The possible effect of methylphenidate on kleptomania in a school-age girl with attention-deficit/hyperactivity disorder

Abstract

Kleptomania is an impulse-control disorder (ICD) defined as the recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. Kleptomania is a relatively rare condition; therefore, few studies have been conducted, and the treatment of the disorder tends to be based on small studies or case reports [1, 4, 6, 8]. Because the frequency of attention deficit/ hyperactivity disorder (ADHD) was found to be higher in patients with ICD [2], some research has focused on the effects of ADHD drugs on the treatment of kleptomania. Two different case reports examined the effect of methylphenidate (MPH) in these patients. In the first report, the authors showed that a combination of sertraline and MPH was successful in treating a child with kleptomania and ADHD [4]. In the second report, the positive effect of MPH on kleptomania was examined on an adolescent with kleptomania and ADHD [8]. The current report presents the case of a 7-year-old girl with kleptomania and ADHD who displayed a complete remission from kleptomania during MPH therapy. The subject patient was referred to the child and adolescent psychiatry outpatient clinic with complaints of stealing behavior, oppositional behavior, and inattention. Her stealing behavior had been observed since she had attended kindergarten. She had stolen her friends’ school materials, including pencil sharpeners, pen cap, eraser dust, a puzzle piece, or Legos. The frequency of her stealing behaviors increased over time, and for last 6 months, she had been stealing these materials nearly every day. Her parents reported that although she collected the things that she had stolen, she almost never used them. They also reported that the girl did not steal the items in anger, and her stealing behavior did not show a temporal relationship with her oppositional attitudes. Although her parents were unsure whether she experienced tension prior to stealing, she typically seemed to be comfortable after the acts. Although the parents had used various punishments to reprimand her for her actions, no reduction in her stealing behaviors was observed. During her psychiatric assessment, inattentiveness, mild hyperactivity, and impulsiveness were clinically observed. There were no signs of anxiety, elevated or depressed mood, psychosis, or compulsive behaviors. Her physical examination was within normal limits, and she had no history of any physical disease. According to Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), she met criteria for ADHD (inattentive type) and kleptomania. The severity of her ADHD and kleptomania were detected with using Conner’s Parent Rating Scale and Clinical Global Impression Scale (Table 1) [5, 7]. The patient’s parents were reluctant to try behavioral intervention, so it was not undertaken at this stage. An 18 mg osmotic-release oral system MPH treatment was initiated daily. It resulted in moderate improvement in the girl’s ADHD symptoms and the complete resolution of the kleptomania within the first 10 days. The parents reported improvement in her ADHD, and her coexisting disruptive behavioral disorders’ symptoms continued over time. Complete resolution of the kleptomania continued as well. At the 4-month follow-up, the girl had not exhibited any stealing behavior. According to DSM-IV-TR, when diagnosing kleptomania, a patient’s stealing behavior is not better accounted for S. Yilmaz (&) A. Bilgic Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey e-mail: drsavash@gmail.com