title: The effects of attention-deficit/hyperactivity disorder on employment and household income. Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. Atomoxetine in the Management of Children with ADHD: Effects on Quality of Life and School Functioning Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement Relative efficacy of long-acting stimulants on children with attention deficit-hyperactivity disorder: a comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine, and pemoline. A comparison of once-daily extended-release methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school (the Comacs Study). Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Effects of OROS Methylphenidate on Academic, Behavioral, and Cognitive Tasks in Children 9 to 12 Years of Age With Attention-Deficit/Hyperactivity Disorder A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. A Comparison of Ritalin and Adderall: Efficacy and Time-course in Children With Attention-deficit/Hyperactivity Disorder The Laboratory School Protocol Analog classroom assessment of Adderall in children with ADHD. A 13-hour laboratory school study of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder The effects of methylphenidate on learning in children with ADDH: the stimulus equivalence paradigm. Atomoxetine treatment in adolescents with attention-deficit/hyperactivity disorder. Adult psychiatric status of hyperactive boys grown up. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for Attention Deficit Disorder children Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder. Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphenidate. Double-blind, placebo-controlled study of single-dose amphetamine formulations in ADHD. Analog classroom assessment of a once-daily mixed amphetamine formulation, SLI381 (Adderall XR), in children with ADHD. Efficacy of two long-acting methylphenidate formulations in children with attention- deficit/hyperactivity disorder in a laboratory classroom setting. A dose-ranging study of a methylphenidate transdermal system in children with ADHD. Methylphenidate in hyperactive children: Differential effects of dose on academic, learning, and social behavior Lisdexamfetamine Dimesylate and Mixed Amphetamine Salts Extended-Release in Children with ADHD: A Double-Blind, Placebo-Controlled, Crossover Analog Classroom Study A Randomized, Double-Blind, Placebo-Controlled, Laboratory Classroom Assessment of Methylphenidate Transdermal System in Children With ADHD Psychostimulant effects on academic and behavioral measures for ADHD junior high school students in a lecture format classroom Comparative efficacy of once–a–day
  extended–release methylphenidate,
  two–times–daily immediate–release
  methylphenidate, and placebo in a
  laboratory school setting Executive functioning in children with attention-deficit/hyperactivity disorder: combined type with and without a stimulant medication history. Differential Effects of Methylphenidate and Self-Reinforcement on Attention-Deficit Hyperactivity Disorder Sustained release and standard methylphenidate effects on cognitive and social behavior in children with attention deficit disorder. Does methylphenidate normalize the classroom performance of children with attention deficit disorder? Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom. Comparing classroom and clinic measures of attention deficit disorder: differential, idiosyncratic, and dose-response effects of methylphenidate. A comparison of morning-only and morning/late afternoon Adderall to morning-only, twice-daily, and three times-daily methylphenidate in children with attention-deficit/hyperactivity disorder. Methylphenidate and children with attention deficit disorder. Dose effects on classroom academic and social behavior. Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children. Comparative effects of methylphenidate on ADD girls and ADD boys. Classroom academic performance: improvement with both methylphenidate and dextroamphetamine in ADHD boys.
abstract: CONTEXT Many children with attention-deficit/hyperactivity disorder ( ADHD ) continue to exhibit symptoms of the disorder into adolescence and adulthood . Although ADHD may have a profound impact on activities of daily living , including educational achievement and work performance , limited research exists on ADHD 's impact on individual income loss and overall economic effect . OBJECTIVES Evaluate ADHD 's impact on individual employment and income , and quantify costs of ADHD on workforce productivity for the US population . DESIGN Two telephone surveys were conducted between April 18 , 2003 , and May 11 , 2003 , to collect demographic , educational , employment , and income information . PARTICIPANTS Two groups of adults aged 18 - 64 years were interviewed : those diagnosed with ADHD ( n = 500 ) derived from a national list of mail-paneled members who identified themselves or a household member as having been diagnosed with ADHD , and an age- and gender-matched control group ( n = 501 ) derived from a r and om digital-dialing sample of a national cross-section not diagnosed with ADHD . RESULTS Statistically fewer subjects in the ADHD group achieved academic milestones beyond some high school ( P < .05 ) . In addition , fewer subjects with ADHD were employed full time ( 34 % ) compared with controls ( 59 % ; P < .001 ) . Except for the subgroup of subjects aged 18 - 24 years , average household incomes were significantly lower among individuals with ADHD compared with controls , regardless of academic achievement or personal characteristics . On the basis of these findings , loss of workforce productivity associated with ADHD was estimated between $ 67 billion and $ 116 billion . CONCLUSIONS Decreased individual income among adults with ADHD contributes to substantial loss in US workforce productivity This study evaluated the separate and combined effects of behavior modification and 2 doses of methylpheni date ( MPH ; 0.3 and 0.6 mg/kg ) compared with baseline ( no behavior modification and a placebo ) on the classroom behavior and academic performance of 31 ADHD ( attention deficit-hyperactivity disorder ) boys attending a summer treatment program . Results revealed significant effects of both interventions , with the mean effect size of medication being more than twice as great as that of behavior modification . Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification , compared with the effects of the low dose of MPH . In contrast , the addition of either dose of MPH result ed in improvement beyond the effects of behavior modification alone . These group effects reflected those obtained in analyses of individual differences . Furthermore , comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder ( ADHD ) symptoms and functional impairments at school and at home . Participants were 153 children ( age 8 to 12 years ) diagnosed with attention-deficit hyperactivity disorder who were r and omized to double-blind treatment with either atomoxetine  ( n = 101 ) or placebo  ( n = 52 ) . Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy . Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents . No significant effects were revealed for the teacher ratings of academic productivity . Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD . The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest , albeit less compelling for this particular investigation , than for the effects on overt symptom display Methylpheni date ( MPH ) often ameliorates attention-deficit/hyperactivity disorder ( ADHD ) behavioral dysfunction according to indirect informant reports and rating scales . The st and ard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy . Documenting “ cool ” executive-working memory ( EWM ) and “ hot ” self-regulation ( SR ) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response . In this study , children aged 6 to 16 with ADHD inattentive type ( IT ; n = 19 ) and combined type ( n = 33)/hyperactive-impulsive type ( n = 4 ) ( CT ) participated in double-blind placebo-controlled MPH trials with baseline and r and omized placebo , low MPH dose , and high MPH dose conditions . EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions , with nonparametric r and omization tests conducted to determine individual MPH response . Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction . Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment , yet response was poor for those with adequate EWM/ SR baseline performance . Even for strong MPH responders , the best dose for neuropsychological functioning was typically lower than the best dose for behavior . Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized . Implication s for academic achievement and medication titration practice s for children with behaviorally diagnosed ADHD will be discussed Twenty-two children with attention deficit-hyperactivity disorder underwent a double-blind , placebo-controlled , crossover evaluation of the efficacy of st and ard methylpheni date twice a day and comparable doses every morning of a sustained-release preparation of methylpheni date ( SR-20 Ritalin ) , a sustained-release form of dextroamphetamine ( Dexedrine Spansule ) , and pemoline . The children were participating in a summer treatment program in which they engaged in recreational and classroom activities . Dependent measures include evaluations of social behavior during group recreational activities , classroom performance , and performance on a continuous performance task . Results revealed generally equivalent and beneficial effects of all four medications . Dexedrine Spansule and pemoline tended to produce the most consistent effects and were recommended for 10 of the 15 children who were responders to medication . The continuous performance task results showed that all four medications had an effect within 2 hours of ingestion , and the effects lasted for 9 hours . The implication s of these results for the use of long-acting stimulant medication in children with attention deficit-hyperactivity disorder are discussed OBJECTIVE The objective of this study was to evaluate differences in the pharmacodynamic ( PD ) profile of 2 second-generation extended-release ( ER ) formulations of methylpheni date ( MPH ) : Meta date CD ( MCD ; methylpheni date HCl , US Pharmacopeia ) extended-release capsules , CII , and Concerta ( CON ; methylpheni date HCl ) extended-release tablets , CII . Little empirical information exists to help the clinician compare the PD effects of the available ER formulations on attention and behavior . Previous studies have shown that the near-equal doses of MCD and CON provide equivalent , total exposure to MPH as measured by area under the plasma concentration time curve , yet their pharmacokinetic ( PK ) plasma concentration versus time profiles are different . We previously offered a theoretical PK/PD account of the similarities and differences among available ER formulations based on the hypothesis that all formulations produce effects related to MPH delivered by 2 processes : 1 ) an initial bolus dose of immediate-release ( IR ) MPH that is expected to achieve peak plasma concentration in the early morning and have rapid onset of efficacy within 2 hours of dosing , which for the MCD capsule is delivered by 30 % of the total daily dose as uncoated beads and for the CON tablet is delivered by an overcoat of 22 % of the total daily dose ; and 2 ) an extended , controlled delivery of ER MPH that is expected to achieve peak plasma concentrations in the afternoon to maintain efficacy for a programmed period of time after the peak of the initial bolus , which for the MCD capsule is delivered by polymer-coated beads and for the CON tablet by an osmotic-release oral system . According to this PK/PD model , clinical superiority is expected at any point in time for the formulation with the highest MPH plasma concentration . METHODS This was a multisite , double-blind , double-dummy , 3-way crossover study of 2 active treatments ( MCD and CON ) and placebo ( PLA ) . Children with confirmed diagnoses of attention-deficit/hyperactivity disorder were stratified to receive bioequivalent doses of MCD and CON that were considered to be low ( 20 mg of MCD and 18 mg of CON ) , medium ( 40 mg of MCD and 36 mg of CON ) , or high ( 60 mg of MCD and 54 mg of CON ) , and in a r and omized order each of the study treatments was administered once daily in the morning for 1 week . On the seventh day of each treatment week , children attended a laboratory school , where surrogate measures of response were obtained by using teacher ratings of attention and deportment and a record of permanent product of performance on a 10-minute math test at each of the 7 classroom sessions spread across the day at 1.5-hour intervals . Safety was assessed by patient reports of adverse events , parent ratings on a stimulant side-effects scale , and measurement of vital signs . RESULTS The analyses of variance revealed large , statistically significant main effects for the within-subject factor of treatment for all 3 outcome measures ( deportment , attention , and permanent product ) . The interactions of treatment x session were also highly significant for all 3 outcome measures . Inspection of the PD profiles for the treatment x session interactions suggested 4 patterns of efficacy across the day : 1 ) PLA > MCD approximately CON ( PLA superiority ) immediately after dosing ; 2 ) MCD > CON > PLA during the morning ( MCD superiority ) ; 3 ) MCD approximately CON > PLA during the afternoon ( PD equivalence of MCD and CON ) ; and 4 ) CON > MCD approximately PLA in the early evening ( CON superiority ) . The effect of site was significant , because some study centers had low and some high scores for behavior in the lab classroom , but both the low- and high-scoring sites showed similar PD patterns across the day . The interaction of dose x treatment was not significant , indicating that the pattern of treatment effects was consistent across each dose level . There were no statistically significant overall differences among the 3 treatments for the frequency of treatment-emergent adverse events , ratings of side effects , or vital signs . Two additional PK/PD questions were addressed : 1 . The a priori hypothesis called for a comparison of the average of sessions ( removing session as a factor ) during a time period that corresponds to the length of a typical school day ( from 1.5 through 7.5 hours after dosing ) . For the planned contrast of the 2 treatment conditions ( MCD versus CON ) , the difference was significant , confirming the a priori hypothesis of superiority of near-equal daily doses of MCD over CON for this predefined postdosing period . 