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Reports of perceived adverse events of stimulant medication on cognition, motivation, and mood : qualitative investigation and the generation of items for the medication and Cognition Rating Scale

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Abstract
Objective: There is no questionnaire to specifically monitor perceived adverse events of methylphenidate (MPH) on cognition, motivation, and mood. The current study therefore had two goals. First, to harvest accounts of such putative events from transcripts of interviews in samples enriched for such potential experiences. Second, to use the derived data to generate items for a new questionnaire that can be used for monitoring such events in medication trials or routine clinical care. Methods: Following a literature search aimed at identifying associations between MPH and cognition and/or motivation, a qualitative semistructured interview was designed to focus specifically on the domains of cognition (i.e., reasoning, depth/breadth of thinking, intellectual capacity, and creativity) and motivation (i.e., drive, effort, and attitudes toward rewards/incentives). Interviews were conducted with 45 participants drawn from the following four groups: (a) clinicians, child and adolescent psychiatrists, and pediatricians specializing in attention-deficit/hyperactivity disorder (ADHD) (n = 15); (2) teachers, with experience of teaching at least 10 medicated children with ADHD (n = 10); (3) parents of children with ADHD (n = 8) treated with MPH; and (4) adolescents/adults with ADHD(n = 12). Purposeful sampling was used to selectively recruit ADHD participants whose histories suggested a degree of vulnerability to MPH adverse events. Data were analyzed using a deductive approach to content analysis. Results: While we probed purposefully for cognitive and motivational adverse events, a third domain, related to mood, emerged from the reports. Therefore, three domains, each with a number of subdomains, were identified from the interview accounts: (i) Cognition (six subdomains; attention/concentration, changes in thinking, reduced creativity, sensory overload, memory, slower processing speed); (ii) motivation (four subdomains; loss of intrinsic motivation for goal-directed activities, external locus of control, lack of effort/engagement in daily tasks, increased focus on incentives); and (iii) mood (three subdomains; dampening of spontaneity/flat affect, mood dysregulation, increased anxiety/edginess). On the basis of these reports, 34 items were specified and incorporated into a prototype questionnaire, which was piloted and refined on the basis of field-testing. Conclusions: Items were identified that capture potential/perceived cognitive, motivational, and mood-related adverse events of MPH. The items generated will allow us to further develop and psychometrically examine their prevalence, and the extent to which they are associated with medication adherence, treatment outcome, impairment, and other reported adverse events (e.g., loss of appetite/cardiovascular effects).
Keywords
ATTENTION-DEFICIT DISORDER, HYPERACTIVITY DISORDER, ADHD, METHYLPHENIDATE, ADOLESCENTS, CHILDREN, METAANALYSIS, MANAGEMENT, ADHERENCE

