Positive Effects of Methylphenidate on Inattention and Hyperactivity in Pervasive Developmental Disorders: An Analysis of Secondary Measures Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. Combined ω3 and ω6 Supplementation in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Refractory to Methylphenidate Treatment Efficacy of Methylphenidate Among Children with Autism and Symptoms of Attention-Deficit Hyperactivity Disorder Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. Methylphenidate and ADHD: influence of age, IQ and neurodevelopmental status. Efficacy of methylphenidate in children with attention-deficit hyperactivity disorder and learning disabilities: a randomized crossover trial. Methylphenidate for pervasive developmental disorders: safety and efficacy of acute single dose test and ongoing therapy: an open-pilot study. Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder. Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. Effects of OROS Methylphenidate on Academic, Behavioral, and Cognitive Tasks in Children 9 to 12 Years of Age With Attention-Deficit/Hyperactivity Disorder Treatment effects of methylphenidate on behavioral adjustment in children with mental retardation and ADHD. Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study.
BACKGROUND Methylpheni date has been shown elsewhere to improve hyperactivity in about half of treated children who have pervasive developmental disorders ( PDD ) and significant hyperactive-inattentive symptoms . We present secondary analyses to better define the scope of effects of methylpheni date on symptoms that define attention-deficit/hyperactivity disorder ( ADHD ) and oppositional defiant disorder ( ODD ) , as well as the core autistic symptom domain of repetitive behavior . METHODS Sixty-six children ( mean age 7.5 y ) with autistic disorder , Asperger 's disorder , and PDD not otherwise specified , were r and omized to varying sequences of placebo and three different doses of methylpheni date during a 4-week blinded , crossover study . Methylpheni date doses used approximated .125 , .25 , and .5 mg/kg per dose , twice daily , with an additional half-dose in the late afternoon . Outcome measures included the Swanson , Nolan , and Pelham Question naire revised for DSM-IV ( ADHD and ODD scales ) and the Children 's Yale-Brown Obsessive Compulsive Scales for PDD . RESULTS Methylpheni date was associated with significant improvement that was most evident at the .25- and .5-mg/kg doses . Hyperactivity and impulsivity improved more than inattention . There were not significant effects on ODD or stereotyped and repetitive behavior . CONCLUSIONS Convergent evidence from different assessment s and raters confirms methylpheni date 's efficacy in relieving ADHD symptoms in some children with PDD . Optimal dose analyses suggested significant interindividual variability in dose response 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 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 Thirteen children ( ages 5.6 to 11.2 years ) with autism and symptoms of attention-deficit hyperactivity disorder ( ADHD ) participated in a double-blind , placebo-controlled crossover study of methylpheni date ( 0.3 and 0.6 mg/kg per dose ) . Eight subjects responded positively , based upon a minimum 50 % decrease on the Conners Hyperactivity Index . Ratings of stereotypy and inappropriate speech , which are often associated with autistic core features , also decreased . However , no changes were found on the Child Autism Rating Scale , a global assessment of autistic symptomotology . Significant adverse side effects occurred in some children including social withdrawal and irritability , especially at the 0.6 mg/kg dose . Results suggest that methylpheni date can be efficacious for children with autism and ADHD symptoms . However , this group of children seems to be particularly susceptible to adverse side effects 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 ) 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 BACKGROUND In the recent past , psychiatrists and paediatricians have avoided prescribing stimulant medication , such as methylpheni date and dexamphetamine to patients with autism spectrum disorders ( ASD ) because of both doubts about efficacy and concern that these medications make stereotypies worse . Recently , a number of small trials have suggested that methypheni date does have a role in the management of hyperactivity in children with autistic spectrum disorders . METHODS Children with ASD and attention deficit hyperactivity disorder ( ADHD ) , and children with ADHD without ASD received st and ard treatment with methypheni date from one specialist centre . A combination of st and ardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospect i ve study of a further 52 children to be carried out . RESULTS After treatment with stimulants , the subjects in both groups