2 . In the design of the study , the dose factor represented the total daily dose , consisting of 2 components : the initial bolus doses of IR MPH , which differ for the near-equal total daily doses of MCD and CON , and the reservoir doses of ER MPH , which were the same for the 2 formulations . To evaluate the moderating effects of the bolus component of dose on outcome , average effect size ( ES ) was calculated for the efficacy outcomes at the time of expected peak PK concentration times of the initial bolus component for each formulation at the 3 dose levels . The correlation ( r ) of ES with IR MPH bolus dose was significant for each of the 3 outcome measures ( r approximately .9 ) , indicating that the magnitude of effects in the early morning may be attributed to the dose administered by the IR MPH bolus of each formulation . For the 2 dose conditions with equal 12-mg IR MPH boluses ( MCD 40 and CON 54 ) , the ESs were large and indistinguishable ( eg , deportment ES approximately 0.75 for both ) . CONCLUSIONS Once-daily doses of MCD and CON produced statistically significantly different PD effects on surrogate measures of behavior and performance among children with attention-deficit/hyperactivity disorder in the laboratory school setting . As predicted by the PK/PD model , superiority at any point in time was achieved by the formulation with the highest expected plasma MPH concentration The effects of methylpheni date on the academic performance and classroom behavior of 45 adolescents with attention deficit hyperactivity disorder were studied . During a 6-week , placebo-controlled medication assessment in the context of a summer treatment program , participants received a double-blind , crossover trial of 3 doses of methylpheni date . Dependent measures included note-taking quality , quiz and worksheet scores , written language usage and productivity , teacher ratings , on-task and disruptive behavior , and homework completion . Group data showed positive effects of methylpheni date on academic measures ; however , the greatest benefit came with the lowest dose . Although additional benefit did occur for some participants with higher doses , the largest increment of change usually occurred between the placebo and 10-mg dose . Many adolescents did not experience added benefit with increased dosages , and in some cases they experienced deterioration . Guidelines for assessment of medication effects are discussed OBJECTIVE This study examined the effectiveness of stimulant medication on multiple domains of functioning in 36 young ( 5 to 6 years old ) children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Five- and 6-year-old children attending a summer treatment program between 1987 and 1997 underwent a r and omized clinical assessment of the effect of two doses of methylpheni date ( 0.3 mg/kg versus 0.6 mg/kg ) and placebo on social behavior and academic performance . RESULTS Methylpheni date had an effect on all four social behaviors and improved two of the three areas of academic functioning . Dose effects were present for three of the seven dependent measures . Individual analyses indicated a therapeutic response rate between 39 % and 100 % across dependent measures . Furthermore , individual analyses of response indicated that across several important dependent measures , 39 % to 98 % of children showed little incremental improvement with the higher dose compared with the lower dose of stimulant medication . CONCLUSIONS Stimulant medication is an effective treatment for young children diagnosed with ADHD ; however , multiple domains of functioning must be assessed to determine the most effective dose for young children with ADHD OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Objective . To assess effects of OROS methylpheni date on cognitive and academic tasks in 9 to 12 year olds with attention-deficit/hyperactivity disorder ( ADHD ) . Methods . A double-blind , within-subject , crossover design was used to compare OROS methylpheni date with placebo in a laboratory classroom setting on several cognitive and academic tasks for 68 children who met r and omization criteria . Results . Performance on the following measures was significantly better when children received individually optimized OROS methylpheni date than placebo :  math fluency and accuracy measured by the Permanent Product Math Test , ADHD symptoms observed in the laboratory setting , computerized indices of attention and impulsivity as measured by the Test of Variables of Attention ( TOVA ) , and visual — spatial working memory ( Finger Windows Backwards ) . Study medication was well tolerated ; adverse events were generally consistent with previous reports . Conclusions . OROS methylpheni date improves performance on measures of attention and vigilance , behavior , and working memory in a laboratory school setting in 9 to 12 year olds with ADHD BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes Objective . Very little research has focused on the efficacy of Adderall ( Shire-Richwood Inc , Florence , KY ) in the treatment of children with attention-deficit/hyperactivity disorder ( ADHD ) , and no studies have compared it with st and ardized doses of Ritalin ( Novartis Pharmaceuticals , East Hanover , NJ ) . It is thought that Adderall has a longer half-life than Ritalin and might minimize the loss of efficacy that occurs 4 or 5 hours after Ritalin ingestion . We compared two doses of Ritalin and Adderall in the treatment of ADHD in children in an acute study and assessed the medications ' time courses . Design . Within-subject , double-blind , placebo-controlled , crossover design lasting 6 weeks . As in our previous work , medication changes occurred on a daily basis in r and om order over days . Setting . Eight-week , weekday ( 9 hours daily )  summer treatment program at the State University of New York at Buffalo , using an intensive behavioral treatment program including a point system and parent training . Study Participants . Twenty-five children ( 21 boys and 4 girls ) diagnosed as ADHD using st and ardized structured interview and rating scales , mean age 9.6 years , 88 % Caucasian , of average intelligence , with no medical conditions that would preclude a trial of stimulant medication . Thirteen were comorbid for opposi-tional-defiant disorder and another 8 for conduct disorder . Interventions . Children received 10 mg of Ritalin , 17.5 mg of Ritalin , 7.5 mg of Adderall , 12.5 mg of Adderall , or placebo , twice a day ( 7:45 am and 12:15 pm ) , in r and om order with conditions changing daily for 24 days . Outcome Measures . Daily rates of behaviors in recreational and classroom setting s , and st and ardized ratings from counselors , teachers , and parents , were averaged across days within condition within child and compared . Within-subject relative sizes of the medication effects were computed by taking the placebo-minus-drug mean difference divided by the placebo st and ard deviation for each child , and were compared hourly between first daily ingestion ( 7:45am ) and 5:00 pm to assess the time course of the two drugs . Measures were taken at 12:00 pm ( recess rule violations ) and at 5:00 