Clinical and Neuropsychological Predictors of Methylphenidate Response in Children and Adolescents with ADHD: A Naturalistic Follow-up Study in a Spanish Sample.

María Vallejo-Valdivielso,Juan J Marín-Méndez,Cesar A Soutullo,Pilar De Castro-Manglano,Azucena Díez-Suárez

doi:10.2174/1745017901915010160

María Vallejo-Valdivielso, Juan J Marín-Méndez + Show 3 more

Open Access

https://doi.org/10.2174/1745017901915010160

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Abstract

Background:Methylphenidate (MPH) is the most commonly used medication for Attention-Deficit/Hyperactivity Disorder (ADHD), but to date, there are neither consistent nor sufficient findings on conditions differentiating responsiveness to MPH response in ADHD.Objective:To develop a predictive model of MPH response, using a longitudinal and naturalistic follow-up study, in a Spanish sample of children and adolescents with ADHD.Methods:We included all children and adolescents with ADHD treated with MPH in our outpatient Clinic (2005 to 2015), evaluated with the K-SADS interview. We collected ADHD-RS-IV.es and CGI-S scores at baseline and at follow up, and neuropsychological testing (WISC-IV, Continuous Performance Test (CPT-II) & Stroop). Clinical response was defined as >30% reduction from baseline of total ADHD-RS-IV.es score and CGI-S final score of 1 or 2 maintained for the previous 3 months.Results:We included 518 children and adolescents with ADHD, mean (SD) age of patients was 11.4 (3.3) years old; 79% male; 51.7% had no comorbidities; and 75.31% had clinical response to a mean MPH dose of 1.2 mg/kg/day. Lower ADHD-RS-IV.es scores, absence of comorbidities (oppositional-defiant symptoms, depressive symptoms and alcohol/cannabis use), fewer altered neuropsychological tests, higher total IQ and low commission errors in CPT-II, were significantly associated with a complete clinical response to methylphenidate treatment.Conclusion:Oppositional-defiant symptoms, depressive symptoms, and a higher number of impaired neuropsychological tests are associated with worse clinical response to methylphenidate. Other stimulants or non-stimulants treatment may be considered when these clinical and neuropsychological variables converged in the first clinical interview.

Highlights

Attention-Deficit/Hyperactivity Disorder (ADHD) is a heter-ogeneous neurodevelopmental disorder defined as develop-mentally inappropriate levels of hyperactivity, impulsivity and/or inattention [1, 2]
Oppositional-defiant symptoms, depressive symptoms, and a higher number of impaired neuropsychological tests are associated with worse clinical response to methylphenidate
According to the multimodal treatment study of ADHD (MTA) [76], we found that children with the most severe levels of ADHD before MPH treatment showed less chance of response than children with less severe ADHD

Summary

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a heter-ogeneous neurodevelopmental disorder defined as develop-mentally inappropriate levels of hyperactivity, impulsivity and/or inattention [1, 2]. Clinical Practice & Epidemiology in Mental Health, 2019, Volume 15 161 interviews with the patient and parents, information from teachers’ questionnaires or interviews [6] and neuropsychological evaluation of intellectual function and Executive Function (EF) [7]. ADHD may be associated with multiple neuropsychological deficits [8 - 12], in the measures of EF [13 - 17]. These studies conclude that the differences between ADHD and controls are focused on inhibition [18], working memory [19, 20], attentional set-shifting and planning [21, 22], reaction time variability [23, 24], and emotional dysregulation [25]. Methylphenidate (MPH) is the most commonly used medication for Attention-Deficit/Hyperactivity Disorder (ADHD), but to date, there are neither consistent nor sufficient findings on conditions differentiating responsiveness to MPH response in ADHD

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