REVIEW OF: López FA et al, J Child Adolesc Psychopharmacol 2021;31(3):179–186

STUDY TYPE: Randomized, double-blind, multicenter, placebo-controlled study

We know that when caregivers are doing better, kids tend to do better developmentally. But when kids improve in treatment, do caregivers find relief?

In this three-week, randomized, double-blinded, multicenter drug trial, 81 children with ADHD ages 6–12 years were treated with delayed-release/extended-release methylphenidate (DR/ER-MPH; Jornay PM), while 80 others received placebo. Outcome scales included several measures of caregiver strain and ADHD symptoms.

Higher caregiver strain scores predicted high severity on most ADHD rating scales. Lower caregiver stress tracked with improved ADHD and global function. Over the course of treatment, a drop in caregiver stress tracked with the child doing better. For instance, when there was a 30% improvement in the ADHD-Rating Scale IV and the Clinical Global Impressions scale, there was a nine-point drop in the caregiver strain scale. Put another way, for every four children treated, one caregiver experienced less stress.

The study had notable limitations. Three weeks is a brief run for chronic and complex problems like caregiver stress, and the study did not look at other stressors in the lives of the caregivers. Also, half of the children did a washout of prior medication before starting DR/ER-MPH, which might have affected stress measures in the caregivers. The study also excluded kids with comorbid conditions, so these kids might not represent the usual complex diagnostic picture we see in day-to-day practice.

Carlat Take

Perception may be reality—caregivers do experience stress with their children’s ADHD behaviors. We want to see more studies on this, but in the meantime, treating the child may help some caregivers as a welcome bonus.