showed statistically significant improvements in target symptoms of ' hyperactivity ' , ' impulsivity ' , ' inattention ' , ' oppositionality ' , ' aggression ' and ' intermittent explosive rage ' . The Clinical Global Impression-Improvement and efficacy index measures also improved in each group . In both the retrospective and the prospect i ve studies , there was no statistically significant difference in the degree of improvements between each group . Importantly , neither tics nor repetitive behaviours worsened in either group . Children in the ' ADHD-only ' group who were prescribed stimulants experienced significant ' nausea ' , ' giddiness ' , ' headaches ' and ' sleep difficulties ' , whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group . CONCLUSIONS Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone . Although r and omized controlled trials remain the gold st and ard for efficacy studies , systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play . Furthermore , such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials 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 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 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 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 OBJECTIVE The aim of this study was to investigate the effects of ongoing methylpheni date ( MPH ) on ADHD-related and autistic symptoms in Pervasive Developmental Disorders ( PDD ) in children who did not present any adverse effects to an initial acute dose administered at the clinic . METHODS Participants included 13 subjects ( 12 males , with a mean age of 7.9 years ) with PDD and moderate to severe hyperactivity/impulsivity . The severity of the symptoms assessment was based on Clinical Global Impression ( CGI ) , Childhood Autism , Child Psychiatric and Conners Parent and Teacher Rating Scales ( CPRS ) . Scores at baseline , and after 1 and 3 months of treatment , were compared to intent-to-treat analyses . RESULTS One ( 1 ) hour after a single MPH dose ( 0.4 mg/kg ) , 5 subjects exhibited increased hyperactivity , stereotypes , dysphoria , or motor tics and were rated as minimally or much worse on the CGI Global Improvement Scale . They received no further treatment with MPH . Four ( 4 ) of the remaining subjects were rated as improved , and four as unchanged ; they proceeded to a 12-week open trial of MPH . Two children remained unchanged : they discontinued treatment after 1 week on maximally tolerated doses . However , in group analyses , behavioral measures of hyperactivity and impulsivity improved significantly , while autism core symptom measures were unaffected . No significant adverse effects were observed in any of the 8 subjects . CONCLUSIONS Administering a single MPH test dose may be useful in identifying children with PDD who may benefit from prolonged therapy 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 INTRODUCTION Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylpheni date preparation ( Medikinet retard , MPH-MR ) , with equal portions of the immediate-release and the sustained-release active substance , and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology . METHODS Eighty five children and adolescents ( 6 - 16 years ) were investigated in a double-blind , r and omized , clinical trial over 5 weeks under a treatment with MPH-MR  using symptom checklists for ADHD , oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) . RESULTS A total of 64.9 % of the children showed oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms . A statistically significant effect was found in the group treated with MPH ( verum-group ) . On the basis of Cohen 's criteria , high effects were found for aggressive symptoms in school ( d = 1.0 ) , but not in the afternoon ( d = 0.4 ) . There were also lower effect sizes for more severe aggressive symptoms . We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention . CONCLUSIONS Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior , especially concerning milder symptoms . The expected correlation between impulsivity and aggressiveness could be confirmed Objective . To assess effects of OROS methylpheni date on cognitive and academic tasks in 9 to 12 year olds with attention-deficit/hyperactivity disorder ( ADHD ) . Methods . A double-blind , within-subject , crossover design was used to compare OROS methylpheni date with placebo in a laboratory classroom setting on several cognitive and academic tasks for 68 children who met r and omization criteria . Results . Performance on the following measures was significantly better when children received individually optimized OROS methylpheni date than placebo :  math fluency and accuracy measured by the Permanent Product Math Test , ADHD symptoms observed in the laboratory setting , computerized indices of attention and impulsivity as measured by the Test of Variables