1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-8-54 10.15844/pedneurbriefs-8-7-10 Attention Deficit and Learning Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant ADDH And Methylphenidate Response http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 07 1994 01 06 2016 8 7 54 55 Copyright: © 1994 The Author(s) 1994 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children

The dose-response, clinical effectiveness, and response prediction in 76 children with ADDH treated with methylphenidate (MPH) were evaluated by a double-blind, placebo-controlled, crossover study at the Department of Psychology, University of Hawaii, Honolulu.

 Methylphenidate Corpus Callosum Attention Deficit Hyperactivity Disorder

The dose-response, clinical effectiveness, and response prediction in 76 children with ADDH treated with methylphenidate (MPH) were evaluated by a double-blind, placebo-controlled, crossover study at the Department of Psychology, University of Hawaii, Honolulu. Four dose levels (5, 10, 15, and 20 mg) were employed. Effects on classroom functioning, (on-task attention, correct completion of assignments, and teacher ratings), were linear and dose related. Accuracy was enhanced at all dose levels, and task completion was significantly greater at doses above 5 mg. Academic improvement was associated with behavioral gains on teacher ratings. In children failing to respond to low dose MPH, attention changes were responsive to dose increments whereas academic and behavioral improvements failed to occur. A significant subset failed to gain academically from treatment with MPH. [1]

COMMENT. Methylphenidate is again proven effective in the treatment of children with ADDH, and improvements in behavior, attention, and academic functioning may be expected in a large percentage. Response to MPH is related to the dose, especially in tasks requiring attention. In one subset, however, academic performance is unrelated to attentional and behavioral response to MPH. In another subset, MPH is ineffective in all domains of classroom functioning. A child’s academic functioning is most important in assessing response to methylphenidate and the need for dose increments.

The need for subtyping is stressed by reports of brain structural changes in a group of 15 children with ADDH examined by MRI at the Massachusetts General Hospital.The splenial area of the corpus callosum was smaller in ADDH children compared to normal controls. Age was not a factor. [2]

Differences in brain glucose metabolism in girls with ADDH compared to boys are reported in PET studies at the National Institute of Mental Health, Bethesda, MD. Global cerebral glucose metabolism in 5 ADDH girls was 15% lower than in 6 normal girls, but was unchanged in ADDH boys compared to normal boys; it was 20% lower in ADDH girls compared to ADDH boys. Adolescents showed no changes in cerebral glucose metabolism. [3]

Attention deficit hyperactivity disorder in adults is reviewed from the New York State Psychiatric Institute [4]. Placebo-controlled studies of MPH in adults are infrequent and largely disappointing. Psychoactive substance use disorder is commonly associated with diagnoses of ADDH in adults and stimulant medication should be used with caution. Adult ADDH is often a self-diagnosed condition, and an excuse for job failure, divorce etc, according to one practicing psychiatrist.

 Rapport MD Denney C DuPaul GJ Gardner MJ Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children J Am Acad Child Adolesc Psychiatry 1994 Jul-Aug 33 6 882 893 10.1097/00004583-199407000-00015 8083146 Semrud-Clikeman M Filipek PA Biederman J Steingard R Kennedy D Renshaw P Attention-deficit hyperactivity disorder: magnetic resonance imaging morphometric analysis of the corpus callosum J Am Acad Child Adolesc Psychiatry 1994 Jul-Aug 33 6 875 881 10.1097/00004583-199407000-00014 8083145 Ernst M Liebenauer L King AC Fitzgerald GA Cohen RM Zametkin AJ Reduced brain metabolism in hyperactive girls J Am Acad Child Adolesc Psychiatry 1994 Jul-Aug 33 6 858 868 10.1097/00004583-199407000-00012 8083143 Shaffer D Attention deficit hyperactivity disorder in adults Am J Psychiatry 1994 May 151 5 633 638 Editorial 7909410