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The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation.
Full Abstract
OBJECTIVES: This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). METHODS: Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean = 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n = 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6 mg/kg t.i.d.) varying daily within each behavioral treatment. RESULTS: Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p < 0.001). Both groups showed robust improvement in externalizing symptoms (p < 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p - 0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p < 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p < 0.05). CONCLUSIONS: MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning.
Author information
Author/s: Waxmonsky, James (J); Pelham, William E (WE); Gnagy, Elizabeth (E); Cummings, Michael R (MR); O'Connor, Briannon (B); Majumdar, Antara (A); Verley, Jessica (J); Hoffman, Martin T (MT); Massetti, Greta A (GA); Burrows-MacLean, Lisa (L); Fabiano, Gregory A (GA); Waschbusch, Daniel A (DA); Chacko, Anil (A); Arnold, Frances W (FW); Walker, Kathryn S (KS); Garefino, Allison C (AC); Robb, Jessica A (JA);
Affiliation: Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York, USA. jgw(-atsign-)buffalo.edu
Grants: MH62946 (Agency:NIMH NIH HHS) ; R34 MH080791-01A1 (Agency:NIMH NIH HHS)
Journal and publication information
Publication Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Journal: Journal of child and adolescent psychopharmacology (J Child Adolesc Psychopharmacol), published in United States. (Language: eng)
Reference: 2008-Dec; vol 18 (issue 6) : pp 573-88
Dates: Created 2008/12/25; Completed 2009/02/27; Revised 2009/05/18;
PMID: 19108662, status: MEDLINE (last retrieval date: 5/19/2009, IMS Date: 19 May 2009 00:00:00)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
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