Efficacy of Atomoxetine for Symptoms of Attention-Deficit/Hyperactivity Disorder in Children with a History of Child Abuse

Objective: Recent studies suggest that the severity and drug response of depression and anxiety are correlated with childhood abuse. However, whether a history of child abuse can predict the severity and/or drug response of attention-deficit/hyperactivity disorder (ADHD) is unclear. Therefore, we conducted a retrospective study to assess the efficacy of atomoxetine in children with a history of child abuse. Methods: We reviewed 41 cases of children treated with atomoxetine. Specifically, we compared dissociation associating symptoms (DAS) and other symptoms (OS) measured via the ADHD Rating Scale (ADHD-RS) in abused and nonabused children at baseline and at 8 weeks after atomoxetine administration. Results: At baseline, abused children had higher total scores (38.7 +/- 9.3 vs. 30.5 +/- 9.4, p=0.011), and greater levels of hyperactivity/impulsivity (17.3 +/- 5.8 vs. 11.3 +/- 6.0, p=0.004) on the ADHD-RS than did nonabused children, whereas the inattention scores were similar between the two groups (21.4 +/- 4.8 vs. 19.2 +/- 4.6). Additionally, the total score and the two subscores decreased at week 8 for both groups. In the nonabused group, DAS (5.5 +/- 2.3 vs. 3.9 +/- 1.7, p<0.001) and OS (25.0 +/- 8.1 vs. 17.4 +/- 6.7, p<0.001) significantly decreased after atomoxetine treatment. However, DAS in the abused group did not change after atomoxetine treatment (5.9 +/- 2.3 vs. 5.1 +/- 1.8), whereas OS significantly decreased (32.8 +/- 7.6 vs. 25.7 +/- 7.2, p=0.002). Conclusions: If DAS were caused by traumatic experiences in abused children, trauma treatment tools other than pharmacotherapy might be useful to treat DAS. These tools may include eye movement desensitization and reprocessing and trauma-focused cognitive behavioral therapy.