The Effects of Methylphenidate on the Classroom Behavior of Elementary School—Age Children With Cerebral Palsy: A Preliminary Observational Analysis

Abstract

High- and low-dose methylphenidate administration was evaluated prospectively for 3 elementary school-age children with cerebral palsy, cognitive impairments, and attention-deficit hyperactivity disorder (ADHD) symptoms using single-case, randomized, double-blind, placebo-controlled designs. An observational time sampling protocol was used to directly measure and quantify classroom behavior. Summary level analysis showed that (1) low-dose (0.3 mg/kg/dose) administration was associated with clinically significant (>50%) reductions in stereotyped and disruptive behavior relative to baseline and placebo conditions, (2) high-dose (0.5 mg/kg/dose) administration was associated with exacerbated amounts of stereotyped and disruptive behavior, and (3) no changes were directly observed for task-related behavior at either dose. Results are discussed with respect to previous research with methylphenidate administration and cerebral palsy, and the suggestion is made that further work using larger, randomly selected study samples with complementary measures of behavior and performance appears warranted.

A systematic review of comorbidity between cerebral palsy, autism spectrum disorders and Attention Deficit Hyperactivity Disorder

“…60 However, pharmacological treatments targeting ADHD symptoms in CP have received little attention. Two studies reported that methylphenidate is effective in children with dual diagnosis of CP and ADHD 60,61 and emphasized that low-dose (0.3 mg/kg/dose) methylphenidate was associated with clinical significant reductions of ADHD symptoms in children with CP, at least in the short term. However, caution is recommended as findings cannot be generalized given the small sample size.…”

“…Symons et al evaluated methylphenidate administration in 3 school-aged children with CP and comorbid ADHD symptoms and found that low-dose vs. highdose methylphenidate resulted in clinically significant reductions in directly observed stereotyped and disruptive behavior. 61 Studies belonging to the third group assume that children with CP present with impairments in attention and executive function similar to ADHD children. Bottcher et al tested attention and executive functions with standardized neuropsychological measures in a group of children with unilateral (n ¼ 15) or bilateral (n ¼ 18) spastic CP, highlighting that children with CP had particular difficulties on measures of sustained and divided attention, while no significant differences on attention tasks were found between participants with unilateral and bilateral spastic CP.…”

The effects of neurofeedback training for children with cerebral palsy and co‐occurring attention deficits: A pilot study

“…Medication, such as stimulants, therefore, is a commonly prescribed treatment (Ahn et al, 2021). Although the use of medications shows positive impacts on attention issues in children with CP with ADHD symptoms (Goodman, 1998; Gross‐Tsur et al, 2002; Symons et al, 2007), concerns about side effects from the parents (Gross‐Tsur et al, 2002) prompt the search for alternative treatments.…”

Autism spectrum symptoms in children with cerebral palsy: Prevalence and co-occurring conditions

“…Despite lack of extensive evidence for CP-specific treatment for psychiatric disorders, there is reason to believe that treatment found to be useful for the general population also would benefit children with CP. For emotional disorders, both psycho-therapeutic, psycho-educative as well as pharmacological approaches are being used in children with neurological conditions with positive clinical results (Maguire, Weston, Singh, & Marson, 2014 Symons, Tervo, Kim, & Hoch, 2007). One study has in fact, found untreated AD/HD leading to later peer problems, suggesting early interventions to enhance positive peer relations for children with CP .…”