The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for Attention Deficit Disorder children Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. Relative efficacy of long-acting stimulants on children with attention deficit-hyperactivity disorder: a comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine, and pemoline. Time-response analysis of the effect of stimulant medication on the learning ability of children referred for hyperactivity. Mediators of Methylphenidate Effects on Math Performance in Children with Attention-Deficit Hyperactivity Disorder Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Classroom academic performance: improvement with both methylphenidate and dextroamphetamine in ADHD boys. Improving Homework Performance Among Children With ADHD: A Randomized Clinical Trial Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Childhood hyperactivity and psychostimulants: a review of extended treatment studies. Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. Exercise impact on sustained attention of ADHD children, methylphenidate effects Efficacy of a new pattern of delivery of methylphenidate for the treatment of ADHD: effects on activity level in the classroom and on the playground. Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Efficacy of methylphenidate in children with attention-deficit hyperactivity disorder and learning disabilities: a randomized crossover trial.
There appear to be beneficial effects of stimulant medication on daily classroom measures of cognitive functioning for Attention Deficit Disorder ( ADD ) children , but the specificity and origin of such effects is unclear . Consistent with previous results , 0.3 mg/kg methylpheni date improved ADD children 's  performance on a classroom reading comprehension measure . Using the Posner letting-matching task and four additional measures of phonological processing , we attempted to isolate the effects of methylpheni date to parameter estimates of ( a ) selective attention , ( b ) the basic cognitive process of retrieving name codes from permanent memory , and ( c ) a constant term that represented nonspecific aspects of information processing . Responses to the letter-matching stimuli were faster and more accurate with medication compared to placebo . The improvement in performance was isolated to the parameter estimate that reflected nonspecific aspects of information processing . A lack of medication effect on the other measures of phonological processing supported the Posner task findings in indicating that methylpheni date appears to exert beneficial effects on academic processing through general rather than specific aspects of information processing OBJECTIVE This study examined the effectiveness of stimulant medication on multiple domains of functioning in 36 young ( 5 to 6 years old ) children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Five- and 6-year-old children attending a summer treatment program between 1987 and 1997 underwent a r and omized clinical assessment of the effect of two doses of methylpheni date ( 0.3 mg/kg versus 0.6 mg/kg ) and placebo on social behavior and academic performance . RESULTS Methylpheni date had an effect on all four social behaviors and improved two of the three areas of academic functioning . Dose effects were present for three of the seven dependent measures . Individual analyses indicated a therapeutic response rate between 39 % and 100 % across dependent measures . Furthermore , individual analyses of response indicated that across several important dependent measures , 39 % to 98 % of children showed little incremental improvement with the higher dose compared with the lower dose of stimulant medication . CONCLUSIONS Stimulant medication is an effective treatment for young children diagnosed with ADHD ; however , multiple domains of functioning must be assessed to determine the most effective dose for young children with ADHD 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 Twenty-two children with attention deficit-hyperactivity disorder underwent a double-blind , placebo-controlled , crossover evaluation of the efficacy of st and ard methylpheni date twice a day and comparable doses every morning of a sustained-release preparation of methylpheni date ( SR-20 Ritalin ) , a sustained-release form of dextroamphetamine ( Dexedrine Spansule ) , and pemoline . The children were participating in a summer treatment program in which they engaged in recreational and classroom activities . Dependent measures include evaluations of social behavior during group recreational activities , classroom performance , and performance on a continuous performance task . Results revealed generally equivalent and beneficial effects of all four medications . Dexedrine Spansule and pemoline tended to produce the most consistent effects and were recommended for 10 of the 15 children who were responders to medication . The continuous performance task results showed that all four medications had an effect within 2 hours of ingestion , and the effects lasted for 9 hours . The implication s of these results for the use of long-acting stimulant medication in children with attention deficit-hyperactivity disorder are discussed This report introduces a method for obtaining behavioral time-response information for a short-acting psychotropic drug ( methylpheni date [ Ritalin ] ) that is widely used to treat behaviorally hyperactive children . We used a laboratory learning task to document that between one and two hours after the administration of a single dose of methylpheni date , the drug exerts its maximum effect on performance in a learning task in the laboratory . This effect on cognitive performance dissipates within the same day . This rapid and transient effect of methylpheni date makes it possible to classify patients in a single day into those who respond favorably and those who respond adversely to the drug in terms of its effect on cognitive behavior Objective : Stimulant medications , such as methylpheni date ( MPH ) , improve the academic performance of children with attention-deficit hyperactivity disorder ( ADHD ) . However , the mechanism by which MPH exerts an effect on academic performance is unclear . We examined MPH effects on math performance and investigated