Impact of stimulant medication on behaviour and executive functions in children with attention-deficit/hyperactivity disorder

Treatment of attention deficit hyperactivity disorder (ADHD), one of the most common behavioral disorders in children in the United States, remains controversial because of concern about stimulant medication use. Extending a previous study of pediatricians, the present study surveyed a random national sample of family practitioners and then directly screened 457 patients of 10 pediatricians and family practitioners in two small midwestern cities. Responses to the national survey indicated that stimulant medication remains the main treatment prescribed by primary care physicians for children with ADHD. In the direct patient screening, the prevalence of ADHD diagnoses was 5.3% (pediatricians) and 4.2% (family practitioners) of all elementary-schoolaged children screened. Eighty-eight percent of these children were treated with methyiphenidate. Although medication was considered an effective treatment by the parents of 85% of the children given the medication, efficacy was unrelated to the accuracy of diagnosis. When explicit DSM-III-R criteria were used, only 72% of those assigned a diagnosis of ADHD by the physicians would have received that diagnosis based on a structured psychiatric interview with the parents and only 53% received that diagnosis based on teacher report of symptoms, even when the child was not receiving medication. Although the majority of physicians (in both the surveys and the direct screenings) reported using at least some behavioral treatments with their patients, parents reported infrequent use of nonpharmacologic forms of therapy, such as behavior modification. These data thus indicate a relatively modest rate of stimulant medication use for ADHD, but a serious underuse of systematic behavioral treatments in primary care.

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Visual attention in adults with attention-deficit/hyperactivity disorder before and after stimulant treatment

Psychological Medicine ◽

10.1017/s0033291718003628 ◽

2018 ◽

Vol 49 (15) ◽

pp. 2617-2625 ◽

Cited By ~ 1

Author(s):

Ann-Marie Low ◽

Signe Vangkilde ◽

Julijana le Sommer ◽

Birgitte Fagerlund ◽

Birte Glenthøj ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Visual Attention ◽

Attention Deficit ◽

Processing Speed ◽

Visual Processing ◽

Stimulant Medication ◽

Hyperactivity Disorder ◽

Visual Processing Speed ◽

Adhd Symptomatology

AbstractBackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder which frequently persists into adulthood. The primary goal of the current study was to (a) investigate attentional functions of stimulant medication-naïve adults with ADHD, and (b) investigate the effects of 6 weeks of methylphenidate treatment on these functions.MethodsThe study was a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 stimulant medication-naïve adult patients with ADHD, and 42 age and parental education-matched healthy controls. Assessments included measures of visual attention, based on Bundesen's Theory of Visual Attention (TVA), which yields five precise measures of aspects of visual attention; general psychopathology; ADHD symptoms; dyslexia screening; and estimates of IQ.ResultsAt baseline, significant differences were found between patients and controls on three attentional parameters: visual short-term memory capacity, threshold of conscious perception, and to a lesser extent visual processing speed. Secondary analyses revealed no significant correlations between TVA parameter estimates and severity of ADHD symptomatology. At follow-up, significant improvements were found specifically for visual processing speed; this improvement had a large effect size, and remained when controlling for re-test effects, IQ, and dyslexia screen performance. There were no significant correlations between changes in visual processing speed and changes in ADHD symptomatology.ConclusionsADHD in adults may be associated with deficits in three distinct aspects of visual attention. Improvements after 6 weeks of medication are seen specifically in visual processing speed, which could represent an improvement in alertness. Clinical symptoms and visual attentional deficits may represent separate aspects of ADHD in adults.

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The effect of methylphenidate-OROS® on the narrative ability of children with attention-deficit hyperactivity disorder

South African Journal of Communication Disorders ◽

10.4102/sajcd.v64i1.180 ◽

2017 ◽

Vol 64 (1) ◽

Author(s):

Tessa L. Rausch ◽

Diane L. Kendall ◽

Sara T. Kover ◽

Elizabeth M. Louw ◽

Ursula L. Zsilavecz ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Stimulant Medication ◽

Full Potential ◽

Systematic Analysis ◽

Children With Adhd ◽

Cascading Effects ◽

Hyperactivity Disorder ◽

Significant Difference ◽

Narrative Ability

Background and objective: Children with attention-deficit hyperactivity disorder (ADHD) experience difficulty with expressive language, including form (e.g. grammatical construction) and content (e.g. coherence). The current study aimed to investigate the effect of methylphenidate-Osmotic Release Oral System® (MPH-OROS®) on the narrative ability of children with ADHD and language impairment, through the analysis of microstructure and macrostructure narrative elements.Method: In a single group off–on medication test design, narratives were obtained from 12 children with ADHD, aged 7–13 years, using wordless picture books. For microstructure, number of words, type–token ratio and mean length of utterance were derived from narrative samples using Systematic Analysis of Language Transcripts conventions. For macrostructure, the narratives were coded according to the Narrative Scoring Scheme, which includes seven narrative characteristics, as well as a composite score reflecting the child’s overall narrative ability.Results: The administration of MPH-OROS® resulted in a significant difference in certain aspects of language macrostructure: cohesion and overall narrative ability. Little effect was noted in microstructure elements.Conclusion: We observed a positive effect of stimulant medication on the macrostructure, but not on the microstructure, of narrative production. Although stimulant medication improves attention and concentration, it does not improve all aspects of language abilities in children with ADHD. Language difficulties associated with ADHD related to language content and use may be more responsive to stimulant medication than language form, which is likely to be affected by cascading effects of inattention, hyperactivity and impulsivity beginning very early in life and to progress over a more protracted period. Therefore, a combination of treatments is advocated to ensure that children with ADHD are successful in reaching their full potential.

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