Guidelines and algorithms for the use of methylphenidate in children with Attention-Deficit/Hyperactivity Disorder

New York State Psychiatric Institute/Columbia University, New York 10032, USA.
Journal of Attention Disorders (Impact Factor: 3.78). 02/2002; 6 Suppl 1:S89-100.
Source: PubMed


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.

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    • "Psychostimulants are considered as first-line for treating children and adolescents with ADHD, with a response rate of 70-80 per cent (Greenhill et al., 2002). Hyperactivity, impulsivity and attention deficit (similar to core symptoms of ADHD) are frequently reported in subjects with ASD. "
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    ABSTRACT: Purpose – The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety. Design/methodology/approach – A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library. Findings – Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options. Originality/value – This is a practice review paper applying recent evidence from the literature.
    No preview · Article · Jan 2016
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    • "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). "
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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.
    Full-text · Article · Apr 2013
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    • "Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioural childhood disorder [1]. The psychostimulant methylphenidate (MPH; Ritalin®) is widely prescribed and effectively reduces the ADHD symptoms of hyperactivity, impulsivity and inattention [2]. However, diagnosis of ADHD relies heavily on subjective interpretations of the diagnostic criteria [3]. "
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    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.
    Full-text · Article · Sep 2012
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