Which boys respond to stimulant medication? A controlled trial of methylphenidate in boys with disruptive behaviour

Abstract

SynopsisThirty-eight boys, referred for psychiatric treatment because of serious problems of behaviour, underwent a double-blind, placebo-controlled, crossover trial of methylphenidate and placebo. Methylphenidate was an effective treatment over a 3-week period. A good response to methylphenidate was predicted by higher levels of inattentive and restless behaviour, impaired performance on tests of attention, clumsiness, younger age and by the absence of symptoms of overt emotional disorder. DSM-III and ICD-9 diagnoses of ‘hyperactivity’ were not good predictors. The results support the validity of a construct of hyperactivity in describing childhood psychopathology, but emphasize the need for a refinement of diagnostic criteria.

Stimulant Drug Effects on Attention Deficit/Hyperactivity Disorder: A Review of the Effects of Age and Sex of Patients

“…Few studies have systematically studied multiple predictors of response and these have tended to report contradictory findings. For example, whilst both Taylor et al (1987) and Buitelaar et al (1995) found younger age to be a positive predictor of clinical response to MPH, the study of Taylor observed greater pre-treatment attentional impairment, and hyperactivity, poor performance on attentional tests lower IQ scores, and clumsiness in 'responders'. Buitelaar et al (1995) however, found the opposite pattern of effects with respect to attentional impairment, hyperactivity and IQ, furthermore it was also revealed that responders were more likely than non-responders to have anxiety related difficulties [46].…”

“…However, six studies were identified from the literature that directly examined age as a moderator of stimulant treatment outcome in children and adolescents albeit often across a narrow age range [27, 46, 111, [134][135][136] and one in adults [128]. Whilst the findings from these studies are somewhat inconsistent, this is probably a consequence of the small numbers of participants in many studies and the limited age ranges of some.…”

“…Whilst the findings from these studies are somewhat inconsistent, this is probably a consequence of the small numbers of participants in many studies and the limited age ranges of some. Taylor et al (1987) conducted a double-blind, placebo-controlled, crossover trial of MPH and placebo with thirty-eight boys (6 -10 years of age), referred for psychiatric treatment due to serious ADHD MEDICATION MODERATORS 22 behaviour problems. As not all subjects had either an ICD 9 or DSM III diagnosis of ADHD some caution is advised when interpreting the results.…”

A high-density SNP linkage scan with 142 combined subtype ADHD sib pairs identifies linkage regions on chromosomes 9 and 16

“…Parental account of childhood symptom (PACS) is a semi-structured, standardized, investigator-based interview developed as an instrument to provide an objective measure of child behavior. [15][16][17] A trained interviewer administers PACS with parents, who are asked for detailed descriptions of the child's typical behavior in a range of specified situations. Such situations either by external events (for example, watching television, reading a book or comic, playing alone, playing with friends, going to bed, traveling) or by behaviors are shown (for example, crying, worried talk, tempers, fighting with siblings).…”

Speed of Inhibition Predicts Teacher‐rated Medication Response in Boys with Attention Deficit Hyperactivity Disorder

“…The following factors have been identified as predicting a positive response to MPH: higher levels of inattentive behaviour (Buitelaar, Van der Gaag, Swaab-Barneveld, & Kuiper, 1995;Taylor et al, 1987;Thomson & Varley, 1998), higher levels of hyperactive behaviour (Barkley, 1976;Thomson & Varley, 1998;Taylor et al, 1987), lower overall severity of the disorder (Buitelaar et al, 1995), poor performance on tests of attention and concentration (Barkley, 1976), younger age (Taylor et al, 1987), high IQ (Buitelaar et al, 1995), presence of a neurological disorder such as seizures (Thomson & Varley, 1998), positive parent cognitions (Hoza et al, 2000), being male (Handen, Janosky, McAuliffe, Breaux, & Feldman, 1994), higher socio-economic status (Handen et al, 1994), and having the 10-repeat DAT1 allele (Kirley et al, 2003). Thus, poor performance on some cognitive tasks (mainly measuring attention and concentration) has been identified as a predictor, but to our knowledge nobody has studied whether performance on a response inhibition task predicts MPH response.…”