Guidelines and algorithms for the use of methylphenidate in children with Attention-Deficit/ Hyperactivity Disorder.
ABSTRACT 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.
Article: Pharmacology of autism[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this review is to discuss the pharmacology of autistic disorder (autism) and other pervasive developmental disorders (PDDs) from the perspective of specific target symptom domains of behavior. Drug treatment strategies directed toward the following target symptom domains are included: motor hyperactivity and inattention; interfering stereotypical and repetitive behavior; aggression and self-injurious behavior (SIB); and the core social impairment of autism and other PDDs. For motor hyperactivity and inattention, studies have indicated that the α2 adrenergic agonists, clonidine and guanfacine, are useful. A placebo-controlled study by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network found methylphenidate to be efficacious in 49% of subjects with various PDDs for these target symptoms. Preliminary data with the norepinephrine reuptake inhibitor atomoxetine are encouraging. For interfering stereotypical and repetitive behavior, controlled studies of the selective serotonin reuptake inhibitor fluvoxamine found the drug to be more efficacious and better tolerated in adults than children with autism and other PDDs. A recent controlled study of low-dose liquid fluoxetine found the drug more efficacious than placebo for interfering repetitive behavior and well tolerated. A large placebo-controlled study of the atypical antipsychotic risperidone found the drug to be efficacious for reducing aggression, SIB and tantrumming in 70% of children with autism and that the response was maintained for up to 6 months. Open-label studies of other atypical antipsychotics are generally encouraging. A small, single-blind study of the glutamatergic agent d-cycloserine showed significant benefit for the social withdrawal of autism. Future directions include studying coactive pharmacological treatment strategies utilizing more than one drug to target more than one target symptom domain in individuals with autism and other PDDs.Clinical Neuroscience Research 10/2006; 6(3):179-188. DOI:10.1016/j.cnr.2006.06.012 · 0.80 Impact Factor
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ABSTRACT: Consistent with findings of aberrant macrostructural brain volume and neural activation in attentiondeficit/hyperactivity disorder (ADHD), diffusion magnetic resonance imaging (dMRI) studies of ADHD have converged to identify atypical findings within the underlying tissue microstructure. However, the direction and magnitude of diffusion metrics as well as the anatomical location of the findings varies considerably between studies. Thus, the biological interpretation of the aberrant neural microstructure in ADHD has been less clear partly due to clinical and technical confounding factors that have largely been unaccounted for in the ADHD dMRI literature. This review is intended to provide an overview of dMRI in vivo assessment of tissue microstructure, the general consistencies and inconsistencies from dMRI studies of ADHD, which is comprised primarily of diffusion tensor imaging (DTI) studies, and highlight the clinical and technical confounds that may contribute to the discrepant results and interpretations. Lastly, I will introduce advanced dMRI methods recently applied to ADHD that address some of the limitations inherent in conventional diffusion metrics. Future studies examining the neural microstructural correlates of ADHD may benefit by systematically accounting for some of the confounding factors discussed and by utilizing advanced dMRI methods. Rather than crudely identifying atypical yet highly variable microstructure properties, this approach could tease out consistent and reproducible tissue microstructure characteristics unique to certain aspects of ADHD.10/2013; 2(5):441-450. DOI:10.1166/jnsne.2013.1076
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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.04/2013; 9(2):316-325. DOI:10.12965/jer.130017