Efficacy of methylphenidate in children with attention-deficit hyperactivity disorder and learning disabilities: a randomized crossover trial. Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Methylphenidate and ADHD: influence of age, IQ and neurodevelopmental status. Randomized, placebo-controlled, crossover study of methylphenidate for attention-deficit/hyperactivity disorder symptoms in preschoolers with developmental disorders. Methylphenidate in Children With ADHD With or Without Learning Disability Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. The effects of methylphenidate on neural systems of attention in attention deficit hyperactivity disorder. Long-Term Follow-Up of Children with Mental Retardation/Borderline Intellectual Functioning and ADHD Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Exercise impact on sustained attention of ADHD children, methylphenidate effects Combined ω3 and ω6 Supplementation in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Refractory to Methylphenidate Treatment Randomized controlled double-blind trial of optimal dose methylphenidate in children and adolescents with severe attention deficit hyperactivity disorder and intellectual disability. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study. Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.
OBJECTIVE To determine whether children with attention-deficit hyperactivity disorder ( ADHD ) and learning disabilities respond differently to methylpheni date ( MPH ) compared with children with ADHD only . METHODS We conducted a prospect i ve , double-blind , placebo-controlled , r and omized , 2-week crossover trial of MPH , during which response to MPH was assessed . Learning ability was appraised using the Wide Range Achievement Test , Revised ( WRAT-R ) , for English-speaking students and the Test de rendement pour francophones for French-speaking students . The study was conducted at the Douglas Hospital , a McGill University-affiliated teaching hospital in Montréal . Ninety-five children , aged 6 - 12 years , who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria for ADHD participated in the study , which ran from 2001 to 2004 . The outcome measure used was the Consensus Clinical Response , an indicator of the degree of clinical improvement shown when taking MPH . RESULTS The proportion of children with learning disabilities who responded to MPH ( 55 % ) was significantly smaller ( chi(2)1 = 4.5 , p = 0.034 ) than the proportion of children without learning disabilities who responded adequately to MPH ( 75 % ) . This difference was mainly because of children with mathematics disability being particularly unresponsive to MPH ( chi(2)1 = 4.5 , p = 0.034 ) . Children with reading disability did not show this pattern of poor response ( chi(2)1 = 1.0 , p = 0.33 ) . CONCLUSION Children with ADHD and comorbid learning disability tended to respond more poorly to MPH . In particular , children with disability in mathematics responded less to MPH than those without disability in mathematics . Additional therapy may be indicated for this group of patients Twelve children with IQ scores of 50 to 74 ( educable mental retardation ) who met rigorous diagnostic criteria for attention deficit hyperactivity disorder participated in a double-blind crossover study of the efficacy of two doses of methylpheni date compared with placebo . Dependent measures included behavioral ratings , classroom work output , laboratory measures of attention and learning , and direct observations of social behavior . Improvement with medication on the Conners Hyperactivity Index was observed in 75 % of subjects . Significant increases in work output , on-task behavior , and attentional skills were associated with methylpheni date . However , gains in measures of attention were not associated with improvement in learning , as measured by a paired associate learning task . Additionally , no significant increases in appropriate social interactions during free play were associated with methylpheni date . The results suggest that mentally retarded children with attention deficit hyperactivity disorder respond to methylpheni date at similar rates and in similar domains to that of the nonretarded population OBJECTIVE To assess the effect of methylpheni date on the diagnosis of oppositional-defiant disorder ( ODD ) comorbid with attention-deficit hyperactivity disorder ( ADHD ) . METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylpheni date . At least one month after ADHD symptoms were under control , ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes ( P-ChIPS ) . RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylpheni date for ADHD . CONCLUSION Methylpheni date seems to be an effective treatment for ODD , as well as for ADHD itself . The implication s for the treatment of patients with ODD not comorbid with ADHD needs further investigation The present investigation examined the effects of methylpheni date on impulsivity in children with attention-deficit hyperactivity disorder ( ADHD ) . A task was design ed to measure empirically the ADHD child 's proclivity to blurt out incorrect answers before giving a final and /or correct response . Twenty-six ADHD children referred for double-blind