This study sought to evaluate the utility of employing systematic assessments of stimulant medication response with teenagers with Attention-Deficit/Hyperactivity Disorder (ADHD) in a routine outpatient clinic setting. In doing so, it compared the efficacy of Adderall and methylphenidate (MPH) for this age group. Thirty-five subjects were randomly assigned to and completed treatment within five different drug orders involving two doses of Adderall (5 mg BID & 10 mg BID) and two doses of MPH (5 mg BID & 10 mg BID) and a lactose placebo. Measures consisted of weekly parent and teacher ratings of ADHD and oppositional symptoms, parent, teen, and teacher ratings of side effects, and tests of inhibition and attention. At the group level of analysis, no significant medication effects could be detected on parent or teacher ratings, the latter occurring in part due to poor cooperation of teachers with the protocol. Significant improvements were found for the 10 mg dose of Adderall on the inhibition task but not on the attention task. Only teen self-report ratings of side effects revealed a significant drug effect. This suggested less severe side effects on the 10 mg Adderall dose than the 5 mg dose of MPH. Nevertheless, nonblinded global clinical judgments of improvement indicated that 46% of teens had an optimal response to Adderall, 40% had an optimal response to MPH, and 14% did not respond to either drug. It is concluded that both Adderall and MPH appear to be clinically effective in the treatment of ADHD in teenagers, based on clinician's global impressions. However, numerous logistical problems plague attempts by clinicians to systematically evaluate teen responding to stimulants in a routine outpatient setting using rating scales. Suggestions are offered as to how practitioners can improve the validity and utility of such systematic evaluations in routine office practice.
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References
1.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Barkley, R.A. (1991). The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. Journal of Abnormal Child Psychology, 19, 149-178.
3.
Barkley, R.A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford.
4.
Barkley, R.A., DuPaul, G.J., & Connor, D.F. (1999). Stimulants. In J. Werry & M. Aman (Eds.), A practitioner's guide to psychoactive drugs for children and adolescents (2nd ed., pp. 213-248). New York: Plenum.
5.
Barkley, R.A., DuPaul, G.J., & McMurray, M.B. (1991). Attention deficit disorder with and without hyperactivity: Clinical response to three dose levels of methylphenidate. Pediatrics, 87, 519-531.
6.
Barkley, R.A., Fischer, M., Edelbrock, C.S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.
7.
Barkley, R.A., Fischer, M., Newby, R., & Breen, M. (1988). Development of a multi-method clinical protocol for assessing stimulant drug responses in ADHD children. Journal of Clinical Child Psychology, 17, 14-24.
8.
Barkley, R.A., McMurray, M.B., Edelbrock, C.S., & Robbins, K. (1990). Side effects of methylphenidate in children with attention deficit hyperactivity disorder: A systemic, placebo-controlled evaluation. Pediatrics, 86, 184-192.
9.
Barkley, R.A., & Murphy, K.R. (1998). Attention deficit hyperactivity disorder: A clinical workbook. New York: Guilford.
10.
Conners, C.K. (1995). The Conners Continuous Performance Test. North Tonawanda, NY: Multi-Health Systems Inc.
11.
DuPaul, G.J., Power, T.J., Anastopoulos, A.D., & Reid, R. (1998). ADHD Rating Scale-IV. Checklists, norms and clinical interpretation. New York: Guilford.
12.
Evans, S.W., & Pelham, W.E. (1991). Psychostimulant effects on academic and behavioral measures for ADHD junior high school students in a lecture format classroom. Journal of Abnormal Child Psychology, 19, 537-552.
13.
Fischer, M. (1997). Persistence of ADHD into adulthood: It depends on whom you ask. The ADHD Report, 5, 7-8.
14.
Goldman, L.S., Genel, M., Bezman, R.J., & Slanetz, P.J., for the Council on Scientific Affairs, American Medical Association. (1998). Diagnosis and treatment of attention deficit/hyperactivity disorder in children and adolescents. Journal of the American Medical Association, 279, 1100-1107.
15.
Jabbour, J.T., Jones, R.C., Bulten, R.G., Harris, R.C., Boehm, R.M., Wilhelm, DJ., Lesser, P.S., & Waugh, L.D. (in press). Adderall in the treatment of attention deficit hyperactivity disorder: A multi-center usage study. Journal of Developmental and Behavioral Pediatrics.
16.
Kaplan, S.L., Busner, J., Kupietz, S., Wasserman, E., & Segal, B. (1990). Effects of methylphenidate on adolescents with aggressive conduct disorder and ADHD: A preliminary report. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 719-723.