possible mediation of MPH effects by changes in time on-task , inhibitory control , selective attention , and reaction time variability . Methods : Children with ADHD aged 7 to 11 years ( N = 93 ) completed a timed math worksheet ( with problems tailored to each individual 's level of proficiency ) and 2 neuropsychological tasks ( Go/No-Go and Child Attention Network Test ) at baseline , then participated in a 4-week , r and omized , controlled , titration trial of MPH . Children were then r and omly assigned to their optimal MPH dose or placebo for 1 week ( administered double-blind ) and repeated the math and neuropsychological tasks ( posttest ) . Baseline and posttest videorecordings of children performing the math task were coded to assess time on-task . Results : Children taking MPH completed 23 more math problems at posttest compared to baseline , whereas the placebo group completed 24 fewer problems on posttest versus baseline , but the effects on math accuracy ( percent correct ) did not differ . Path analyses revealed that only change in time on-task was a significant mediator of MPH 's improvements in math productivity . Conclusions : MPH-derived  math productivity improvements may be explained in part by increased time spent on-task , rather than improvements in neurocognitive parameters , such as inhibitory control , selective attention , or reaction time variability 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 ) Daily academic classroom performance was recorded in a day hospital school using a commonly employed reading and math series as part of an 11-week double-blind , placebo controlled , crossover comparison of dextroamphetamine ( d-AMPH ) and methylpheni date ( MPH ) in 33 hyperactive boys . Students attempted more math and reading tasks while on either active drug . The percent correct and the number of attempted problems of the reading series improved with both drugs while the percent correct for the math series occurred with d-AMPH only . No dose-response relationship was found for either stimulant . Moderate , transient adverse effects were common for both drugs Objective : Evidence indicates that children with Attention Deficit Hyperactivity Disorder ( ADHD ) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework . This study is the first to examine the effects of behavioral , psychostimulant , and combined treatments on homework problems , which have been shown to predict academic performance longitudinally . Method : Children with ADHD ( ages 5–12 , N = 75 , 71 % male , 83 % Hispanic/Latino ) and their families were r and omly assigned to either behavioral treatment ( homework-focused parent training and a daily report card ; BPT + DRC ) or a waitlist control group . Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program . Children ’s objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills . Results : BPT + DRC had large effects on objective measures of homework completion and accuracy ( Cohen ’s ds from 1.40 to 2.21 , ps < .001 ) . Other findings , including unimodal medication and incremental combined treatment benefits , were not significant . Conclusions : Behavioral treatment focused on homework problems results in clear benefits for children ’s homework completion and accuracy ( the difference between passing and failing , on average ) , whereas long-acting stimulant medication result ed in limited and largely nonsignificant acute effects on homework performance Treatment with psychostimulant medication has been shown to improve scholastic functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) . However , the extent to which long-term academic gains are apparent in those having received such treatment remains elusive . This study examined prospect ively the relationship of childhood stimulant treatment to academic functioning during adolescence . Children ( n = 169 ) were initially recruited and diagnosed with ADHD when they were 7 - 11 years old . A sub sample of those with childhood ADHD ( n = 90 ) was reevaluated on average 9.13 ( SD = 1.5 ) years later . Prob and s who did and did not receive treatment with stimulant medication were compared to each other and to a never-ADHD comparison group ( n = 80 ) on three subtests from the Wechsler Individual Achievement Test-II ( WIAT-II ) , as well as high school grade point average ( GPA ) and number of retentions in school as derived from school records . Analyses of covariance controlling for severity of childhood ADHD symptoms indicated that prob and s treated with psychostimulant medication achieved better academic outcomes , as measured by WIAT-II subtests and high school GPA , than those not treated with psychostimulants ( p < .05 ) . However , treated prob and s did not fare as well as the never-ADHD comparison group . Psychostimulant treatment for children with ADHD may benefit long-term adolescent academic performance , although the extent of improvement is likely to vary as a function of multiple factors ABSTRACT Clinical trials with a treatment duration of at least 3 months were review ed to determine the effect of psychostimulants on the core symptoms of attention-deficit hyperactivity disorder ( ADHD ) and on its commonly associated features . Eighteen studies were identified : 17 were studies of  methylpheni date  , 1 was a study of dextroamphetamine , and none involved  pemoline  or  slow-release stimulants . Eleven of these studies were r and omized controlled trials , whereas seven employed quasi-experimental design s without r and omization . The results of r and omized controlled trials showed that psychostimulants provided greater benefit than did the nonr and omized trials , suggesting that the efficacy of extended treatment may have been underestimated because more seriously disturbed children were assigned to medication treatment than to control treatments in nonr and omized trials . Evidence from the more definitive r and omized controlled trials indicates that stimulants are more effective in ameliorating the core behavioral symptoms of ADHD ( restlessness , inattentiveness , impulsiveness ) than placebos , nonpharmacological therapies , or no treatment-at least in 3 - 7-month trials . During extended psychostimulant treatment , few children become symptom-free , clinical effects