Clinical use of a modified release methylphenidate in the treatment of childhood attention deficit hyperactivity disorder

Inyang Takon

doi:10.1186/1744-859x-10-25

Abstract

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood, affecting over 5% of children worldwide. As well as the core symptoms of inattention, hyperactivity and impulsivity, patients often exhibit learning difficulties and impairment in social functioning. The frequency of referral is higher for boys than for girls (about 2:1), and girls are generally older at the time of referral.Pharmacological therapy is considered the first-line treatment for patients with severe ADHD and severe impairment. Stimulant medications are licensed in the UK for the management of ADHD in school-age children and young people, and are effective in controlling ADHD symptoms.While immediate-release preparations of methylphenidate (MPH) have proven effective in the treatment of ADHD, there are a number of problems associated with their use, most notably compliance, stigma and medication diversion. Modified release preparations are now available that overcome the need for multiple daily dosing, and which offer different MPH release profiles, thereby enabling the physician to match the medication to the patient's particular requirements.This review describes the diagnosis, referral and treatment pathways for patients with ADHD in the UK and the practical considerations when initiating pharmacological treatment. The clinical experience of treating ADHD with a modified-release MPH preparation (Equasym XL®) is illustrated with case studies.

Highlights

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood; a recent meta-regression analysis estimated a worldwide prevalence of 5.29% among children and adolescents [1]
This review focuses on the practical and clinical experience with the MR preparation MPH-MR 30:70 in a UK paediatric ADHD clinic
The early identification of ADHD symptoms in children is essential to prevent the complications that arise from late diagnosis

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder in childhood; a recent meta-regression analysis estimated a worldwide prevalence of 5.29% among children and adolescents [1]. Pharmacological therapy is considered the first-line treatment for patients with severe ADHD and severe impairment [9] Stimulant medications, such as methylphenidate (MPH) and dexamfetamine, and the non-stimulant, atomoxetine, are licensed in the UK for the management of ADHD in school-age children and young people, and are effective in controlling ADHD symptoms [9]. The COMACS secondary analyses made it clear that different patients respond in different ways to MPH-MR formulations [35,36] This heterogeneity of response is an important consideration when deciding treatment options for children with ADHD. Dose and duration 20-60 mg/day, titrated to optimum efficacy (3 weeks) Outcome measures Teacher and Parent Conners’ Global Index, CGI-S, CGI-I

Conclusions

Findings

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