Transdermal Methylphenidate, Behavioral, and Combined Treatment for Children With ADHD.

Abstract

Stimulant medication and behavioral treatments are evidence-based for children with attention-deficit/hyperactivity disorder, but the combination of the 2 treatments has been understudied. In this investigation, methylphenidate (MPH) was crossed with 2 levels of behavior modification (BMOD) in a summer treatment program. Twenty-seven children with attentiondeficit/hyperactivity disorder, aged 6 -12, participated. Children received placebo and 3 doses of transdermal MPH (12.5 cm 2 , 25.0 cm 2 , and 37.5 cm 2 ). BMOD was implemented on alternating weeks. Both treatments produced large and significant effects. Combined treatment was superior to either treatment alone. The effects of transdermal MPH were comparable to those found in this setting in previous studies with multiple stimulant medications and formulations. Consistent with other research, low doses of MPH-even lower than in previous studies-yielded enhanced effects in combination with behavior modification.

The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 1: Psychostimulants, Alpha-2 Agonists, and Atomoxetine

“…The SMD between guanfacine extended release and placebo for oppositional behaviour was 0.43 (95% CI 0.18 to 0.68; I 2 = 5 4%, P < 0.001), by 13 Gadow et al 19 Gorman et al 16 Gorman et al 16 Greenhill et al 12 Pelham et al 9 Sinzig et al 14 Wilens et al Table 1. Overall, there is moderate-quality evidence that guanfacine has a small-to-moderate effect on oppositional behaviour in youth with ADHD, with and without ODD.…”

“…Eleven evaluated methylphenidate [9][10][11][12][13][14][15][16][17][18][19] and 1 studied lisdexamphetamine 20 in children with ADHD. These 12 RCTs included a total of 1681 participants.…”

New Developments in the Treatment of Attention-Deficit/Hyperactivity Disorder in Primary Care

“…8 Although the number of neuropsychological studies of other comorbidities in ADHD is limited, youths with ADHD and anxiety disorders show fewer severe deficits in response inhibition tasks but more severe deficits in working memory tasks than youths with only ADHD. 9 Meta-analyses have not yielded strong evidence of neuropsychological differences between ADHD DSM-IV subtypes 10 ; however, one study 11 documented greater difficulty with resistance to interference in patients with ADHD-Inattentive subtype compared to those with other subtypes.…”

“…One study 10 reported high remission rates of tic disorders and an overall limited impact on the course of ADHD. In contrast to the severe consequences of other comorbid disorders such as conduct, mood, and anxiety disorders, tic disorders minimally affect the overall outcome of ADHD.…”

“…The mechanism of action of bupropion involves the reuptake inhibition of dopamine and norepinephrine, and has been shown to potentiate dopaminergic neurotransmission. 10 …”