pm ( parent behavior ratings ) to determine whether Adderall was still effective at times when the effects of Ritalin should have worn off . Parent ratings were also made for evening behavior to assess possible rebound , and side effects ratings were obtained from parents , counselors , and teachers . Parents , counselors , and teachers also rated their perceptions of medication status and whether they recommended the continued use of the medication given that day . Finally , a clinical team made recommendations for treatment taking into account each child 's individual response . Results . Both drugs were routinely superior to placebo and produced dramatic improvements in rates of negative behavior , academic productivity , and staff/parent ratings of behavior . The doses of Adderall that were assessed produced greater improvement than did the assessed doses of Ritalin , particularly the lower dose of Ritalin , on numerous but not all measures . This result suggests that the doses of Adderall used were functionally more potent than those for Ritalin . Adderall was generally superior to the low dose of Ritalin when the effects of Ritalin were wearing off at midday and late afternoon/early evening . The lower dose of Adderall produced effects comparable to those of the higher dose of Ritalin . Both drugs produced low and comparable levels of clinical ly significant side effects . Staff clinical recommendations for continued medication favored Adderall three to one . Almost 25 % of the study participants were judged to be nonresponders by the clinical team , presumably because of their large beneficial response to the concurrent behavioral intervention and minimal incremental benefit from medication . Conclusions . This is the first investigation to assess comparable doses of Adderall and Ritalin directly . Results showed that Adderall is at least as effective as Ritalin in improving acutely the behavior and academic productivity of children with ADHD . These results show clearly that Adderall should be added to the armamentarium of effective treatment for ADHD , particularly for children in whom the effects of Ritalin dissipate rapidly and a longer acting medication is desired . Measures taken at times of the day when Ritalin is expected to have worn off—4 to 5 hours after ingestion — generally showed that Adderall was more effective than Ritalin at these times . The 7.5-mg twice-a-day dose of Adderall and the 17.5-mg twice-a-day dose of Ritalin produced equivalent behavioral changes . This indicates that a 5-mg dose of Adderall ( or slightly less ) is equivalent to a 10-mg dose of Ritalin , indicating that Adderall is twice as potent ; this potency ratio is similar to the well-known 1:2 ratio between d-amphetamine and methylpheni date . A higher dose of Adderall did not produce incremental improvement beyond that of the 7.5-mg dose , and parents were less likely to desire the continuation of the higher Adderall dose than the other medication conditions . Three-quarters of the responders to medication were recommended the lower rather than higher of the doses assessed . These findings are similar to our previous reports that there is a diminishing incremental value with stimulant medications beyond low to moderate doses , particularly when a behavioral intervention is concurrently implemented . Time-course results indicated that the afternoon dose of medication seemed to have a larger effect than the morning dose , raising the possibility that afternoon doses of stimulant medication may be able to be reduced relative to the morning dose without a corresponding reduction in efficacy . Although this practice is commonly used with some cases in clinical setting s , it is almost never used in empirical investigations and no studies have systematic ally investigated the practice . Our results suggest that systematic studies of a reduced midday dose are indicated . Further studies of dose equivalence and dose-response , including mg/kg dosing rather than absolute dosing , are necessary to firmly establish the  Adderall : Ritalin  dosing ratio and guidelines for clinical practice . Studies comparing Adderall to d-amphetamine should be conducted to determine whether the compound is superior to d-amphetamine alone . Further examinations of time-course are necessary to determine the length of action of  Adderall  — for example , whether a single morning dose will be sufficient to provide coverage throughout the school day Objective : ADHD is the most common childhood psychiatric disorder , with impairments seen in home and academic setting s. To investigate such impairments in a school-like setting , the laboratory school protocol ( LSP ) was developed at the University of California , Irvine . Method : This model provides a rigorously controlled environment to examine pharmacodynamic and pharmacokinetic aspects of responses to treatment . A key principle of this methodology is to exercise tight control of the timing and context of measurements by establishing a cycle of activities repeated across each study day . In addition , the LSP approach has been extended to both younger and older population s than the typically studied school-aged group . This extension requires corresponding modifications in measures to characterize drug efficacy and to allow evaluation of ADHD symptoms in a highly st and ardized setting . Results : This article provides guidelines for employing the LSP for the assessment of medication effects for both preschool and adolescent/adult population s. Conclusion : The LSP can be modified to form either an Adult Workplace Environment or a Preschool Assessment Laboratory OBJECTIVE This was a r and omized , double-blind , crossover study of 30 children with attention-deficit/hyperactivity disorder ( ADHD ) that evaluated the time course effects of four doses of Adderall ( 5 , 10 , 15 , and 20 mg ) , an inactive control ( placebo ) , and a positive control ( clinical dose of methylpheni date ) . METHOD For each treatment condition , a capsule was administered in the morning and assessment s were performed in an analog classroom setting every 1.5 hours across the day . Subjective ( teacher ratings of deportment and attention ) and objective ( scores on math tests ) measures were obtained for each classroom session , and these measures were used to evaluate time-response and dose response effects of Adderall . RESULTS For doses of Adderall greater than 5 mg , significant time course effects were observed . Rapid improvements on teacher ratings and math performance were observed by 1.5 hours after administration , and these effects dissipated by the end of the day . The specific pattern of time course effects depended on dose : the time of peak effects and the duration of action increased with dose of Adderall . CONCLUSIONS This documentation of efficacy in a controlled study supports the addition of Adderall to the armamentarium of psychotropic medications for the treatment of ADHD . The differences in time-response patterns of Adderall and methylpheni date may help tailor treatment to meet specific clinical needs of different children with ADHD Abstract Background Lisdexamfetamine dimesylate ( LDX ) is indicated for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) in children 6 to 12 years of age and in adults . In a previous laboratory school study , LDX demonstrated efficacy 2 hours postdose with duration of efficacy through 12 hours . The current study further characterizes the time course of effect of LDX . Methods Children aged 6 to 12 years with ADHD were enrolled in a laboratory school study . The multicenter study consisted of open-label , dose-optimization of LDX ( 30 , 50 , 70 mg/d , 4 weeks ) followed by a r and omized , placebo-controlled , 2-way crossover phase ( 1 week each ) . Efficacy measures included the SKAMP ( deportment [ primary ] and attention [ secondary ] ) and PERMP ( attempted/correct ) scales ( secondary ) measured at predose and at 1.5 , 2.5 , 5 , 7.5 , 10 , 12 , and 13 hours postdose . Safety measures included treatment-emergent adverse events ( AEs ) , physical examination , vital signs , and ECGs . Results A total of 117 subjects were r and omized and 111 completed the study . Compared with placebo , LDX demonstrated significantly greater efficacy at each postdose time point ( 1.5 hours to 13.0 hours ) , as measured by SKAMP deportment and attention scales and PERMP ( P < .005 ) . The most common treatment-emergent AEs during dose optimization were decreased appetite ( 47 % ) , insomnia ( 27 % ) , headache ( 17 % ) , irritability ( 16 % ) , upper abdominal pain ( 16 % ) , and affect lability ( 10 % ) , which were less frequent in the crossover phase ( 6 % , 4 % , 5 % , 1 % , 2 % , and 0 % respectively ) . Conclusion In school-aged children ( 6 to 12 years ) with ADHD , efficacy of LDX was maintained from the first time point ( 1.5 hours ) up to the last time point assessed ( 13.0 hours ) . LDX was generally well tolerated , result ing in typical stimulant AEs . Trial registration Official Title : A Phase IIIb , R and omized , Double-Blind , Multi-Center , Placebo-Controlled , Dose-Optimization , Cross-Over , Analog Classroom Study to Assess the Time of Onset of Vyvanse ( Lisdexamfetamine Dimesylate ) in Pediatric Subjects Aged 6–12 With Attention-Deficit/Hyperactivity Disorder . Clinical Trials.gov Identifier : NCT00500149 http:// clinical Investigated the effect of methylpheni date ( MPH ) on the ability of children with Attention Deficit Disorder with Hyperactivity ( ADDH ) to learn both trained and untrained complex visual relationships and compared these findings to their school performance under identical dosage parameters . 26 children between the ages of 6 and 12 years with ADDH participated in a double-blind , placebo control , within-subjects design in which each child received four doses of MPH ( 5 , 10 , 15 , 20 mg ) and a placebo in a counterbalanced sequence . MPH enhanced children 's learning of both taught and untaught visual relationships , and most changes were similar to , albeit less dramatic than , those obtained for the children 's attention and academic performance in school . Results of group and single-subject analyses are presented and discussed with relevance to psychopharmacological research and underst and ing the complex relationship between learning and psychostimulants used in treating children with ADDH INTRODUCTION This study compared two atomoxetine titration dosing schedules and two atomoxetine maintenance doses for treating adolescent attention-deficit/hyperactivity disorder ( ADHD ) inattention and hyperactivity/impulsivity .  METHODS Adolescents ( N = 267 ) were r and omized to a slow or fast titration schedule . Patients who responded continued on a 40-week maintenance treatment , r and omized to either 0.8 or 1.4 mg/kg/day . RESULTS During the acute period , significant benefit was demonstrated with both titration schedules on the ADHD Rating Scale total score . Although patients in both groups maintained benefit relative to week 0 , statistically significant loss of benefit was found for patients maintained on 0.8 mg/kg/day but not on 1.4 mg/kg/day . A similar pattern was observed on the Clinical Global Impressions-ADHD-Severity scores and Life Participation Scale for ADHD-Child Version scores . Mean grade s for most subjects improved for patients in both maintenance treatment groups although most improvements were not statistically significant . CONCLUSIONS In adolescents with ADHD , treatment benefit at 8 weeks was better maintained long-term with 1.4 mg/kg/day than with 0.8 mg/kg/day . Improvement in adaptive functioning and age-appropriate developmental function was also demonstrated . Atomoxetine 0.8 and 1.4 mg/kg/day were equally well tolerated . CLINICAL TRIALS REGISTRY Maintenance of benefit with atomoxetine hydrochloride in adolescents with ADHD , NCT00191035 OBJECTIVE Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder ( ADHD ) .  In marked contrast , relatively little is known about the adult outcome of these children . There have been only two controlled , prospect i ve studies of psychiatric status into adulthood . The present study was conducted to gain further underst and ing of the natural course of this common childhood condition . METHOD This was a prospect i ve follow-up of clinical ly diagnosed , white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years . At a mean age of 24.1 years , 85 prob and s ( 82 % of the childhood cohort ) and 73 comparison subjects ( 94 % of adolescent comparison subjects ) were directly interviewed by trained clinicians who were blind to group status . RESULTS Evaluations of the prob and s and comparison subjects indicated significantly higher prevalences of antisocial personality disorder ( 12 % versus 3 % ) and nonalcohol substance abuse ( 12 % versus 4 % ) in the prob and s , whereas mood disorders ( 4 % versus 4 % ) and anxiety disorders ( 2 % versus 7 % ) were not significantly different . At adult follow-up , ADHD was rare , occurring in only 4 % of the prob and s ( no comparison subjects ) . CONCLUSIONS The results of the present study are consistent with the authors ' previously reported major findings . They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders BACKGROUND Our objective was to estimate the lifetime prevalence of psychopathology in a sample of youth with and without attention deficit hyperactivity disorder ( ADHD ) through young adulthood using contemporaneous diagnostic and analytic techniques . METHOD We conducted a case-control , 10-year prospect i ve study of ADHD youth . At baseline , we assessed consecutively referred male , Caucasian children with ( n=140 ) and without ( n=120 ) DSM-III-R ADHD , aged 6 - 18 years , ascertained from psychiatric and pediatric sources to allow for generalizability of results . At the 10-year follow-up , 112 ( 80 % ) and 105 ( 88 % ) of the ADHD and control children , respectively , were reassessed ( mean age 22 years ) . We created the following categories of psychiatric disorders : Major Psychopathology ( mood disorders and psychosis ) , Anxiety Disorders , Antisocial Disorders ( conduct , oppositional-defiant , and antisocial personality disorder ) , Developmental Disorders ( elimination , language , and tics disorder ) , and Substance Dependence Disorders ( alcohol , drug , and nicotine dependence ) , as measured by blinded structured diagnostic interview . RESULTS The lifetime prevalence for all categories of psychopathology were significantly greater in ADHD young adults compared to controls , with hazard ratios and 95 % confidence