Response to Methylphenidate in Children with Attention Deficit Hyperactivity Disorder and Manic Symptoms in the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder Titration Trial

Abstract

Objective:Recent reports raise concern that children with attention deficit hyperactivity disorder (ADHD) and some manic symptoms may worsen with stimulant treatment. This study examines the response to methylphenidate in such children. Methods:Data from children participating in the 1-month methylphenidate titration trial of the Multimodal Treatment Study of Children with ADHD were reanalyzed by dividing the sample into children with and without some manic symptoms. Two "mania proxies" were constructed using items from the Diagnostic Interview Schedule for Children (DISC) or the Child Behavior Checklist (CBCL). Treatment response and side effects are compared between participants with and without proxies. Results:Thirty-two (11%) and 29 (10%) participants fulfilled criteria for the CBCL mania proxy and DISC mania proxy, respectively. Presence or absence of either proxy did not predict a greater or lesser response or side effects. Conclusion:Findings suggest that children with ADHD and manic symptoms respond robustly to methylphenidate during the first month of treatment and that these children are not more likely to have an adverse response to methylphenidate. Further research is needed to explore how such children will respond during long-term treatment. Clinicians should not a priori avoid stimulants in children with ADHD and some manic symptoms.

A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents

“…109 Galanter and colleagues examined the response to MPH in children with ADHD and some manic symptoms. 112 Their findings suggested that these children respond robustly to MPH during the first month of treatment and that they are not more likely to have an adverse response to MPH. 112 In 2004, the authors of the MTA trial published results of a follow-up 10 months beyond the 14 months of intensive intervention.…”

“…112 Their findings suggested that these children respond robustly to MPH during the first month of treatment and that they are not more likely to have an adverse response to MPH. 112 In 2004, the authors of the MTA trial published results of a follow-up 10 months beyond the 14 months of intensive intervention. 113 Of the 579 children who entered the study, 540 (93%) participated in this first follow-up.…”

“…[106][107][108][109][110][111][112][113] Most of these are cross-sectional analyses, overview studies or studies focusing on covariates, such as socio-economic status or ethnicity, which will not be discussed in this report. 106,107,110,111 Other papers focused on subgroup analyses.…”

“…106,107,110,111 Other papers focused on subgroup analyses. 108,109,112 As the samples were not designed for this purpose, results should be interpreted with caution. Vitiello and colleagues examined the trajectory of MPH dosage over time, following a controlled titration.…”

Mood regulation in youth

“…It should be noted that psychoeducation and family involvement (which may in certain cases require targeted specific family interventions 34,35 ) are essential components of our approach. Below we describe some of the evidence that is emerging for targeting mood regulation in CBT and how it is used in our clinic.…”