placebo-controlled assessment of medication responsiveness and 14 non-ADHD controls were given a visual search word-matching task to assess impulsive responding . An analysis of covariance showed that ADHD children on methylpheni date made fewer impulsive errors than ADHD children on placebo . The control group made fewer impulsive errors than the ADHD children in the placebo condition , but the performance of the ADHD children on medication approximated the performance of the children without ADHD . These preliminary findings suggest that the word-matching task may be a useful tool for assessing impulsive responding and determining the benefits of stimulant medication on impulsivity . ( J Child Neurol 1993;8:157 - 163 ) Sixty-nine children with attention deficit hyperactivity disorder ( ADHD ) underwent blind methylpheni date trials . 36 had ADHD alone ( with or without a learning disability ) and 33 had additional neurodevelopmental disorders . Of the children with ADHD alone , 88 per cent improved significantly on methylpheni date . This did not differ significantly from the 69 per cent response rate for children with ADHD and other neurodevelopmental disorders . The results confirm and add to the research literature indicating that ADHD children who are of preschool age and /or who have co-existing neurological disorders may benefit from methylpheni date OBJECTIVE The aim of this study was to investigate the short-term efficacy and safety of methylpheni date ( MPH ) to treat attention-deficit/hyperactivity disorder ( ADHD ) symptoms in an understudied population of preschoolers with pervasive developmental disorder ( PDD ) or intellectual disability ( ID ) . METHODS Fourteen preschoolers with developmental disorders ( DD , n = 14 ; PDD , n = 12 ; ID , n = 2 ) underwent MPH titration in a single-blind manner followed by a 4-week double-blind crossover phase . Each child was administered placebo for 2 weeks and " optimal dose " for 2 weeks . The primary outcome measure was the Diagnostic and Statistical Manual of Mental Disorders , 4(th ) edition ( DSM-IV ) ADHD subscale of the Conners ' Parent Rating Scale-Revised ( CPRS-R-DSM-IV-ADHD ) . RESULTS MPH improved parent-rated ADHD symptoms of the preschoolers ; 50 % were rated as responders . The CPRS-R-DSM-IV-ADHD subscale was significant for the PDD subgroup ( p = 0.005 , Cohen d = 0.97 ) and marginally significant for the entire DD sample ( p = 0.08 , Cohen d = 0.50 ) . Half of the preschoolers experienced side effects with MPH , including reports of increased stereotypic behavior , upset stomach , sleep-related difficulties , and emotional lability . One child discontinued during titration due to side effects . CONCLUSION The predominant direction of response in these preschoolers with both ADHD and PDD/ID favored MPH , even though the response was more subtle and variable than in older and typically developing children . Due to high rates of adverse effects , preschoolers should be monitored closely Objective : To explore treatment response to Osmotic Release Oral System ® ( OROS ) methylpheni date in children with ADHD with and without comorbid learning disability ( LD ) . Method : Data were analyzed from two 6-week , double-blind , r and omized , placebo-controlled , crossover studies evaluating individually determined doses of OROS methylpheni date versus placebo in 135 children ( ages 9 to 12 years ) with ADHD with or without an LD in reading , math , or both . The sample was demographically diverse , with 31 % females and more than 40 % minority , predominantly African American and Hispanic . On two laboratory school days , participants received either OROS methylpheni date or placebo and were given a battery of cognitive and behavioral tests . Results : Treatment with OROS methylpheni date led to improvement in ADHD Rating Scale scores for participants with or without comorbid LD . Both groups performed better during treatment with OROS methylpheni date than placebo on measures of cognitive skills ( i.e. , Test of Variables of Attention , Finger Windows Backwards ) , academically related tasks ( i.e. , Dynamic Indicators of Basic Early Literacy Skills , Test of H and writing Skills – Revised , Permanent Product Math Test ) , and observed classroom behavior ( i.e. , Swanson , Kotkin , Alger , M-Flynn , and Pelham Scale ) . Conclusion : In children with ADHD with or without comorbid LD  , behavior and performance improved during treatment with OROS methylpheni date OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients OBJECTIVE Recent studies have suggested that attention deficit hyperactivity disorder ( ADHD ) is associated with abnormalities in basal ganglia and prefrontal cortical functioning . However , these studies have primarily relied upon cognitive tasks that reflect impulse control rather than attentional mechanisms . METHOD The authors used functional magnetic resonance imaging to investigate the neural correlates of selective and divided attention in a r and omized , double-blind , placebo-controlled pharmacological challenge with methylpheni date in 15 adolescents with ADHD ( ages 14 - 17 ) , eight adolescents with reading disorder ( ages 12 - 17 ) , and four adolescents with both reading disorder and ADHD ( ages 14 - 18 ) who were scanned during both a methylpheni date and a placebo session . Fourteen healthy comparison subjects ( ages 12 - 20 ) who were not given methylpheni date served as the primary comparison group . RESULTS During the divided attention task , unmedicated subjects with ADHD or reading disorder  recruited the left ventral basal ganglia significantly less than the healthy comparison subjects . Methylpheni date led to an increase in activation in this region but had no effect on task performance .  