Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESEfficacy of a New Pattern of Delivery of Methylphenidate for the Treatment of ADHD: Effects on Activity Level in the Classroom and on the Playground
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In the treatment of children with attention-deficit/hyperactivity disorder (ADHD), methylphenidate (MPH) is prescribed to reduce inappropriately high and impairing levels of activity, inattention, and impulsivity in the classroom. But there has been concern that the clinical use of MPH may reduce
METHOD
The detailed methods for this study are described in a report that presents the analyses of the primary outcome measures (Swanson et al., in press). Briefly, children aged 7–12 years, who met DSM-IV criteria for a diagnosis of ADHD and were taking 5 to 15 mg of MPH administered BID or TID, participated in this “proof of concept” study, providing they had normal blood pressure, were not physically ill, and were able to understand that they could withdraw from the study at any time. Children with
RESULTS
Thirty-two children (28 boys and 4 girls; aged 7–12 years, mean age 9.9 years), who met DSM-IV criteria for a diagnosis of ADHD (30 with combined type; 2 with hyperactivity/impulsivity) were enrolled. Upon entry, these subjects were being treated with 5–15 mg of MPH administered BID or TID, with a mean initial MPH dose of 11.6 mg (0.4 mg/kg per day) and a mean absolute daily dose of 28.9 mg (0.9 mg/kg per day). Based on prestudy dosage, each subject was assigned to the low (n = 7), intermediate
DISCUSSION
In the analyses of secondary outcome measures from this “proof of concept” study, we evaluated the effects of two patterns of MPH delivery (EXP and TID), and we found that these two medication conditions produced equal improvements across all three domains (activity, attention, deportment). This finding supports the conceptual framework (based on acute tolerance) for the application of an osmotically driven continuous delivery system (OROS) for a once-a-day dosing formulation of MPH (Concerta).
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Supported by the ALZA Corporation, Mountain View, CA.
Correspondence to Dr. Swanson, Department of Pediatrics, Child Development Center, 19722 MacArthur Blvd., Irvine, CA 92612.
DOI: 10.1097/01.CHI.0000024841.60748.54