and test taking easier (e.g., studying in quiet settings, taking frequent breaks). However, there are few alternatives for improving child cancer survivors' cognitive and behavioral problems. Cognitive remediation programs give children practical strategies to help them improve their cognitive and behavioral problems and view their struggles in a more positive light, but the improvements were modest and the time investment large (20 two-hour, one-on-one sessions with a clinician).

According to the researchers, additional, nonpharmaceutical treatments that are effective and affordable are needed. Side effects of methylphenidate include appetite problems, insomnia, headaches, dizziness, and stomach aches.

The study had limitations. The children were not randomly assigned to the treatment or nontreatment group: all those in the methylphenidate group had responded to the drug in an initial three-week study. One quarter of the children in the treatment group dropped out because of the adverse drug effects. Finally, one of the coresearchers worked as a consultant to the maker of a methylphenidate product for ADHD sold in Europe.

Conklin, H.M., Reddick, W.E., Ashford, J., Ogg, S., Howard, S.C., Morris, E.B., ... Khan, R.B. (2010). Long-term efficacy of methylphenidate in enhancing attention regulation, social skills, and academic abilities of childhood cancer survivors. Journal of Clinical Oncology, 28, 4465-4472. doi: 10.1200/JCO.2010.28.4026

[By Deborah McBride, RN, MSN, CPON[R], Contributor]

Contributor Deborah McBride, RN, MSN, CPON[R], is a staff nurse III at the Kaiser Permanente Oakland Medical Center and an assistant professor at Samuel Merritt University in Oakland, CA.
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Title Annotation:new treatments, new hope; attention-deficit hyperactivity disorder
Author:McBride, Deborah
Publication:ONS Connect
Geographic Code:1USA
Date:Mar 1, 2011
Words:486
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