Subjects with ADHD also recruited the middle temporal gyrus significantly less than the comparison subjects , but methylpheni date did not have a direct effect on activation in this region . CONCLUSIONS These results suggest that ADHD is associated with abnormal processing in attentional networks , with specific dysfunction in striatal circuitry . Methylpheni date may act to normalize activity within this network Fifty-two children ( ages 7 to 14 years ) with moderate mental retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind , placebo-controlled trial of methylpheni date ( MPH ) . Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up . While 72 % of the sample evidence d improvement , over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners . In fact , 22 % of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up . Finally , subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings . The results suggested that children with ADHD and mental retardation or borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder ( ADHD ) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties BACKGROUND Stimulants are not considered appropriate for the treatment of children with conduct disorders ( CDs ) . The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder ( ADHD ) and CD led to the hypothesis that methylpheni date hydrochloride , which is effective in ADHD , would not significantly improve symptoms of CD . METHODS We r and omly assigned 84 children with CD , between the ages of 6 and 15 years , to receive methylpheni date hydrochloride ( up to 60 mg/d ) or placebo for 5 weeks . Behavior was evaluated by parent , teacher , and clinician reports and by direct classroom observations . Two thirds of the children also met criteria for ADHD . RESULTS Contrary to prediction , ratings of antisocial behaviors specific to CD were significantly reduced by methylpheni date treatment . The magnitude of methylpheni date effect indicated meaningful clinical benefit . Partialling out severity of ADHD did not alter the significant superiority of methylpheni date on CD ratings specifically ( P < .001 ) . CONCLUSIONS Methylpheni date has short-term positive effects on children and adolescents with CD . Key aspects of antisocial adjustment appear to be treatment responsive . This effect was independent of severity of the children 's initial ADHD symptoms Attention deficit hyperactivity disorder ( ADHD ) is related to a deficiency of central catecholamines ( CA ) in cognitive , biochemical , and physical tests , and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment . The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity ( PA ) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV ( DSM-IV ) criteria . It is possible that practicing sports assists in the management of the disorder . The children were divided between users ( US ) and non-users ( NUS ) of methylpheni date ( MTP ) , and the groups were compared to evaluate the effect of the drug on cognition after PA . Post-exercise performance on Conner ’s Continuous Performance Test-II ( CPT ) was not affected by MTP , we observed significant improvements in response time , and we saw normalization in the impulsivity and vigilance measures . These results suggest that the improvements in cognition after physical effort are not CA dependent . Additionally , our results suggest that  children ’s attention deficits can be minimized through PA irrespective of treatment with MTP . Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD Children ( 6 - 12 years ) with attention-deficit hyperactivity disorder ( ADHD ) being treated with methylpheni date and st and ard behavior therapy for more than 6 months , whose parents reported no improvement in behavior and academic learning , were r and omly assigned to receive supplementation with a combined ω3 and ω6 preparation or a placebo . Outcome was measured at 3 and 6 months after treatment using a self- assessment checklist completed by the parents . Statistically significant improvement was found in the treatment group compared with the placebo group ( P < .01 ) in the following measures : restlessness , aggressiveness , completing work , and academic performance . Statistically significant improvement was not found at 3 months of treatment between groups but was evident at 6 months of treatment ( P < .05 ) with inattention , impulsiveness , and cooperation with parents and teachers . Distractibility failed to show improvement . Effect sizes ranged from 0.3 to 1.1 at 3 months and 0.2 to 1.4 at 6 months for individual symptom variables BACKGROUND Attention deficit hyperactivity disorder is increased in children with intellectual disability . Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks . METHOD One hundred and twenty two drug-free children aged 7 - 15 with hyperkinetic disorder and IQ 30 - 69 were recruited to a double-blind , placebo-controlled trial that r and omized participants using minimization by probability , stratified by referral source and IQ level in a one to one ratio .  Methylpheni date was compared with placebo . Dose titration comprised at least 1 week each of low ( 0.5 mg/kg/day ) , medium ( 1.0 mg/kg/day ) and high dose ( 1.5 mg/kg/day ) . Parent and teacher Attention deficit hyperactivity disorder ( ADHD ) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures . Clinical response was determined with the Clinical Global Impressions scale ( CGI-I ) . Adverse effects were evaluated by a parent-rated question naire , weight , pulse and blood pressure . Analyses were by intention to treat . TRIAL REGISTRATION IS RCT N 68384912 . RESULTS Methylpheni date was superior to placebo with effect sizes of 0.39 [ 95 % confidence intervals ( CIs ) 0.09 , 0.70 ] and 0.52 ( 95 % CIs 0.23 , 0.82 ) for the parent and teacher Conners ADHD index . Four ( 7 % ) children on placebo versus 24 ( 40 % ) of those on methylpheni date were judged improved or much improved on the CGI . IQ and autistic symptoms did not affect treatment efficacy . Active medication was associated with sleep difficulty , loss of appetite and weight loss but there were no significant differences in pulse or blood pressure . CONCLUSIONS Optimal dosing of methylpheni date is practical and effective in some children with hyperkinetic disorder and intellectual disability . Adverse effects typical of methylpheni date were seen and medication use may require close monitoring in this vulnerable group This pilot study was design ed to assess the short-term effectiveness and side effects of methylpheni date in treating symptoms of attention deficit hyperactivity disorder ( ADHD ) in Native American children ( 5 to 12 years old ) with documented fetal alcohol syndrome ( FAS ) or partial fetal alcohol syndrome . Using strict criteria for the diagnosis of FAS and ADHD , a r and omized double-blind cross-over study of two placebos and a fixed dose of methylpheni date was completed in 4 Native American children in a residential school . Each treatment condition lasted 5 days , and daily observational outcome measures , the Conners Parent Rating Scale ( CPRS-48 ) , and the Conners Teacher Rating Scale ( CTRS-39 ) , were employed . Methylpheni date significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39 . Side effects were similar to those traditionally found in other population s. The promising preliminary results suggest that a more definitive study of methylpheni date in Native and non-Native children with FAS and ADHD is warranted CONTEXT Attention-deficit/hyperactivity disorder ( ADHD ) is a highly prevalent and impairing psychiatric disorder that affects both children and adults . There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD ; however , little is known about the mechanisms by which these different treatments exert their therapeutic effects . OBJECTIVE To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylpheni date hydrochloride vs the nonstimulant atomoxetine hydrochloride . DESIGN Functional magnetic resonance imaging before and after 6 to 8 weeks of treatment with methylpheni date ( n = 18 ) or atomoxetine ( n = 18 ) using a parallel-groups design . SETTING Specialized ADHD clinical research program at Mount Sinai School of Medicine , New York , New York . PARTICIPANTS Thirty-six youth with ADHD ( mean [ SD ] age , 11.2 [ 2.7 ] years ; 27 boys ) recruited from r and omized clinical trials . MAIN OUTCOME MEASURES Changes in brain activation during a go/no-go test of response inhibition and investigator-completed ratings on the ADHD Rating Scale-IV-Parent Version . RESULTS Treatment with methylpheni date vs atomoxetine was associated with comparable improvements in both response inhibition on the go/no-go test and mean ( SD ) improvements in ratings of ADHD symptoms ( 55 % [ 30 % ] vs 57 % [ 25 % ] ) . Improvement in ADHD symptoms was associated with common reductions in bilateral motor cortex activation for both treatments . Symptomatic improvement was also differentially related to gains in task-related activation for atomoxetine and reductions in activation for methylpheni date in the right inferior frontal gyrus , left anterior cingulate/supplementary motor area , and bilateral posterior cingulate cortex . These findings were not attributable to baseline differences in activation . CONCLUSIONS Treatment with methylpheni date and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the pathophysiology of ADHD . These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years
Our study suggests that methylpheni date retains its efficacy in children with ADHD and borderline intellectual functioning or ID
Attention-deficit/hyperactivity disorder ( ADHD ) frequently co-occurs with intellectual disability in children , and may further compromise learning .
Methylpheni date is a first-line treatment for ADHD , however no previous meta- analysis has evaluated its overall efficacy for ADHD in children with comorbid intellectual disability ( ID ) or borderline intellectual functioning .