Moderators and Other Predictors of Methylphenidate Response in Children and Adolescents with ADHD.

Barbara D’Aiello,Deny Menghini,Silvia Di Vara,Stefano Vicari,Pietro De Rossi,Italo Pretelli

doi:10.3390/ijerph19031640

Abstract

Methylphenidate (MPH) is the treatment of first choice for developmental ADHD. To date, no reliable method to predict how patients will respond to MPH exists and conflicting results are reported on clinical characteristics of responders. The present study aims to give a more precise characterization of the patients who will respond best to MPH to help clinicians in defining the treatment plan. Age, neuropsychological functioning (i.e., attention and working memory), and behavioral/emotional symptoms of 48 drug-naïve children and adolescents with ADHD (42 boys and 6 girls, age-range 6–16 years, mean age 10.5 ± 2.5 years, mean IQ 101.3 ± 11.2) were studied to assess how these different characteristics affected a single-dose MPH response. Four hierarchical linear regression models were used to explore whether age, neuropsychological measures at baseline, and behavioral/emotional symptoms could predict attention and working memory measures after a single-dose MPH administration. We found that improvement in attention and working memory was predicted by age, neuropsychological measures at baseline, and severity of ADHD symptoms. No behavioral and emotional symptoms predicted single-dose MPH response with the exception of conduct symptoms.

Highlights

Executive functions (EF) are cognitive processes that allow problem-solving behavior geared toward the attainment of a future goal [1]
Working memory deficits are found in 30% to 37% of children with attention-deficit hyperactivity disorder (ADHD) [4,5] and inhibitory control deficits in 21% to Studies have demonstrates that patients with ADHD improve significantly in EF when on methylphenidate (MPH), the first-choice treatment for ADHD in the developmental age [9,10]
We found that attention and working memory improved after a single MPH administration and that age, EF measures at baseline, the severity of ADHD symptoms, and conduct problems modulated MPH effect on EF performances

Summary

Introduction

Executive functions (EF) are cognitive processes that allow problem-solving behavior geared toward the attainment of a future goal [1]. Several studies [2–4] have documented that a set of EF, including response inhibition and working memory, are deficient in attention-deficit hyperactivity disorder (ADHD). Working memory deficits are found in 30% to 37% of children with ADHD [4,5] and inhibitory control deficits in 21% to 46% [4,6–8]. Studies have demonstrates that patients with ADHD improve significantly in EF when on methylphenidate (MPH), the first-choice treatment for ADHD in the developmental age [9,10]. MPH ameliorated inhibitory control [4,11–14], visual-spatial working memory [15], sustained and selective attention [16], and reaction times (RT) [14]. A recent meta-analysis [17] suggests that after a flexible titration, i.e., considering the presence of ADHD symptoms, and tolerated, i.e., considering the presence of dose-limiting adverse effects, higher doses of stimulants were associated with both better efficacy and acceptability

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