Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. The effects of methylphenidate on neural systems of attention in attention deficit hyperactivity disorder. Methylphenidate and children with attention deficit disorder. Dose effects on classroom academic and social behavior. Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder. Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom. Effects of OROS Methylphenidate on Academic, Behavioral, and Cognitive Tasks in Children 9 to 12 Years of Age With Attention-Deficit/Hyperactivity Disorder Time-response analysis of the effect of stimulant medication on the learning ability of children referred for hyperactivity. Effects and noneffects of methylphenidate in children with mental retardation and ADHD. Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Positive Effects of Methylphenidate on Inattention and Hyperactivity in Pervasive Developmental Disorders: An Analysis of Secondary Measures The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for Attention Deficit Disorder children Positive Effects of Methylphenidate on Social Communication and Self-Regulation in Children with Pervasive Developmental Disorders and Hyperactivity Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study. Methylphenidate in the treatment of children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder. Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment.
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 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 The short-term , dose-response effects of methylpheni date hydrochloride were evaluated on academic and social classroom measures in 29 children with attention deficit disorder . In a double-blind , cross-over design with order r and omized , children received a placebo for two weeks and three doses of methylpheni date hydrochloride ( 0.15 mg/kg , 0.3 mg/kg , and 0.6 mg/kg ) for one week each . Dependent measures included the output and accuracy of performance in grade -appropriate reading comprehension workbooks and arithmetic problems , spelling word acquisition , and observations of disruptive and on-task behavior . Beneficial drug effects and linear dose-response curves on all dependent measures were found . The results suggest that beneficial methylpheni date effects on classroom behavior may be accompanied by enhanced academic achievement in some hyperactive children BACKGROUND The findings from case reports and patient question naire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder . METHODS Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylpheni date hydrochloride ( 0.1 , 0.3 , and 0.5 mg/kg ) twice daily for 2 weeks each , under double-blind conditions . Treatment effects were assessed using direct observations of child behavior in a simulated ( clinic-based ) classroom and using rating scales completed by the parents , teachers , and physician . RESULTS Methylpheni date effectively suppressed hyperactive , disruptive , and aggressive behavior . There was no evidence that methylpheni date altered the severity of tic disorder , but it may have a weak effect on the frequency of motor ( increase ) and vocal ( decrease ) tics . CONCLUSION Methylpheni date appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder 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 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 Sixteen children meeting diagnostic criteria for Attention Deficit Disorder with Hyperactivity ( ADD-H ) were tested on methylpheni date ( 0.3 mg/kg ) and placebo on cognitive , learning , academic and behavioral measures in a double-blind study . Assessment s were carried out in the laboratory and in the children 's regular classrooms . Results indicate methylpheni date -induced improvements on a majority of the measures . Drug-induced changes reflected increased output , accuracy and efficiency and improved learning acquisition . There was also evidence of increased effort and self-correcting behaviours . It is argued that review ers have underestimated the potential of stimulants to improve the performance of ADD-H children on academic , learning and cognitive tasks 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 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 Stimulant medication efficacy was evaluated in 14 children with attention-deficit hyperactivity disorder and IQs of 48 to 74 in a double-blind crossover study of two methylpheni date doses and placebo . Dependent measures included behavioral ratings , work output , measures of learning , attention and impulsivity , and direct observation of peer social interactions . Nine children ( 64 % ) were methylpheni date -responders , based upon the Conners Hyperactivity Index . Significant gains in on-task behavior and attentional skills were noted with methylpheni date in comparison to placebo . No improvement on measures of learning or social interactions were observed . Results extend and replicate previous research conducted by the authors 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 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 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 This report examined the effect of methylpheni date on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity in a secondary analysis of RUPP Autism Network data . Participants were 33 children ( 29 boys ) between the ages of 5 and 13 years who participated in a four-week crossover trial of placebo and increasing doses of methylpheni date given in r and om order each for one week . Observational measures of certain aspects of children ’s social communication , self-regulation , and affective behavior were obtained each week . A significant positive effect of methylpheni date was seen on children ’s use of joint attention initiations , response to bids for joint attention , self-regulation , and regulated affective state . The results go beyond the recent literature and suggest that methylpheni date may have positive effects on social behaviors in children with PDD and hyperactivity 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 OBJECTIVE To examine the short-term efficacy of methylpheni date in the treatment of youths with bipolar disorder ( BD ) and comorbid attention deficit/hyperactivity disorder ( ADHD ) . METHOD A 4-week double-blind , placebo-controlled trial in youths ages 5 to 17 years was conducted . Subjects met DSM-IV criteria for bipolar disorder and ADHD , were currently receiving a stable dose of at least one thymoleptic , and while euthymic continued to have clinical ly significant symptoms of ADHD . Patients received 1 week each of placebo , methylpheni date 5 mg twice daily , methylpheni date 10 mg twice daily , and methylpheni date 15 mg twice daily using a crossover design . Subjects were r and omly assigned to receive one of six possible dosing orders . At study 's end , and before the blind being broken , a " best dose week " for each subject was determined . The primary outcome measure was the total score on the parent-completed ADHD Rating Scale-IV . RESULTS Sixteen patients , with a mean age of 10.43 ( SD 3.14 ) years completed the trial . Lower scores during best dose treatment compared to the week of placebo treatment were found on the ADHD Rating Scale-IV ( p < .05 ) , suggesting a therapeutic benefit . A large effect size ( Cohen 's d = 0.90 ) was found for methylpheni date . Treatment was generally well tolerated . CONCLUSIONS Euthymic youths with bipolar disorder and ADHD may benefit from short-term concomitant treatment with methylpheni date OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . 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 receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years
What this study adds The results suggest that among children and adolescents with a diagnosis of ADHD , methylpheni date may improve teacher reported symptoms of ADHD and general behaviour and parent reported quality of life .
Methylpheni date is associated with an increased risk of non-serious but not serious adverse events .
Study question Is methylpheni date beneficial or harmful for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) in children and adolescents ?