Interventions for ADHD in children & adolescents with epilepsy: A review and decision tree to guide clinicians

• Published in: Epilepsy & behavior 2022-10, Vol.135, p.108872-108872, Article 108872
• Main Authors: Ono, Kim E., Bearden, Donald J., Lee, Susan M., Moss, Cierra, Kheder, Ammar, Cernokova, Ivana, Drane, Daniel L., Gedela, Satyanarayana
• Format: Article
• Language: English
• Subjects: ADHD; Adolescent; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - therapy; Central Nervous System Stimulants - therapeutic use; Child; Cross-Sectional Studies; Decision Trees; Epilepsy; Epilepsy - drug therapy; Epilepsy - therapy; Humans; Interventions; Retrospective Studies
• ISSN: 1525-5050; 1525-5069; 1525-5069
• DOI: 10.1016/j.yebeh.2022.108872

•ADHD and epilepsy are highly comorbid in the pediatric population; however, parents are hesitant about adding extra medication to their child’s epilepsy regimen.•To our knowledge, we created the first review and an easy-to-use guide for clinicians that includes medication and non-medication interventions, including psychosocial interventions and the ketogenic diet.•The results indicated that stimulant medication remains the leading treatment for ADHD in youth with epilepsy.•Parents and patient psychoeducation about ADHD in the context of epilepsy is beneficial with adherence and persistence to ADHD treatment.•Psychosocial treatments are expected to work well as an alternative or adjunctive treatment to pharmacological interventions. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common pediatric epilepsy comorbidities. Treating ADHD in the context of epilepsy can be overwhelming for parents and clinicians. Current frontline treatment for ADHD is stimulant medication. However, some parents of pediatric patients with epilepsy have concerns about adding additional medication to their child’s epilepsy regimen and/or about adverse effects of stimulant medication. Non-medication ADHD treatments including psychosocial interventions and ketogenic diet have also shown success in improving ADHD symptoms. Our focused review provides an easy-to-use guide for clinicians on ADHD interventions and combinations of interventions for pediatric patients with epilepsy and ADHD. Our guide includes information from 8 electronic databases for peer-reviewed, English language studies of psychosocial treatments for youth with epilepsy and ADHD. One hundred eight studies were selected based on inclusion criteria (21 systematic reviews, 12 meta-analyses, 8 literature reviews, 6 population surveys, 31 clinical trials, 20 cross-sectional studies, and 10 retrospective reviews). Results indicated that stimulant medication is a frontline treatment for ADHD symptoms in youth with epilepsy, with important caveats and alternatives.