17.
Klorman, R., Brumaghim, J.T., Fitzpatrick, P.A., & Borgstedt, A.D. (1992). Methylphenidate reduces abnormalities of stimulus classification in adolescents with attention deficit disorder. Journal of Abnormal Psychology, 101, 130-138.
18.
Klorman, R., Brumaghim, J.T., Fitzpatrick, P.A., & Borgstedt, A.D. (1990). Clinical effects of a controlled trial of methylphenidate on adolescents with attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 702-709.
19.
Lerer, R.J., & Lerer, M.P. (1977). Response of adolescents with minimal brain dysfunction to methylphenidate. Journal of Learning Disabilities, 10, 35-40.
20.
MacKay, M.C., Beck, L., & Taylor, R. (1973). Methylphenidate for adolescents with minimal brain dysfunction. New York State Journal of Medicine, 73, 550-554.
21.
Mannuzza, S., Gittelman-Klein, R., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565-576.
22.
Molina, B.S.G., Pelham, W.E., Blumenthal, J., & Galiszewski, E. (1999). Agreement among teachers' behavior ratings of adolescents with a childhood history of attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 27, 330-339.
23.
Ottinger, D.R., Halpin, B., Miller, M., Demian, L., & Hanneman, R. (1985). Evaluating drug effectiveness in an office setting for children with attention deficit disorders. Clinical Pediatrics, 24, 245-251.
24.
Pelham, W.E., Aronoff, H.R., Midlam, J.K., Shapiro, CJ., Gnagy, E.M., Waxmonsky, J., Chronis, A.M., Onyango, A.N., Forehand, G., Nguyen, A., Hauber, A., Barry, P., & Kaye, D. (1999). A comparison of Ritalin and Adderall: Efficacy and time-course in children with ADHD. Submitted for publication.
25.
Pelham, W.E., Vodde-Hamilton, M., Murphy, D.A., Greenstein, J., & Vallano, G. (1991). The effects of methylphenidate on ADHD adolescents in recreational, peer group, and classroom settings. Journal of Clinical Child Psychology, 20, 293-300.
26.
Popper, C.W. (1994). The story of four salts. Journal of Child and Adolescent Psychopharmacology, 4, 217-223.
27.
Rapport, M.D., Denney, C., DuPaul, DJ., & Gardner, MJ. (1994). Attention deficit disorder and methylphenidate: Normalization rates, clinical effectiveness, and response prediction in 76 children. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 882-893.
28.
Rapport, M.D., DuPaul, GJ., Stoner, G., & Jones, J.T. (1986). Comparing classroom and clinic measures of attention deficit disorder: Differential, idiosyncratic, and dose-repose effects of methylphenidate. Journal of Consulting and Clinical Psychology, 54, 334-341.
29.
Rapport, M.D., & Kelly, K.L. (1993). Psychostimulant effects on learning and cognitive function. In J.L. Matson (Ed.), Handbook of hyperactivity in children (pp. 97-135). Boston: Allyn & Bacon.
30.
Riggs, P.D., Thompson, L.L., Mikulich, S.K., Whitmore, E.A., & Crowley, T.J. (1996). An open trial of pemoline in drug-dependent delinquents with attention deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1018-1024.
31.
Safer, DJ., Zito, J.M., & Fine, E.M. (1996). Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics, 98, 1084-1088.
32.
Smith, B.H., Pelham, W.E., Gnagy, E., & Yudell, R.S. (1998). Equivalent effects of stimulant treatment for attention-deficit hyperactivity disorder during childhood and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 314-321.
33.
Stroop, J.P. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643-462.
34.
Swanson, J.M., McBurnett, K., Christian, D.L., & Wigal, T. (1995). Stimulant medications and the treatment of children with ADHD. In T.H. Ollendick & RJ. Prinz (Eds.), Advances in clinical child psychology (vol. 17). New York: Plenum.
35.
Swanson, J.M., Wigal, S., Greenhill, L.L., Browne, R., Waslik, B., Lerner, M., Williams, L., Flynn, D., Agler, D., Crowley, K., Fineberg, E., Baren, M., & Cantwell, D.P. (1998). Analogue classroom assessment of Adderall in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 519-526.
36.
Varley, C.K. (1983). Effects of methylphenidate in adolescents with attention deficit disorder. Journal of the American Academy of Child Psychiatry, 22, 351-354.
37.
Weiss, G., & Hechtman, L. (1993). Hyperactive children grown up. New York: Guilford.