intervals of 6.1 ( 3.5 - 10.7 ) , 2.2 ( 1.5 - 3.2 ) , 5.9 ( 3.9 - 8.8 ) , 2.5 ( 1.7 - 3.6 ) , and 2.0 ( 1.3 - 3.0 ) , respectively , for the categories described above . CONCLUSIONS By their young adult years , ADHD youth were at high risk for a wide range of adverse psychiatric outcomes including markedly elevated rates of antisocial , addictive , mood and anxiety disorders . These prospect i ve findings provide further evidence for the high morbidity associated with ADHD across the life-cycle and stress the importance of early recognition of this disorder for prevention and intervention strategies There appear to be beneficial effects of stimulant medication on daily classroom measures of cognitive functioning for Attention Deficit Disorder ( ADD ) children , but the specificity and origin of such effects is unclear . Consistent with previous results , 0.3 mg/kg methylpheni date improved ADD children 's  performance on a classroom reading comprehension measure . Using the Posner letting-matching task and four additional measures of phonological processing , we attempted to isolate the effects of methylpheni date to parameter estimates of ( a ) selective attention , ( b ) the basic cognitive process of retrieving name codes from permanent memory , and ( c ) a constant term that represented nonspecific aspects of information processing . Responses to the letter-matching stimuli were faster and more accurate with medication compared to placebo . The improvement in performance was isolated to the parameter estimate that reflected nonspecific aspects of information processing . A lack of medication effect on the other measures of phonological processing supported the Posner task findings in indicating that methylpheni date appears to exert beneficial effects on academic processing through general rather than specific aspects of information processing OBJECTIVE The aim of this study was to assess changes in symptomatology of attention-deficit/ hyperactivity disorder ( ADHD ) with extended-release dexmethylpheni date ( d-MPHER ) versus placebo in a laboratory classroom setting . METHODS This double-blind , placebo-controlled , crossover study r and omized 54 children 6 - 12 years of age , stabilized on methylpheni date 20 - 40 mg/day . Patients participated in a practice day , then received 5 days of treatment with d-MPH-ER 20 mg/day or placebo . After a 1-day wash-out , they returned to the classroom and received 1 dose of their assigned treatment . Evaluations occurred predose and at postdose hours 1 , 2 , 4 , 6 , 8 , 9 , 10 , 11 , and 12 . Children were then crossed over to the alternate treatment , using identical protocol . Primary efficacy variable was the Swanson , Kotkin , Agler , M-Flynn , and Pelham rating scale (SKAMP)-Combined scores , and primary analysis time point was 1 hour postdose ; secondary efficacy variables over 12 hours included SKAMP-Attention and -Deportment scores and written math test results . Safety was assessed by adverse event ( AE ) recording following each period . Vital signs were recorded at each visit ; laboratory tests were conducted at screening and final visit . RESULTS D-MPH-ER 20 mg/day showed a significant advantage over placebo as early as 1 hour postdose on SKAMP-Combined scores ( p < 0.001 ) . When analyzing the entire sample of 54 children , d-MPH-ER maintained significant superiority over placebo from hours 1 through 12 ( p-values ranged from < 0.001 to 0.046 ) . D-MPH-ER was well tolerated , with no severe AEs reported . CONCLUSIONS D-MPH-ER is safe and effective and improves classroom attention , deportment , and performance in children with ADHD The response of 23 children with attention deficit disorder ( ADD ) with hyperactivity ( + H ) and 17 children with ADD without hyperactivity ( -H ) to three doses of methylpheni date ( 5 , 10 , and 15 mg twice a day ) was evaluated in a triple-blind , placebo-controlled cross-over design using parent and teacher ratings of behavior , laboratory tests of ADD symptoms , and behavioral observations during academic performance . Results indicated that the children with ADD+H were rated as having more pervasive behavioral problems at home and more pervasive and severe conduct problems at school than the children with ADD-H. Laboratory tests found the children with ADD+H to be impaired in behavioral inhibition and vigilance whereas children with ADD-H were more impaired in the consistent retrieval of verbally learned material Drug effects were noted on the parent and teacher ratings and on most laboratory measures , with all three doses typically producing significant changes but rarely differing among themselves in effectiveness . The groups were not found to differ significantly on any measures in their response to methylpheni date . However , more children with ADD-H were clinical ly judged as having either no clinical response ( 24 % ) or responding best to the low dose ( 35 % ) of medication . In contrast , most ADD+H ( 95 % ) children were judged to be positive responders and most were recommended to receive the moderate to high dose ( 71 % ) OBJECTIVE To compare the efficacy and time course of single morning doses of Adderall , extended-release , and immediate-release dextroamphetamine sulfate . METHOD Thirty-five children with attention-deficit/hyperactivity disorder , combined type , were given Adderall , immediate-release dextroamphetamine , dextroamphetamine Spansules , and placebo in a r and omized , double-blind , crossover study . Behavior ratings , locomotor activity measurements , and academic measures were obtained over a period of 8 weeks . RESULTS All three drugs exhibited robust efficacy versus placebo on nearly all measures . The effects of dextroamphetamine Spansules were less robust in the morning , particularly compared with Adderall , but they lasted 3 to 6 hours longer , depending on the measure . Although parent behavior ratings and locomotor activity showed improvements up to 12 hours after single doses of all three drugs , the number of math problems attempted and completed correctly 4 hours after dosing were only robustly increased by Spansules . CONCLUSIONS Both immediate-release amphetamines demonstrated earlier onset of effects , but dextroamphetamine Spansules showed more sustained effects that were present on a wider range of measures OBJECTIVES This investigation was conducted primarily to assess the safety and efficacy of SLI381 ( Adderall XR ) , developed as a once-daily treatment for children with attention-deficit/hyperactivity disorder ( ADHD ) . Secondary objectives included examination of the time course , pharmacokinetic , and pharmacodynamic properties of SLI381 . METHOD This was a r and omized , double-blind , crossover study of three doses of SLI381 ( 10 , 20 , and 30 mg ) , placebo , and an active control ( Adderall 10 mg ) given once daily to 51 children with ADHD . Weekly assessment s in an analog classroom setting included blind ratings of attention and deportment and a performance measure ( math test ) obtained every 1.5 hours over a 12-hour period . RESULTS SLI381 was well tolerated . All active treatment conditions displayed significant time course effects and were superior to placebo in improving efficacy measures . Dose-dependent improvements were evident for SLI381 . SLI381 20 and 30 