Atomoxetine as an Alternative Therapy for Adolescent Adhd With Comorbid Cerebral Palsy: A Case Report

Aims The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in children with Cerebral Palsy (CP) is 19%. Whilst there evidence that methylphenidate an efficacious first line therapy for patients ADHD, a lack literature describing atomoxetine use ADHD comorbid CP. Methods Here we report the case 17-year old Caucasian female and patient was referred to Child Adolescent Mental Health Services (CAMHS) ongoing anxiety following extensive orthopaedic surgery, which managed sertraline concurrent Cognitive Behavioural Therapy. A CAMHS assessment led her subsequent diagnosis resulting initial treatment low-dose (Ritalin). This discontinued after four days due progressive headache, tachycardia, unilateral leg restlessness. hesitant commence lisdexamfetamine, second stimulant medication, possibility similar adverse side effects. Atomoxetine (20mg/day) commenced month then increased 30mg/day. After five months, it discontinued. reported no significant improvements attention or concentration, but later onset escalating prior discontinuation. Consultation revealed patient's may be attributed biopsychosocial factors unrelated pharmacotherapy, could not discount this effect atomoxetine. Following discontinuation atomoxetine, carer were amenable trialling lisdexamfetamine. Results Previous data have demonstrated CP lower tolerance particular pharmacological agents, therefore started at low dose permit gradual titration up recommended therapeutic dose. Worsening whilst on (30mg/day) result one combination following: (1) long-term effect, (2) subtherapeutic response, (3) identified precipitating perpetuating psychosocial factors, particularly school setting. Conclusion acceptable safety profile young person expected benefits been offset by extenuating factors. Further research needed determine whether exists causal relationship between worsened within group. Furthermore, highlights importance understanding complexities confounding environmental neurological disorders.