The findings from case reports and patient questionnaire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder.
Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylphenidate hydrochloride (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each, under double-blind conditions. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and using rating scales completed by the parents, teachers, and physician.
Methylphenidate effectively suppressed hyperactive, disruptive, and aggressive behavior. There was no evidence that methylphenidate altered the severity of tic disorder, but it may have a weak effect on the frequency of motor (increase) and vocal (decrease) tics.
Methylphenidate appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder.
"It is also increasingly abused as a nonprescribed 'cognitive enhancer' (Smith and Farah, 2011). For ADHD patients characterized by inappropriate social behavior as evaluated by authority figures and peers, MPH and other stimulants tend to improve social performance (Gadow et al, 1995; Hinshaw et al, 1989; Klein et al, 1997; Pelham et al, 1985; Spencer et al, 2005; Sprague and Sleater 1977; Whalen et al, 1989). This effect may occur, in part, from increased conformity. "
[Show abstract][Hide abstract] ABSTRACT: The ability to infer value from the reactions of other people is a common and essential ability with a poorly understood neurobiology. Commonly, social learning matches one's values and behavior to what is perceived as normal for one's social group. This is known as conformity. Conformity of value correlates with neural activity shared by cognitions that depend on optimum catecholamine levels, but catecholamine involvement in conformity has not been tested empirically. Methylphenidate (MPH) is an indirect dopamine and noradrenalin agonist, commonly used for the treatment of attention-deficit hyperactivity disorder for which it reduces undesirable behavior as evaluated by peers and authority figures, indicative of increased conformity. We hypothesized that MPH might increase conformity of value. In all, 38 healthy adult females received either a single oral 20 mg dose of MPH or placebo (PL). Each subject rated 153 faces for trustworthiness followed immediately by the face's mean rating from a group of peers. After 30 min and a 2-back continuous-performance working-memory task, subjects were unexpectedly asked to rate all the faces again. Both the groups tended to change their ratings towards the social norm. The MPH group exhibited twice the conformity effect of the PL group following moderate social conflict, but this did not occur following large conflicts. This suggests that MPH might enhance signals that would otherwise be too weak to evoke conformity. MPH did not affect 2-back performance. We provide a new working hypothesis of a neurocognitive mechanism by which MPH reduces socially disruptive behavior. We also provide novel evidence of catecholamine mediation of social learning [corrected].
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 02/2012; 37(6):1517-25. DOI:10.1038/npp.2011.337 · 7.05 Impact Factor
"Similarly, in a double-blind, placebo-controlled study of children with TD and ADHD, MPH improved ADHD symptoms without exacerbating tics in 9 of the 11 patients; of the other 2, 1 showed no change and the other showed behavioral deterioration (Konkol et al. 1990). In another double-blind, placebo-controlled study of children with ADHD and tic disorder, MPH effectively suppressed hyperactive, disruptive, and aggressive behaviors without increasing tic severity (Gadow et al. 1995). Still other placebocontrolled , double-blind studies (Law and Schachar 1999; Gadow et al. 1999) of ADHD children treated with MPH, at doses based on the typical titration procedure, during long-term treatment, did not produce significantly more tics than the placebo in children with or without preexisting tics. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to review the efficacy of various treatments for Tourette's disorder (TD) and tics.
This study is a historical review of the treatment modalities prior to the advent of neuroleptics. A review of double-blind and placebo-controlled clinical trials and open studies on the use of neuroleptics and selected reports was also carried out.
The literature review reveals that the treatment of TD and tics has evolved from an early history of marginally effective approaches to the advent of neuroleptics, which started a new era in TD and tic treatment, with a significantly broader range of effectiveness.
Although progress has been made, the literature review nevertheless reveals a great deal of confusion as related to the clinical heterogeneity of TD and tics, differences in populations, medication-dose combinations, and outcomes. However, a role for a limited number of pharmacologic agents, combined with psychosocial approaches, has been identified. There is a need for studies in larger, diagnostically homogenous samples and for the use of more sophisticated methodology, to identify intelligible models that would allow the development of more effective treatment approaches.
Journal of child and adolescent psychopharmacology 08/2010; 20(4):249-62. DOI:10.1089/cap.2010.0027 · 2.93 Impact Factor
"Medication was administered twice daily, approximately 3.5 hr apart, 7 days a week, and dispensed in dated, sealed envelopes at 2-week intervals. Detailed descriptions of the procedure and all measures have been previously published (Gadow et al., 1995; Gadow, Sverd, Nolan, Sprafkin, & Schneider, 2007). Once the medication evaluation began, each child and at least one parent (typically the mother) were required to come to the clinic at "
[Show abstract][Hide abstract] ABSTRACT: Rating scales developed to measure child emotional and behavioral problems typically are so long as to make their use in progress monitoring impractical in typical school settings. This study examined two methods of selecting items from existing rating scales to create shorter instruments for use in assessing response to intervention. The psychometric properties of two sets of abbreviated rating scales derived from the IOWA Conners Teacher Rating Scale and the teacher-completed Peer Conflict Scale were examined and compared to the longer original versions of these scales. The rating scales were evaluated using data from a randomized, placebo-controlled, crossover trial of immediate release methylphenidate involving a sample 65 children between 6 and 12 years old who met research diagnostic criteria for attention deficit hyperactivity disorder and either chronic motor tic disorder or Tourette's disorder. Specifically, the abbre-viated and original versions of the rating scales were examined for internal consistency, temporal stability, concurrent validity, and treatment sensitivity. Results indicate that there were few significant differences between versions of the scales, which support the use of abbreviated rating scales for use in progress monitoring. Implications for practice and future research are discussed. A problem-solving approach to treating child emotional and behavior problems in-volves continuous monitoring of student be-havior in response to intervention for the pur-pose of assessing progress toward predeter-mined goals. Unfortunately, efforts to develop Volkersz for conducting clinic evaluations, and Michele and Michael De Angelis for providing pharmacy services. The authors are particularly indebted to the families who made this study possible.
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