ADHD (attention deficit hyperactivity disorder) and Cystic Fibrosis

Question

Our son (18) suffers from CF (permanent antibiotic treatment etc. for the last 15 years). Even since the earliest childhood he showed the typical symptoms of ADHD (attention deficit hyperactivity disorder), a final diagnosis has not been made yet.
(My suspicion is that the physicians are reserved in making that diagnosis, as long as the outer framework conditions are working halfway. But on the other hand our son has probably only passed the secondary school certificate because the teachers had consideration due to his CF...)
Is there any experience with ADHD and CF? Is there especially any experience about the interplay of the possible drugs?
Thanks for your information

Answer

Hello,
if you are talking about the typical symptoms of ADHD, then I assume that the illness has been diagnosed by the corresponding specialized collegues (neurologists and children's psychologists). The conspiciousness of behaviour, which you are probably talking about, is characterized primarily by easy distraction and minor endurance as well as a choleric nature with the affinity to imprudent action, often in combination with hyperactivity. The attention deficit disorder is a multifactorial caused clinical picture, untreated patients and their relatives are often under large pressure. Failure in school or job and development of further psychical disorders are frequent.
Many attributes, also the lack of concentration, could eventually be true for the illness of CF, but could also be a sign of puberty (delayed/prolonged puberty).

There is no data available in the literature that gives information about the frequency of ADHD in CF patients. But of course, children with CF can also suffer from ADHD. I could not find any data about the specific care of children with CF and ADHD.
The most prescribed drug for children with ADHD in Germany is Methylphenidat. There are interactions with several other drugs, such as anti-hypertensive drugs (Guanethidin, Amantadin), anti-coaglulation drugs from the curmarine-type, anti-epileptic drugs, neuroleptika, anti-depressive drugs and antacids. As in some cases of CF antacids are given to improve the effect of the pancreatic enzymes, one has to consider not to take Metyhlphenidat togehter with the antacids but with a time interval inbetween. The other drugs mentioned above do not belong to the "standard CF therapy regimen". However, one has to take into account that Methylphenidat has side effects such as a decreased appetite and a decreased intake of fluid as well as abdominal pain and vomiting. This could be a problem in case of a probable poor nutritional status as a CF patient.
Besides Methylphenidat, there is the drug Atomoxetin which is available for the therapy of ADHD since 2005. The metabolism of the drug itself can be influenced by many other drugs as it is metabolised by a common enzyme-system (cytochrome-system). The latest discovered side effect is the increased risk of commiting suicide. As a CF patient (with a probable liver disease) one has to take into account that this drug can induce liver damage.

Some different clinical questions are arising, which are important for being able to give an adequate answer in this forum. Please contact your pediatrician about this. The diagnosis of the illness and the complexity of the disorder require different approaches of treatment.

Yours sincerely,
C.v.Mallinckrodt

20.11.2008