Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder

ArticleinArchives of General Psychiatry 52(6):444-55 · July 1995with10 Reads
Source: PubMed
Abstract
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.
    • "Approximately 9% of children developed tics or dyskinesias, which predominantly were transient, with <1% developing chronic tics or Tourette's syndrome. Personal or family tic history and medication selection or dosage were not related to onset of tics or dyskinesias Gadow et al, 1995 15 ; ADHD with TD Methylphenidate variable dose, placebo-controlled, 2-week trials (N = 24) "
    Full-text · Article · Mar 2012 · Journal of child and adolescent psychopharmacology
    • "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].
    Full-text · Article · Feb 2012
    • "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.
    Article · Aug 2010
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