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01-08-2009

Stimulant Treatment Reduces Lapses in Attention among Children with ADHD: The Effects of Methylphenidate on Intra-Individual Response Time Distributions

Auteurs: Sarah V. Spencer, Larry W. Hawk Jr., Jerry B. Richards, Keri Shiels, William E. Pelham Jr., James G. Waxmonsky

Gepubliceerd in: Research on Child and Adolescent Psychopathology | Uitgave 6/2009

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Abstract

Recent research has suggested that intra-individual variability in reaction time (RT) distributions of children with ADHD is characterized by a particularly large rightward skew that may reflect lapses in attention. The purpose of the study was to provide the first randomized, placebo-controlled test of the effects of the stimulant methylphenidate (MPH) on this tail and other RT distribution characteristics. Participants were 49 9- to 12-year-old children with ADHD. Children participated in a 3-day double-blind, placebo-controlled medication assessment during which they received long-acting MPH (Concerta®), with the nearest equivalents of 0.3 and 0.6 mg/kg t.i.d. immediate-release MPH. Children completed a simple two-choice speeded discrimination task on and off of medication. Mode RT and deviation from the mode were used to examine the peak and skew, respectively, of RT distributions. MPH significantly reduced the peak and skew of RT distributions. Importantly, the two medication effects were uncorrelated suggesting that MPH works to improve both the speed and variability in responding. The improvement in variability with stimulant treatment is interpreted as a reduction in lapses in attention. This, in turn, may reflect stimulant enhancement of self-regulatory processes theorized to be at the core of ADHD.
Voetnoten
1
One child exhibited a marked discrepancy between the verbal and performance subscales, limiting the reliability of the brief assessment. Because the estimated IQ of 77 was very near our cutoff, the child was allowed to participate.
 
2
Teacher reports were missing from 5 children. Analyses were re-run with these 5 children excluded and results remained the same.Teacher reports were missing from 5 children. Analyses were re-run with these 5 children excluded and results remained the same.
 
3
One child met provisional criteria for having a math learning disability (math standard score 1.5 standard deviation below the mean for the child’s age; see Martinussen & Tannock, 2006).
 
4
As a result of the relatively small number of girls (n = 10) and children with ADHD-Inattentive (n = 12) and ADHD-Hyperactive/Impulsive subtype (n = 2) we conducted only exploratory tests of sex and subtype differences. Girls were slower and more variable overall, and unpredicted interactions with medication dose suggested that the higher dose of MPH was necessary to achieve similar reductions in mode RT and deviation from the mode in girls compared to the low dose of MPH for boys. Exploratory analyses with subtype (ADHD-C vs. ADHD-I) revealed no reliable differences between subtypes for mode RT and deviation from the mode; of course, the present study was underpowered to detect such effects. It is important to note that 40% of girls (n = 4) but only 22% of males (n = 8) were of the inattentive subtype, further muddying the interpretation of the sex effects above. Future work with larger samples will be necessary to thoroughly evaluate sex and subtype differences.
 
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Metagegevens
Titel
Stimulant Treatment Reduces Lapses in Attention among Children with ADHD: The Effects of Methylphenidate on Intra-Individual Response Time Distributions
Auteurs
Sarah V. Spencer
Larry W. Hawk Jr.
Jerry B. Richards
Keri Shiels
William E. Pelham Jr.
James G. Waxmonsky
Publicatiedatum
01-08-2009
Uitgeverij
Springer US
Gepubliceerd in
Research on Child and Adolescent Psychopathology / Uitgave 6/2009
Print ISSN: 2730-7166
Elektronisch ISSN: 2730-7174
DOI
https://doi.org/10.1007/s10802-009-9316-2

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