of Attention ( TOVA ) , and visual — spatial working memory ( Finger Windows Backwards ) . Study medication was well tolerated ; adverse events were generally consistent with previous reports . Conclusions . OROS methylpheni date improves performance on measures of attention and vigilance , behavior , and working memory in a laboratory school setting in 9 to 12 year olds with ADHD OBJECTIVE The effects of stimulant medication treatment were investigated in children with mental retardation ( MR ) and attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Parent and teacher behavioral ratings and reports of side effects were obtained for children ( N = 24 , mean age = 10.9 years , SD = 2.4 ) during a placebo-controlled , double-blind , crossover treatment trial with 0.15 mg/kg , 0.30 mg/kg , and 0.60 mg/kg b.i.d . dosages of methylpheni date . RESULTS The most significant improvements occurred at the 0.60 mg/kg methylpheni date dose for teacher ratings of inattention ( p = .024 ) , hyperactivity ( p < .001 ) , aggression ( p < .001 ) , and asocial behavior ( p = .009 ) . No significant improvements , relative to placebo , occurred at the 0.15 mg/kg dosage . Of interest , nearly all significant medication-related behavioral improvements were detected by teachers . However , parents were sensitive raters of side effects , noting more sleeping problems and loss of appetite at the 0.60 mg/kg dose compared with placebo . CONCLUSIONS These results suggest that symptoms of ADHD can be treated successfully in children with ADHD/MR , and consistent with MTA study results , higher doses were most effective . Furthermore , these improvements were not accompanied by increases in symptoms such as staring , social withdrawal , or anxiety OBJECTIVE The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylpheni date , dexamphetamine , and atomoxetine in children and adolescents , within three diagnostic groups : 1 ) autism spectrum disorder ( ASD ) , 2 ) attention-deficit/hyperactivity disorder ( ADHD ) , and 3 ) other psychiatric disorders . METHODS Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 ( n=852,711 ) . Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylpheni date , dexamphetamine , and atomoxetine were extracted from the registers . Prescriptions were also stratified by duration ( < 6 months . vs.≥ 6 months ) . RESULTS Sixteen percent of 9698 children and adolescents with ASD ( n=1577 ) , 61 % of 11,553 children and adolescents with ADHD ( n=7021 ) and 3 % of 48,468 children and adolescents with other psychiatric disorders ( n=1537 ) were treated with one or more ADHD medications . There was a significant increase in prescription rates of these medications for all three groups . From 2003 to 2010 , youth 6 - 13 years of age with ASD , ADHD , and other psychiatric disorders had 4.7-fold ( 4.4 - 4.9 ) , 6.3-fold ( 6.0 - 6.4 ) , and 5.5-fold ( 5.0 - 5.9 ) increases , respectively , in prescription rates of ADHD medications . CONCLUSION This is the largest study to date assessing stimulant treatment in children and adolescents with ASD , and is the first prospect i ve study quantifying the change over time in the prevalence of treatment with ADHD medications in a population -based national cohort of children and adolescents with ASD . The prevalence of stimulant treatment in youth with ASD of 16 % is consistent with earlier studies . The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark . This increase is not limited to only those with ADHD , but includes others with neuropsychiatric disorders , including ASD . The risks and benefits of this practice await further study
No trials reported serious adverse events .
Subgroup analysis by dose did not identify any significant differences in effect on our primary outcomes between low- , medium- or high-dose ranges .
We found that short-term use of methylpheni date might improve symptoms of hyperactivity and possibly inattention in children with ASD who are tolerant of the medication , although the low quality of evidence means that we can not be certain of the true magnitude of any effect .
There was no evidence that methylpheni date has a negative impact on the core symptoms of ASD , or that it improves social interaction , stereotypical behaviours , or overall ASD .
BACKGROUND Children with autistic spectrum disorder ( ASD ) frequently present with inattention , impulsivity and hyperactivity , which are the cardinal symptoms of attention deficit hyperactivity disorder ( ADHD ) .
The effectiveness of methylpheni date , a commonly used ADHD treatment , is therefore of interest in these children .
OBJECTIVES To assess the effects of methylpheni date for symptoms of ADHD ( inattention , impulsivity and hyperactivity ) and ASD ( impairments in social interaction and communication , and repetitive , restricted or stereotypical behaviours ) in children and adolescents aged 6 to 18 years with ASD .