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MLA
Kovshoff, Hanna et al. “Reports of Perceived Adverse Events of Stimulant Medication on Cognition, Motivation, and Mood : Qualitative Investigation and the Generation of Items for the Medication and Cognition Rating Scale.” JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY 26.6 (2016): 537–547. Print.
APA
Kovshoff, H., Banaschewski, T., Buitelaar, J. K., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., et al. (2016). Reports of perceived adverse events of stimulant medication on cognition, motivation, and mood : qualitative investigation and the generation of items for the medication and Cognition Rating Scale. JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, 26(6), 537–547.
Chicago author-date
Kovshoff, Hanna, Tobias Banaschewski, Jan K Buitelaar, Sara Carucci, David Coghill, Marina Danckaerts, Ralf W Dittmann, et al. 2016. “Reports of Perceived Adverse Events of Stimulant Medication on Cognition, Motivation, and Mood : Qualitative Investigation and the Generation of Items for the Medication and Cognition Rating Scale.” Journal of Child and Adolescent Psychopharmacology 26 (6): 537–547.
Chicago author-date (all authors)
Kovshoff, Hanna, Tobias Banaschewski, Jan K Buitelaar, Sara Carucci, David Coghill, Marina Danckaerts, Ralf W Dittmann, Bruno Falissard, Dina Gojkovic Grimshaw, Chris Hollis, Sarah Inglis, Kerstin Konrad, Elizabeth Liddle, Suzanne McCarthy, Peter Nagy, Margaret Thompson, Ian CK Wong, Alessandro Zuddas, and Edmund Barke. 2016. “Reports of Perceived Adverse Events of Stimulant Medication on Cognition, Motivation, and Mood : Qualitative Investigation and the Generation of Items for the Medication and Cognition Rating Scale.” Journal of Child and Adolescent Psychopharmacology 26 (6): 537–547.
Vancouver
1.
Kovshoff H, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, et al. Reports of perceived adverse events of stimulant medication on cognition, motivation, and mood : qualitative investigation and the generation of items for the medication and Cognition Rating Scale. JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY. New rochelle: Mary Ann Liebert, Inc; 2016;26(6):537–47.
IEEE
[1]
H. Kovshoff et al., “Reports of perceived adverse events of stimulant medication on cognition, motivation, and mood : qualitative investigation and the generation of items for the medication and Cognition Rating Scale,” JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, vol. 26, no. 6, pp. 537–547, 2016.
@article{8509686,
  abstract     = {Objective: There is no questionnaire to specifically monitor perceived adverse events of methylphenidate (MPH) on cognition, motivation, and mood. The current study therefore had two goals. First, to harvest accounts of such putative events from transcripts of interviews in samples enriched for such potential experiences. Second, to use the derived data to generate items for a new questionnaire that can be used for monitoring such events in medication trials or routine clinical care. Methods: Following a literature search aimed at identifying associations between MPH and cognition and/or motivation, a qualitative semistructured interview was designed to focus specifically on the domains of cognition (i.e., reasoning, depth/breadth of thinking, intellectual capacity, and creativity) and motivation (i.e., drive, effort, and attitudes toward rewards/incentives). Interviews were conducted with 45 participants drawn from the following four groups: (a) clinicians, child and adolescent psychiatrists, and pediatricians specializing in attention-deficit/hyperactivity disorder (ADHD) (n = 15); (2) teachers, with experience of teaching at least 10 medicated children with ADHD (n = 10); (3) parents of children with ADHD (n = 8) treated with MPH; and (4) adolescents/adults with ADHD(n = 12). Purposeful sampling was used to selectively recruit ADHD participants whose histories suggested a degree of vulnerability to MPH adverse events. Data were analyzed using a deductive approach to content analysis. Results: While we probed purposefully for cognitive and motivational adverse events, a third domain, related to mood, emerged from the reports. Therefore, three domains, each with a number of subdomains, were identified from the interview accounts: (i) Cognition (six subdomains; attention/concentration, changes in thinking, reduced creativity, sensory overload, memory, slower processing speed); (ii) motivation (four subdomains; loss of intrinsic motivation for goal-directed activities, external locus of control, lack of effort/engagement in daily tasks, increased focus on incentives); and (iii) mood (three subdomains; dampening of spontaneity/flat affect, mood dysregulation, increased anxiety/edginess). On the basis of these reports, 34 items were specified and incorporated into a prototype questionnaire, which was piloted and refined on the basis of field-testing. Conclusions: Items were identified that capture potential/perceived cognitive, motivational, and mood-related adverse events of MPH. The items generated will allow us to further develop and psychometrically examine their prevalence, and the extent to which they are associated with medication adherence, treatment outcome, impairment, and other reported adverse events (e.g., loss of appetite/cardiovascular effects).},
  author       = {Kovshoff, Hanna and Banaschewski, Tobias and Buitelaar, Jan K and Carucci, Sara and Coghill, David and Danckaerts, Marina and Dittmann, Ralf W and Falissard, Bruno and Grimshaw, Dina Gojkovic and Hollis, Chris and Inglis, Sarah and Konrad, Kerstin and Liddle, Elizabeth and McCarthy, Suzanne and Nagy, Peter and Thompson, Margaret and Wong, Ian CK and Zuddas, Alessandro and Barke, Edmund},
  issn         = {1044-5463},
  journal      = {JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY},
  keywords     = {ATTENTION-DEFICIT DISORDER,HYPERACTIVITY DISORDER,ADHD,METHYLPHENIDATE,ADOLESCENTS,CHILDREN,METAANALYSIS,MANAGEMENT,ADHERENCE},
  language     = {eng},
  number       = {6},
  pages        = {537--547},
  publisher    = {Mary Ann Liebert, Inc},
  title        = {Reports of perceived adverse events of stimulant medication on cognition, motivation, and mood : qualitative investigation and the generation of items for the medication and Cognition Rating Scale},
  url          = {http://dx.doi.org/10.1089/cap.2015.0218},
  volume       = {26},
  year         = {2016},
}

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