Effects of Discontinuing Methylphenidate on Strengths and Difficulties, Quality of Life and Parenting Stress

Abstract

Objectives: To study the effects of discontinuation of long-term methylphenidate use on secondary outcome measures of strengths and difficulties, quality of life (QoL), and parenting stress. Methods: Ninety-four children and adolescents aged 8 to 18 years who had used methylphenidate for over 2 years were randomly assigned to double-blind continuation of treatment for 7 weeks (36 or 54 mg extended release methylphenidate) or to gradual withdrawal over 3 to 4 weeks placebo. We used mixed models for repeated measures to investigate effects on parent, teacher, and child ratings of hyperactivity/inattention and comorbid symptoms with the Strengths and Difficulties Questionnaire (SDQ), investigator-and teacher-rated oppositional symptoms (Conners Teacher Rating Scale-Revised: short form [CTRS-R:S]), and parent-rated aggression with the Retrospective Modified Overt Aggression Scale. QoL was assessed with the Revised Questionnaire for Children and Adolescents to record health-related quality of life and parenting stress with the Nijmegen Parental Stress Index. Results: Hyperactivity/inattention scores from the parent-and teacher-rated SDQ (difference in mean change over time of respectively:-1.1 [95% confidence interval, CI,-2.0 to-0.3]; p = 0.01;-2.9 [95% CI-2.9 to-0.7; p = 0.01]) and oppositional scores of the teacher-rated CTRS-R:S (difference in mean change-1.9 95% CI [-3.1 to-0.6; p < 0.01]) deteriorated to a significantly larger extent in the discontinuation group than in the continuation group. We did not find effects on other symptom domains, aggression, QoL, and parenting stress after discontinuation of methylphenidate. Conclusion: Our study suggests beneficial effects of long-term methylphenidate use beyond 2 years for oppositional behaviors in the school environment. Similarly, beneficial effects were found on hyperactivity-inattention symptoms as rated by parent and teacher scales, confirming our primary study on investigator ratings of attention-deficit/hyperactivity disorder. However, discontinuation of methylphenidate did not appear to have impact on other comorbid problems or aspects of the child's or parental functioning.

Methylphenidate for attention-deficit/hyperactivity disorder in patients with Smith–Magenis syndrome: protocol for a series of N-of-1 trials

“…The difference between the mean SDQ hyperactivity/inattention ratings in MPH periods and placebo periods was used as a summary measure for the treatment effect in an individual subject. The estimated standard deviation (SD) of 2.3 points for single ratings was used based on a reported standard error for the parent-rated SDQ subscale [42]. Using a test-retest intraclass correlation coefficient (ICC) of 0.84 [43], we decomposed a SD into a within-subject SD of 0.92 and a between-subject SD of 2.11.…”

ADHS im Kindes- und Jugendalter. Update 2020

“…Beim ersten Follow-up nach 10 Monaten waren die ADHS-Score-Effekte nur mehr halb so gut und nach 3 Jahren [162] bei leichter Verbesserung in allen Therapiegruppen nicht mehr signifikant unterschiedlich. Nach 8 Jahren [217] [209]. Daher und auch wegen der negativen Konsequenzen in der Transitionszeit [342] im Erwachsenenalter [259] sollte die Therapie bei persistierender Symptomatik auch über das Adoleszenzalter hinaus fortgesetzt werden.…”

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

“…2 Other studies found no association with QOL. 5,6 It is unclear how much of the negative outcomes associated with ADHD in children can be attributed to impairment resulting from the condition itself and how much is due to the labeling effect of the ADHD diagnosis. 7 H/I behaviors exist on a spectrum and correlate positively with impairment in domains, such as academic performance or socioemotional problems.…”