Comparative study of OROS-MPH and atomoxetine on executive function improvement in ADHD: a randomized controlled trial

Abstract

This study aimed to compare the effects of osmotic release oral system-methylphenidate (OROS-MPH) and atomoxetine (ATX) on executive function in children and adolescents with attention deficit hyperactivity disorder (ADHD) by a randomized controlled trial. Subjects who met DSM-IV ADHD criteria were randomized to receive either OROS-MPH or ATX treatment. The doses were titrated to achieve optimal response and then maintained for 4-6 wk. A battery of executive function tests and the Behavior Rating Inventory of Executive Function (BRIEF) were administered to subjects who completed the dose titration (OROS-MPH, n=85; ATX, n=57) at the pre- and post-treatment periods. Forty-six children without ADHD were recruited as controls. Both OROS-MPH and ATX significantly improved scores in the Rey Complex Figure Test (RCFT), digit span, and Stroop color-word task. The scores in RCFT and the reverse digit span were not significantly different from the control group at post-treatment assessment (OROS-MPH=ATX=control, p>0.05), whereas the word interference time of the Stroop test was still more than that of the control group (OROS-MPH=ATX>control, p>0.05). OROS-MPH also significantly improved the total correct response in the verbal fluency test to normal level, and the shifting time in the trail-making test to subnormal level. The current findings suggest both OROS-MPH and ATX improved executive function generally in children and adolescents with ADHD, and could return working memory back to normative performance level.

Attention-deficit/hyperactivity disorder: the impact of methylphenidate on working memory, inhibition capacity and mental flexibility

“…Our results are consistent with many studies on neuropsychological evaluation and ADHD, showing an improvement in WM, IC, and MF, as well as a relevant medication effect on EF performance at various levels 11,13,15,27,28 . Other studies that also analyzed attention and EF, and the effects of methylphenidate treatment in children with ADHD, did not find similar results to ours, but most of them ADHD: attention-deficit/hyperactivity disorder; M: mean; SD: standard deviation; p: t-student probability statistical significance was set at the p < 0.05 level.…”

“…Normative data on typical children have shown adequate developmental progression, highlighting the differences between the first assessment and after methylphenidate in the children with ADHD. These results suggest that these measures provide an important tool to assess children at risk for ADHD showing deficits in attention areas and EF 11,13,15,27,28,31 . We used the WISC III digit span backward and arithmetic tests to evaluate WM abilities 19 .…”

“…Adaptive inhibition requires a multitude of interrelated processes, such as the monitoring of behavior, sustained attention, conflict detection and others, before the inhibition of theplanned course of action and the behavior can be adjusted according to the moment 7,8,9,10,11 . A wide variety of neuropsychological tests indicate that ADHD children exhibit relatively weak, or sub-average, performances on various EFs 5,6,7,8,9,10,11,12,13,14,15,16,17 . Stimulants are the most commonly-used medications in the treatment of ADHD and their clinical efficacy is well established 14 .…”

Variants of Dopamine Beta Hydroxylase Gene Moderate Atomoxetine Response in Children with Attention-Deficit/Hyperactivity Disorder

“…Another study was performed by our group. We found that rs3785143 in SLC6A2 had significant association with responder status, whereas rs2279805 was associated with remission status (Yang et al 2012). The former SNP was Robust response was defined as the decrease of ‡40% on the ADHD-RS-IV total score from baseline to the end of the trial.…”

“…Therefore, our result was consistent with Ramoz's. In the Yang et al (2012) study, we also reported a haplotype with two SNPs at ADRA2A (rs1800544 and rs553668) in association with nonremission of ADHD symptoms after atomoxetine treatment. There was no previous study investigating the association between DBH and atomoxetine response.…”