The use of stimulant drugs for the treatment of children with attention-deficit hyperactivity disorder (ADHD) is one of the most widespread pharmacological interventions in child psychiatry and behavioral pediatrics. This treatment is well grounded on controlled studies showing efficacy of low oral doses of methylphenidate and amphetamine in reducing the behavioral symptoms of the disorder as reported by parents and teachers, both for the cognitive (inattention and impulsivity) and noncognitive (hyperactivity) domains. Our main aim is to review the objectively measured cognitive effects that accompany the subjectively assessed clinical responses to stimulant medications. Recently, methods from the cognitive neurosciences have been used to provide information about brain processes that underlie the cognitive deficits of ADHD and the cognitive effects of stimulant medications. We will review some key findings from the recent literature, and then offer interpretations of the progress that has been made over the past decade in understanding the cognitive effects of stimulant medication on individuals with ADHD. Neuropsychopharmacology Reviews (2011) 36, 207-226; doi:10.1038/npp.2010; published online 29 September 2010Keywords: methylphenidate; amphetamine; dopamine; prefrontal cortex; executive function; cognitive enhancement
INTRODUCTIONCognitive deficits and behavioral symptoms associated with attention-deficit/hyperactivity disorder (ADHD) have been studied intensively and are well documented in the literature. Stimulant drugs (methylphenidate (MP) and amphetamine (AMP)) are particularly effective for the clinical treatment of ADHD, and accordingly, pediatricians and psychiatrists have been prescribing them for over seven decades (Bradley, 1937). Clear reductions in symptoms justify treatment with stimulant medications (MTA, 1999b), but the cognitive effects are less clear. Here, we will review the current understanding of some underlying neural processes that may account for the ADHD symptoms of inattention and impulsivity, and we will review evidence from neuropsychological and neuroimaging studies about how stimulant medications may affect these processes. To focus our review, we will not revisit related topics that are addressed elsewhere: the medical use of non-stimulant drugs to treat ADHD (Dopheide and Pliszka, 2009;Waxmonsky, 2005), the non-medical use of stimulants and non-stimulants for cognitive enhancement (Sahakian and Morein-Zamir, 2007;Stix, 2009), and nonmedical alternative treatments based on neurofeedback (Gevensleben et al, 2009) and working memory training (Klingberg et al, 2005) that have recently been evaluated and have gained some support in randomized clinical trials.In the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, Version IV (APA, 1994(APA, , 2000, the cognitive symptoms of ADHD are grouped into two domains: inattention and hyperactivity/impulsivity. Currently, nine are specified for inattention (poor attending to details, sustaining attention, lis...