The Diagnosis and Treatment of Attention Deficit-Hyperactivity Disorder in Children and Adolescents with Cystic Fibrosis: A Retrospective Study

BackgroundThere has been minimal study of the impact of attention deficit-hyperactivity disorder (ADHD) in cystic fibrosis (CF) or other chronic illness.ObjectiveTo examine patterns of ADHD diagnosis and treatment in CF.MethodRetrospective chart review of all pediatric patients in the Massachusetts General Hospital (MGH) CF Program referred from 8/05–12/08 for outpatient child psychiatric consultation and diagnosed with ADHD. The medication trial resulting in the best improvement in ADHD symptoms with the most tolerable side effects was designated the Best Regimen for each patient.ResultsOf the 188 patients aged 5–18 followed in the MGH CF Program during this time, 18 (9.6%) were referred to the liaison psychiatrist and diagnosed with ADHD. Eleven (61%) had CF treatment non-adherence as a presenting problem. Psychopharmacologic treatment of ADHD was attempted in 13 of the 18 cases. In eight cases the Best Regimen achieved a Clinical Global Impression improvement rating of much or very much improved. In three cases, the Best Regimen consisted of stimulant monotherapy; two consisted of nonstimulant monotherapy; two used a combination of two nonstimulants; and one used a combination of a stimulant and a nonstimulant.ConclusionADHD is common and treatable in pediatric patients with CF. Stimulants, nonstimulants, and combination therapies are viable treatment options. The presence of ADHD or other psychiatric disorders should be considered when behavior is interfering with adherence to medical care. Further research is needed into the prevalence and treatment of ADHD in CF and its impact on medical adherence and outcomes.