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    3 Ways Pharmacogenetic Testing Can Personalize ADHD Treatment

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    Posted by Genomind on Sep 17, 2020 10:37:43 AM

    If you’ve watched your child struggle for months to maintain focus or sit still, it can be a relief to hear a diagnosis of attention deficit hyperactivity disorder (ADHD). Now you understand why school or activities may be difficult for your child.

    Plus, getting a proper diagnosis is an important step in helping your child get treatment and navigate everyday life.

    But if your child’s clinician recommends ADHD medication, you likely have a few more hurdles ahead. Though there are many medications that can help children with ADHD, it can be a challenge to find the appropriate one for your child.

    “I’ve been a clinician for 30 years, and it’s well-established that not all kids respond to the most commonly prescribed medications for ADHD,” says Amy Edgar, APRN, a nurse practitioner and founder of the Children’s Integrated Center for Success in Allentown, Pennsylvania.

    In some cases, the medication simply won’t work for your child. In others, a child may experience side effects, such as sleep problems, weight loss, irritability, headaches, or dulling or “flattening” of emotions.

    What to do? One option: Some clinicians may order a pharmacogenetic (PGx) test, which can provide information about a patient’s unique genetic makeup to help them personalize treatment.

    Edgar, for example, uses Genomind® Professional PGx Express™, which looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions, including ADHD, and 130+ medications to help clinicians determine:

    • Which medications will likely be the most effective
    • Which medications may have side effects
    • How you metabolize medications for personalized dosing guidance

    Edgar uses this information, along with her clinical evaluation and the wishes of the child and parents, to tailor treatments for each child. “We put all of that together, and that’s how we understand a child and are able to put together a high-value target for treatment,” Edgar says.

    Here are three ways PGx testing may help if your child has ADHD.

    PGx Can Help Clinicians Determine Which Medications to Try

    ADHD medications fall into two main classes: stimulants and nonstimulants. Though they can both be used to treat ADHD, they work differently, and children may not react to them in the same way.

    Stimulants

    This class includes methylphenidate (for example, Ritalin or Concerta) and amphetamines (for example, Adderall or Vyvanse).

    Stimulants, Edgar explains, give dopamine to your brain. Dopamine is a neurotransmitter, meaning it transmits signals in different areas of the brain. Dopamine is tied to attention, motivation, and movement.

    “Stimulants are waking up part of the brain that’s asleep for the child,” Edgar says. “It turns on executive function powers. Now, attention regulation is not so challenging, and they’re less easily distracted.”

    Nonstimulants

    This class includes atomoxetine (Strattera).

    Nonstimulants target norepinephrine, another type of neurotransmitter. Like dopamine, norepinephrine increases activity in the part of the brain that helps children stay on task, manage impulses, and solve problems.

    “These medications are working on a different molecule than stimulants, but the impact is the same,” Edgar says. “They’re a nice alternative if a child isn’t a good candidate for a stimulant.”

    A subgroup of nonstimulants includes clonidine (Kapvay) and guanfacine (Intuniv). These medications work well “when the target is hyperactivity,” Edgar says. That’s because they modulate norepinephrine and lessen the stimulation in the body’s central nervous system. The result is a calming effect that helps improve concentration.

    How the Genomind Test Can Help

    The traditional way of starting a child on ADHD medication can include cycles of trial and error. “You pick one medication, and you switch, switch, switch on one side of the class,” Edgar says. “If that doesn’t work, you go to the other side of the class.”

    With the Genomind test, clinicians can see a child’s dynamic genes, as well as degrees of variation within those genes, to provide insight into how a medication might work for that particular child.

    “The COMT gene is one of my favorites,” Edgar says. “It has three different presentations—one being typical and the other two being atypical. One of the atypical presentations makes you a good candidate for stimulant medications.”

    For Edgar, the Genomind test helps her make more informed medication decisions the first time around. “We know that stimulants aren’t right for every child,” she says. “This test gives me a piece of information that tells me why, or possibly why, and helps me decide based on the individual where to start with medication.”

    PGx Can Help Clinicians Determine Which Doses to Try

    After a clinician picks an ADHD medication class—stimulants or nonstimulants—the next step is figuring out which medication within that class and at which dose.

    This is where the Genomind test information on a child’s CYP450  genes can help, Edgar says. CYP450 genes, often called metabolism genes, are responsible for how your child’s body breaks down medication.

    Poor or Intermediate Metabolizer

    If your child’s body metabolizes a medication too slowly, the medication stays active longer and may be associated with side effects.

    Rapid Metabolizer

    If your child’s body metabolizes a medication too quickly, your child may not get any benefit from the prescribed dose. The dose may need to be increased to reach a therapeutic effect.

    How the Genomind Test Can Help

    Edgar provides an example: Let’s say a clinician determines that your child may respond well to stimulant medication and specifically to Ritalin. “Then we’re going to start a Ritalin trial,” Edgar says.

    On the other hand, the other stimulants (amphetamines) may be impacted by CYP450 genes. “Let’s go look at the metabolism genes and make sure they’re metabolizing the medication typically,” she adds. “If they’re not—if they’re a poor, an intermediate, or a rapid metabolizer—that has an impact on dosing.”

    Some kids, she explains, will need a lower dose. Others will need a higher dose or even a split dose to get the medication to be effective evenly throughout the day.

    On the flip side, the Genomind test can also help clinicians determine if it’s time to take a child off of medication. “Using this tool, I take kids off medication as often as I put them on,” Edgar says.

    Sometimes new patients will come to her already on the highest possible doses of stimulants or who are on a combination of medications, and they’re experiencing a cluster of side effects that are counterproductive to treating their ADHD.

    “Under those conditions, I will start to decrease until we get to an acceptable quality of life for the child and the family,” Edgar says. “And then we can decide on a new course of treatment that will allow them to see better outcomes.”

    PGx Can Help Families Focus on What Matters Most to Them

    Children with ADHD may share similar symptoms, but each child is unique and will have individual treatment goals. For example, one child may need more help staying focused at school, but another child may be more concerned about handling social interactions.

    The goal of ADHD treatment is to improve the quality of life for the child and the family. The Genomind test can help her evaluate different medications against the primary symptom that the child and family have defined as their main target, Edgar says.

    “Using precision medicine allows us to improve the quality of the family’s experience,” Edgar says. By taking into account a child’s genes along with their medical history, lifestyle, and other factors, Edgar can make smarter decisions about which ADHD medications to use and how much.

    With this strategy, Edgar says her clinic is able to see positive results in an average of three visits. For her, that means they’ve found the right medication and the right dose for that child, and the child and family are seeing fewer symptoms with minimal side effects.

    “Everyone feels like this is a good thing,” Edgar says. “That’s how we evaluate success with medication trials.”

    Does Your Medication Work for You?

    Get a lifetime of smarter mental health treatment guidance. Genomind’s leading pharmacogenetic test was designed to help your clinician personalize your treatment plan based on your genetic profile.

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    Topics: ADHD

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