To review published algorithms for guiding the use of methylphenidate (MPH) in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents.
A consensus roundtable of 12 experts was convened to review the evidence for the safety and efficacy of MPH in the treatment of ADHD, as well as the published algorithms and practice guidelines for using MPH. The experts reviewed the algorithms for practicality and acceptability by clinicians.
Algorithms that included MPH commonly selected it as the initial medication to be employed in the treatment of children with ADHD. Factors involved included its high efficacy, good safety record, and the ubiquitous nature of its appearance in the ADHD treatment literature.
MPH should be considered as the first medication to be used in a treatment algorithm for children and adolescents with ADHD.
"One of the accepted hypotheses for ADHD occurrence is decreased function in the frontal lobe of the cerebrum. In other words, ADHD children have decreased basic motor skills such as balance, coordination, muscle strength, reaction time, and attentiveness (Greenhill, 2006). These children show subaverage brain function and reduced blood flow to the brain on brainwave tests, manifested as a significant drop in metabolic function in the frontal lobe of the cerebrum that controls movement and attentiveness (Korean Academy of Medical Sciences, 2008). "
[Show abstract][Hide abstract] ABSTRACT: We investigated the effects of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. Forty-seven male children (7-13 yr old), who were clinically diagnosed with ADHD at the Balance Brain Center in Seoul, Korea, were included in this study. The complex treatment consisted of visual and auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration. All subjects completed the complex treatment for 60 min/day, 2-3 times/week for more than 12 weeks. Data regarding visual and auditory reaction time and cognitive function were obtained using the Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence (TONI) at pre- and post-treatment. The complex treatment significantly decreased the total reaction time, while it increased the number of combo actions on visual and auditory stimuli (P< 0.05). The Stroop color, word, and color-word scores were significantly increased at post-treatment compared to the scores at pretreatment (P< 0.05). There was no significant change in the TONI scores, although a tendency toward an increase in these scores was observed. In conclusion, complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children. In addition, visual and auditory function might be possible indicators for demonstrating effective ADHD intervention.
"Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioural childhood disorder . The psychostimulant methylphenidate (MPH; Ritalin®) is widely prescribed and effectively reduces the ADHD symptoms of hyperactivity, impulsivity and inattention . However, diagnosis of ADHD relies heavily on subjective interpretations of the diagnostic criteria . "
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) often results in chronic treatment with psychostimulants such as methylphenidate (MPH, Ritalin®). With increases in misdiagnosis of ADHD, children may be inappropriately exposed to chronic psychostimulant treatment during development. The aim of this study was to assess the effect of chronic Ritalin treatment on cognitive and neural development in misdiagnosed “normal” (Wistar Kyoto, WKY) rats and in Spontaneously Hypertensive Rats (SHR), a model of ADHD. Adolescent male animals were treated for four weeks with oral Ritalin® (2 × 2 mg/kg/day) or distilled water (dH2O). The effect of chronic treatment on delayed reinforcement tasks (DRT) and tyrosine hydroxylase immunoreactivity (TH-ir) in the prefrontal cortex was assessed. Two weeks following chronic treatment, WKY rats previously exposed to MPH chose the delayed reinforcer significantly less than the dH2O treated controls in both the DRT and extinction task. MPH treatment did not significantly alter cognitive performance in the SHR. TH-ir in the infralimbic cortex was significantly altered by age and behavioural experience in WKY and SHR, however this effect was not evident in WKY rats treated with MPH. These results suggest that chronic treatment with MPH throughout adolescence in “normal” WKY rats increased impulsive choice and altered catecholamine development when compared to vehicle controls.
"Dosing with ATX involves weight-based dosing up to 1.4 mg/kg/day; benefit is generally observed within 2-8 weeks of initiation of treatment (May and Kratochvil, 2010). In the case of ADHD, practice parameters from the American Academy of Child and Adolescent Psychiatry provide clear guidelines and describe the three common approaches taken by clinicians in dose titration with ATX: prescribing and waiting for the effects to occur, gradual up-titration of the dose until behavioral improvement is seen, and increasing the dose until side effects occur with gradual reduction of the dose to the level before the side effects appeared (Greenhill et al., 2002b; Manos et al., 2007; Daughton and Kratochvil 2009). It has been suggested that treatment algorithms involving the initial use of atomoxetine appear more cost-effective as compared to algorithms involving initial use of MPH or other medications (Garnock-Jones and Keating, 2009). "
[Show abstract][Hide abstract] ABSTRACT: Attention deficit hyperactivity disorder is a developmental disorder with an age onset prior to 7 years. Children with ADHD have significantly lower ability to focus and sustain attention and also score higher on impulsivity and hyperactivity. Stimulants, such as methylphenidate, have remained the mainstay of ADHD treatment for decades with evidence supporting their use. However, recent years have seen emergence of newer drugs and drug delivery systems, like osmotic release oral systems and transdermal patches, to mention a few. The use of nonstimulant drugs like atomoxetine and various other drugs, such as α-agonists, and a few antidepressants, being used in an off-label manner, have added to the pharmacotherapy of ADHD. This review discusses current trends in drug therapy of ADHD and highlights the promise pharmacogenomics may hold in the future.
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