Evaluation of individual subjects in the analog classroom setting: I. Examples of graphical and statistical procedures for within-subject ranking of responses to different delivery patterns of methylphenidate
Describes graphical and statistical methods to evaluate differences in response patterns of children with attention deficit hyperactivity disorder (ADHD) to different treatment conditions with methylphenidate (MP) in a double-blind crossover study of 4 conditions (3 patterns of delivery of MP and a placebo control). Ss were evaluated across an 11-hr (7 AM to 6 PM) laboratory school day, and classroom behavior was assessed at regular intervals with the SKAMP rating scale of impairment and the CLAM rating scale of symptom presence. Graphical displays of the time courses of behavior ratings across each double-blind test day were developed for each individual. Expert clinicians judged these graphs and used this information to rank-order the test days from best to worst. A within-S variant of Kendall's W evaluated concordance of rankings; generalized κ evaluated the reliability of rankings across conditions; and ANOVA evaluated whether the conditions differed in terms of consensus ranks for the study as a whole. Results support the use of expert judges in summarizing and evaluating repeated classroom behavior measures to determine response patterns. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"In addition, weaning off periods are often implemented to assess symptom resolution and limit the development of negative side effects (Kidd, 2000). MPH is given orally, and is absorbed rapidly, reaching peak blood plasma levels in 1 to 3 hrs, at which point peak behavioral modification is also noted (Dollery, 1991; J. M. Swanson et al., 1998). The drug is also rapidly metabolized and excreted, with a short half-life of approximately 2 to 3 hr (a range of 1-5 hr) in children and 3 to 4 hr in adults (Kimko, Cross, & Abernethy, 1999). "
[Show abstract][Hide abstract] ABSTRACT: Objective:
Methylphenidate (MPH) is the most often prescribed medication for treatment of ADHD. However, many of its specific cellular and molecular mechanisms of action, as well as developmental consequences of treatment, are largely unknown. This review provides an overview of current understanding of MPH efficacy, safety, and dosage in adult and pediatric ADHD patients, as well as adult animal studies and pioneering studies in juvenile animals treated with MPH.
A thorough review of the current literature on MPH efficacy and safety in children, adults, and animal models was included. Results of studies were compared and contrasted.
While MPH is currently considered safe, there is a lack of knowledge of potential developmental consequences of early treatment, as well as differences in drug actions in the developing versus mature brain system.
This review emphasizes the need for further research into the age-dependent activities and potency of MPH, and a need for tighter control and clinical relevance in future studies.
"As early as 1973, it was accepted that a substantial proportion of children who have TS first manifest various behavioural disturbances often called minimal brain dysfunction (MBD), hyperkinetic disorder (HKD), hyperactivity or attention deficit disorder (Shapiro et al. 1973). Although early studies found ADHD in as few as 13 % of TS patients (Lieh Mak et al.), it is now evident that ADHD occurs in a substantial proportion of TS patients, ranging from 21–90% (Robertson and Eapen 1992) to 24–75 % of clinic populations (Walkup et al. 1999), and as high as 25 % of school-based studies (Walkup et al. 1999), clearly way in excess of the 4–19 % (Taylor et al. 1998) or 1–10 % (Swanson et al. 1998) of ADHD encountered in the general population. A PUBMED search in late June 2005, using the words Tourette and ADHD, gave rise to 340 hits and tics and ADHD gave rise to 435 hits. "
[Show abstract][Hide abstract] ABSTRACT: Tourette's Syndrome (TS) is now recognised to be a common childhood onset neurodevelopmental disorder. Attention deficit hyperactivity disorder (ADHD) is also a common childhood disorder. There are many cases in which the two disorders are comorbid. The reasons for this are unclear, but the comorbidity does not necessarily point to one genetic cause. Sleep is also often disturbed in individuals with TS and ADHD. The treatment implications of ADHD in the setting of tics or TS are important. Clonidine is suggested as a first line treatment. It was once thought that stimulants were contraindicated in the treatment of ADHD in the setting of TS, whereas it is suggested that they may be safe, but should be used judiciously. In addition, it was once thought that the combination of stimulants and clonidine was contraindicated, but from a large study the combination does appear to be safe. A relatively new medication for ADHD is atomoxetine, and although not documented widely in the setting of tics and TS, it may prove useful in this setting; further research is required. This commentary briefly discusses the comorbidity between TS and ADHD and offers treatment suggestions.
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