Clinical Evaluation of Subjective and Objective Changes in Motor Activity and Attention in Children with Attention-Deficit/Hyperactivity Disorder in a Double-Blind Methylphenidate Trial

Abstract

The aim of this study was to determine drug-dependent effects on attention and motor activity in children with attention-deficit/hyperactivity disorder (ADHD) in a double-blind methylphenidate (MPH) trial using both subjective behavior ratings and objective measures of function. In particular, we were interested in the relationship between changes of those subjective and objective measures. A total of 44 ADHD children with the combined subtype completed a randomized, double-blind, placebo-controlled, crossover trial with 2 doses of MPH (0.25; 0.5 mg/kg body weight) and placebo. In each condition, computerized attention tasks were performed, teacher-behavior ratings were obtained, and actigraph data were collected in both clinical and naturalistic settings. Trend tests revealed linear effects of MPH dose on actigraph data in the test session (p = 0.02) and at school (p = 0.001), as well as on sustained attention (p < 0.001), while inhibitory control showed a quadratic dose-response curve (p < 0.001). Multivariate regression analyses revealed that changes of both, hyperactive-impulsive symptoms (28%) and inattentive symptoms (23%) could be explained by objective changes of motor activity. Thus, for clinical practice, it should be taken into account that behavior ratings of ADHD symptoms seemed to be predominantly influenced by changes of motor activity.

Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder

“…This finding reinforces previous findings of dose-response relationships, where higher doses of stimulant medication were generally more effective in improving cognitive function in children with ADHD (Greenhill, 2001). Some studies that administered multiple doses of methylphenidate also noted a quadratic dose-response relationships for performance on tests of inhibitory control (e.g., Konrad et al, 2005), which is consistent with the findings of studies on catecholamine modulation of prefrontal neurons (see reviews by Arnsten, 1998;Arnsten and Li, 2005). Table 2 highlights cognitive functions that demonstrate reliable improvement when children with ADHD are treated with methylphenidate.…”

?Show Me How Your Wrist Moves, and I Will Tell You How Active You Are!? Towards an Objective Measure of Preschoolers? Motor Activity

“…Other frequent use of accelerometry is the study of motor activity in neonates [25], infants and children [25], adolescents with chronic pain [26] or obesity [27][28][29][30]. Since overactivity is conceptualized as one of the core features of the DSM-IV ADHD diagnosis [31], it is not surprising that accelerometry specifically designed to capture motor activity, is also employed among diagnosed ADHD subjects.…”

“…They finally argue for the inclusion of an objective assessment within a multi informant multi method approach as a good method for generating a quantitative reliable trait of hyperactivity [40]. With regard to the clinical issues, several studies document drug efficiency for the reduction of objective motor activity in ADHD patients in clinical setting during test sessions [26], in school setting [41], or at the playground [39] as well as during the night [42][43][44][45]. Other studies demonstrate the reduction of objective motor activity among ADHD children after intervention programs such as yoga sessions [21].…”

“…This could be helpful for the early identification of EB problems through its inclusion in a multi-method, multi-informant approach and by providing a benchmark for conventional questionnaire-based assessment, which is affected by respondents' subjectivity [23]. It may also be helpful for objectively estimating treatment or intervention efficacy [26].…”

Effect of Methylphenidate On Neuropsychological Functions in Children with Attention Deficit Hyperactivity Disorder

“…Bu konuda yapılan araştırmaların çoğunluğunda metilfenidat tedavisinin dikkati sürdürme/uyanıklık, davranış ketlemesi, çalışma belleği, bilgi işlemleme hızı, tepki verme zamanı ve dikkat kurulumunu değiştirme gibi işlevler üzerine olumlu etkileri olduğu bildirilmiştir. 13,[18][19][20][21][22][23][24] Ancak diğer bazı araştırmalarda, metilfenidatın bilişsel işlevler üzerinde anlamlı etki yapmadığı bulunmuştur. [24][25][26] Bir çalışmada ise metilfenidatın bilişsel işlevler üzerinde olumsuz etki yaptığı görülmüştür.…”