may diminish with time , and improvement dissipates rapidly upon discontinuation of medication . There is minimal evidence that extended stimulant treatment improves cognitive deficits or associated problems such as conduct disturbance , low self-esteem , poor peer relationships , or academic underachievement . The belief that stimulants do not improve the long-term prognosis of  children with ADHD  may be based on weakly design ed studies that focus on associated rather than core symptoms . A failure to assign patients of similar clinical severity to different treatment conditions may also have contributed to obscuring the efficacy of extended psychostimulant treatments This study evaluated the separate and combined effects of behavior modification and 2 doses of methylpheni date ( MPH ; 0.3 and 0.6 mg/kg ) compared with baseline ( no behavior modification and a placebo ) on the classroom behavior and academic performance of 31 ADHD ( attention deficit-hyperactivity disorder ) boys attending a summer treatment program . Results revealed significant effects of both interventions , with the mean effect size of medication being more than twice as great as that of behavior modification . Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification , compared with the effects of the low dose of MPH . In contrast , the addition of either dose of MPH result ed in improvement beyond the effects of behavior modification alone . These group effects reflected those obtained in analyses of individual differences . Furthermore , comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other OBJECTIVE To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder ( ADHD ) over 5 years . METHOD Seventy-nine of 91 participants in a 12-month r and omized controlled trial of methylpheni date and parent groups enrolled in a follow-up study . Adherence to stimulants , treatment response , and adverse effects were evaluated annually for 5 years . Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2 , 3 , 4 , and 5 years for 3 groups : adherents , nonadherents on medication , or nonadherents off medication . Controlling for age , gender , and baseline severity , adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses . RESULTS At 2 years , adherents ( n = 41 ) showed greater improvement in teacher-reported symptoms than those off medication ( n = 16 ) and equivalent response to nonadherents on stimulants ( n = 16 ) ( p = .02 ) . At 5 years , adherents ( n = 16 ) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants ( n = 15 ) and those off medication ( n = 14 ) ( p = .04 ) . At year 2 medication status ( beta = 4.67 [ 0.40 - 8.95 , p = .033 ] ) and at year 5 adherence status ( beta = 7.23 [ 3.01 - 11.44 , p = .001 ] ) correlated with higher teacher-reported symptom scores . Clinical ly significant adverse effects were present for 5 years , most commonly loss of appetite . CONCLUSIONS Psychostimulants improve ADHD symptoms for up to 5 years , but adverse effects persist 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 OBJECTIVES To evaluate the pharmacodynamic effects of an experimental ( EXP ) delivery of methylpheni date ( MPH ) in children with attention-deficit/hyperactivity disorder and to investigate the situational nature of effects in laboratory classroom and playground setting s. METHOD A " sipping " study methodology was used to deliver a bolus followed by small but increasing MPH doses as the EXP regimen . A r and omized , double-blind crossover design was used to compare the EXP regimen to a thrice-daily ( TID ) regimen and a placebo ( PLA ) regimen . Measures of efficacy were obtained from a Motionlogger actigraph to quantify activity and from the Swanson , Kotkin , Agler , M-Flynn , and Pelham ( SKAMP ) rating scale to quantify two domains of behavior ( attention and deportment ) . RESULTS Compared with PLA , both EXP and TID delivery of MPH produced large , significant reductions in activity and inappropriate behavior in the classroom , but the two MPH regimens did not differ in onset or duration of effects across the day . The MPH effects were situationally dependent and were smaller for the playground than for the classroom setting s. CONCLUSIONS The findings of this " proof of concept " study support the efficacy of a continuous , ascending delivery of MPH . The situational effects of MPH provide support for the theory of selective effects of stimulants , dependent on the dem and s of the environment The effects of methylpheni date on the academic performance and classroom behavior of 45 adolescents with attention deficit hyperactivity disorder were studied . During a 6-week , placebo-controlled medication assessment in the context of a summer treatment program , participants received a double-blind , crossover trial of 3 doses of methylpheni date . Dependent measures included note-taking quality , quiz and worksheet scores , written language usage and productivity , teacher ratings , on-task and disruptive behavior , and homework completion . Group data showed positive effects of methylpheni date on academic measures ; however , the greatest benefit came with the lowest dose . Although additional benefit did occur for some participants with higher doses , the largest increment of change usually occurred between the placebo and 10-mg dose . Many adolescents did not experience added benefit with increased dosages , and in some cases they experienced deterioration . Guidelines for assessment of medication effects are discussed 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
None of the mediators or moderators tested affected methylpheni date efficacy .
Academic improvements were small compared to symptom improvements ; qualitative changes limited to math .
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD .
Previous review s on stimulant-related academic improvements are inconclusive and focus on task engagement .
Recent literature suggests outcome -domain-specific medication effects that are larger for productivity than for accuracy .
The aims of this study are quantifying methylpheni date effects on academic productivity and accuracy for math , reading , spelling ; exploring the mediating or moderating effects of symptom improvements , demographic- , design - and disorder-related variables .