mg and Adderall all showed rapid improvements by 1.5 hours , but only the SLI381 20- and 30-mg doses showed continued activity at 10.5 and 12 hours for classroom behavior and math test performance versus placebo . CONCLUSIONS These data provide support for the benefit of this novel , once-daily amphetamine preparation in the treatment of ADHD . The longer duration of action of SLI381 has the potential to simplify psychostimulant dosing , thus reducing dose diversion and eliminating the need for in-school administration . SLI381 appears to be a useful treatment option for many children with ADHD OBJECTIVE The aim of this study was to compare efficacy and safety of two long-acting formulations of methylpheni date ( MPH ) for attention-deficit/hyperactivity disorder ( ADHD ) in school-age children . METHODS Children 6 - 12 years of age diagnosed with ADHD and stabilized on MPH ( 20 - 40 mg/day ) participated in a five-way , r and omized , placebo-controlled , single-blind , crossover study conducted in a laboratory classroom setting . Children alternately received single doses of extended-release MPH ( ER-MPH ) 20 and 40 mg , modified-release MPH ( OROS-MPH ) 18 and 36 mg , and placebo over 6 consecutive weeks .  Efficacy was assessed using SKAMP rating subscales and written math tests . Data were examined using between-treatment comparisons of area under the curve ( AUC ) for change from predose values during hours 0 - 4 , 0 - 8 , 8 - 12 , and 0 - 12 . Safety was assessed . RESULTS Fifty-three children completed the study . For all efficacy measures , improvements from predose were significantly greater with ER-MPH 40 mg than with OROS-MPH 36 mg in terms of AUC(0 - 4 ) ( p < or = 0.005 ) , AUC(0 - 8 ) ( p < or = 0.006 ) , and AUC(0 - 12 ) ( p < or = 0.035 ) . For most measures , ER-MPH 20 mg was equivalent to both doses of OROS-MPH in AUC(0 - 4 ) , AUC(0 - 8 ) , and AUC(0 - 12 ) . No serious adverse events were reported . CONCLUSIONS The efficacy of ER-MPH 20 mg is similar to that of OROS-MPH 18 and 36 mg during the first 8 hours postdose . Statistically greater benefits are observed with ER-MPH 40 mg than with OROS-MPH 36 mg and persist through hour 8 . Active treatments show comparable efficacy from 8 to 12 hours postdose . Both doses of each MPH formulation are well tolerated OBJECTIVE This was a multicenter , double-blind , r and omized , dose-ranging study of a methylpheni date ( MPH ) transdermal system ( MTS ) . Medication ( placebo , 0.45 , 0.9 , and 1.8 mg/h ) was crossed with application time ( 6 a.m. , 7 a.m. ) to evaluate MTS efficacy and influence of exposure time on morning effects . METHOD The study took place in a summer treatment program ( STP ) at three sites , with 36 children aged 7 - 12 years with attention-deficit/hyperactivity disorder . Each treatment was administered for 1 day in r and om order , for a total of 8 days . Behavioral and academic measures were taken as well as patch wear characteristics and side effects . RESULTS Evaluable participant data were analyzed in a series of dose x application time multivariate analyses of variance . All MTS conditions were significantly different from placebo across measures . Time of application had no significant effect on daily behavior , and effects of application time on morning behavior were inconclusive . Consistent with previous results in this setting , the highest dose produced limited incremental benefit compared with the mid-range dose . The wear characteristics of the MTS were acceptable , and the formulation was well tolerated . CONCLUSIONS The MTS produced significant effects that were similar to those previously reported with comparable MPH doses . There does not appear to be a substantial effect of application time on total daily functioning in this setting ; further controlled time-course studies will be necessary to evaluate the question of morning onset fully Methylpheni date ( Ritalin ) has been shown to have differential effects on hyperactive children 's behavior as a function of dose level . In the present investigation , a triple-blind , placebo-control , within-subject ( crossover ) experimental design was employed in which 12 hyperactive boys between 6 and 10 years received three different dosages of methylpheni date ( 5 , 10 , and 15 mg ) in a r and omly assigned sequence . Dosage effects were assessed on clinic(PAL-Paired Associates Learning test ) and school-(percent on task , teacher ratings , work completion rates , and accuracy ) related behaviors . For 10 of the children , classified as responders to medication by the PAL using the criteria of Swanson , Kinsbourne , and colleagues , a series of ANCOVAs with repeated measures showed significant dosage effects on teacher ratings ( p ⋖01 ) , percent on task ( p ⋖01 ) , academic accuracy ( p ⋖05 ) , and assignment completion rates ( p ⋖05 ) . PAL performance was also significantly enhanced ( p ⋖01 ) after optimal dose levels were considered . Subsequent trend analysis showed a significant positive linear relationship between dose and each of the dependent variables . A comparison of fixed-dose and miligram-per-kilogram plots showed that children 's performance across the different dosages were clearly individualistic and task-specific , even when similar body weights were compared . The implication s of using clinic-based testing to determine optimal medication responsivity were discussed BACKGROUND Lisdexamfetamine dimesylate is a therapeutically inactive prodrug in which d-amphetamine is covalently bound to l-lysine , a naturally occurring amino acid . Pharmacologically active d-amphetamine is released from lisdexamfetamine following oral ingestion . METHODS This phase 2 , r and omized , double-blind , placebo- and active-controlled crossover study compared the efficacy and safety of lisdexamfetamine ( LDX : 30 , 50 , or 70 mg ) with placebo , with mixed amphetamine salts extended-release ( MAS XR : 10 , 20 , or 30 mg ) included as a reference arm of the study , in 52 children aged 6 to 12 years with attention-deficit/hyperactivity disorder ( ADHD ) in an analog classroom setting . The primary efficacy measure was the Swanson , Kotkin , Agler , M-Flynn , and Pelham ( SKAMP ) Rating Scale ; secondary efficacy measures included the Permanent Product Measure of Performance ( PERMP ) Derived Measures , and the Clinical Global Impression ( CGI ) Scale . RESULTS LDX treatment significantly improved scores on SKAMP-deportment , SKAMP-attention , PERMP-attempted , PERMP-correct , and CGI-improvement from baseline . Adverse events were similar for both active treatments . CONCLUSIONS In a laboratory classroom environment , LDX significantly improved ADHD symptoms versus placebo in school-age children with ADHD Objective : This study evaluates the efficacy , duration of action , and tolerability of methylpheni date transdermal system ( MTS ) in children with ADHD . Method : Participants were dose optimized over 5 weeks utilizing patch doses of 10 , 16 , 20 , and 27 mg applied in the morning and worn for 9 hours . Following optimization , 80 participants were r and omized to 1 week of MTS or placebo followed by 1 week of the opposite treatment . Laboratory classroom sessions conducted after each r and omized week included blinded ratings of attention , behavior , and academic performance . Results : MTS was well tolerated and displayed significant improvement compared with placebo . Improvements were seen at the first postdose time point measured and continued through 12 hours . Conclusions : Treatment with MTS result ed in statistically significant improvements on all efficacy measures . Time course and therapeutic effects of MTS suggest that this novel methylpheni date delivery system is an efficacious once-daily treatment for ADHD This study evaluated the effects of two doses of psychostimulants on nine ADHD students ' performance in a classroom design ed to be analogous to a junior high school American history class conducted during a summer treatment program . Double-bline , placebo-controlled assessment revealed significant and clinical ly important effects of psychostimulants on quiz and test performance , observations of attention and behavior during lectures , and teacher ratings , as well as accuracy on assignments completed during study hall . Analysis of individual differences revealed a 66 % positive response rate . The implication s for use of psychostimulants with ADHD young adolescents are discussed Abstract Background Given the dosing limitations of methylpheni date short – acting preparations in treating ADHD , galenics with longer release of the substance were developed mainly to avoid drug intake during school hours . Objectives This investigation was conducted to assess the efficacy and the duration of action of a new extended-release formulation of methylpheni date ( Medikinet ® retard ) as a once – daily treatment for children with attention – deficit hyperactivity disorder ( ADHD ) . Method This was a r and omized , double – blind , crossover multicentre study with three treatment conditions : once – daily extended – release methylpheni date , twice – daily immediate – release methylpheni date and placebo given to 79 children ( 8–14 years old ) with ADHD . Daily assessment s in an analogue classroom setting included blind ratings of attention and deportment and a performance measure ( math test ) obtained 5 times over an 8–hour period . Secondary measures included an ADHD rating scale , based on DSMIV/ ICD–10 separately rated for the morning and the afternoon . Results Both active treatment conditions displayed significant time course effects and were superior to placebo in improving all efficacy measures . Once a day extended – release methylpheni date was not different from the same dose of twice daily immediate – release methylpheni date . Conclusions These data provide support for the benefit of this novel , once-daily methylpheni date preparation in the treatment of ADHD . The longer duration of action of Medikinet Retard has the potential to simplify psychostimulant treatment , thus reducing dose diversion and eliminating the need for in – school administration Behavioral and neuropsychological functioning in unmedicated children with attention-deficit/hyperactivity disorder ( ADHD ) who have a history of medication treatment ( Rx ) versus those who are treatment naïve ( TN ) has , to our knowledge , not been previously studied . Ninety-four children in four groups ( ADHD/Rx , ADHD/TN , learning disabilities [ LD ] , and controls ) were evaluated , while unmedicated , on measures of achievement , neuropsychological functioning , and behavior . The ADHD/Rx group performed significantly better than the TN group on writing , Stroop interference , and measures of attention , and performed as well as the control group on executive functioning , verbal working memory , and academics . Behaviorally , the ADHD groups showed more difficulty with mood and externalizing behaviors compared with the LD and control groups , with the ADHD/TN performing the most poorly . Findings suggest that the ADHD/Rx group shows better executive and academic functioning even when unmedicated Six boys aged 9 to 12 years attended a tutoring class focusing on reading for 30 minutes each morning . The investigators employed a modified Latin-square design in which each child began with a 5-day baseline phase followed by six 10-day treatment phases that used drug placebo , noncontingent reinforcers , 0.3 mg/kg methylpheni date , 0.7 mg/kg methylpheni date , and self-re-inforcement in various combinations . Amount of academic performance was the major measure of outcome and the target behavior of self-reinforcement . Drug placebo and noncontingent reinforcers had no systematic impact . Methylpheni date had differential effects across the recorded behaviors . Self-reinforcement improved the target behavior ; the mean effect size for self-reinforcement was 2.66 . The combined effects of methylpheni date and self-reinforcement on academic performance were greater than either of the treatments given alone ( mean effect size = 2.89 ) Two studies were conducted to investigate the relative effects of sustained release methylpheni date ( Ritalin [ SR-20 ] ) and st and ard methylpheni date ( Ritalin , 10 mg , administered twice daily ) . In the first study , 13 boys with attention deficit disorder participating in a summer treatment program went through a double-blind , within-subject trial of each form of methylpheni date and placebo . Measures of social and cognitive behavior were gathered in classroom and play setting s. Although group analyses of the data showed that both drugs were effective and there were few differences between them , st and ard methylpheni date was superior to SR-20 on several important measures of disruptive behavior . Furthermore , analyses of individual responsivity showed clearly that most boys responded more positively to st and ard methylpheni date than to SR-20 . The second study involved a partially overlapping group of nine boys with attention deficit disorder participating in the same summer treatment program . Also double-blind , within-subject , and placebo controlled , this study tracked the time courses of the two forms of methylpheni date . Both were shown to have similar time courses on the Abbreviated Conners Rating Scale and other measures , but SR-20 had a slower onset than did the st and ard drug form on a continuous performance task . Effects of SR-20 were still evident eight hours after ingestion The present study examined the degree to which methylpheni date ( MPH ) normalized the classroom behavior and academic functioning of 31 children with attention deficit disorder ( ADD ) . Subjects with ADD participated in a double-blind , placebo-controlled trial in which children received each of four doses ( 5 , 10 , 15 , and 20 mg ) of MPH and a placebo following baseline measures . Children with ADD were compared with a group of 25 normal control children on teacher ratings of social conduct , direct observations of on-task behavior , and academic efficiency . At a group level of analysis , MPH exerted a significant effect on classroom measures of attention and academic efficiency to a point where they were no longer statistically deviant from scores obtained by normal control children . Nevertheless , when examined at the individual level , 25 % of the sample failed to show normalized levels of classroom performance , thus implying the need for ancillary school-based interventions Sixteen children meeting diagnostic criteria for Attention Deficit Disorder with Hyperactivity ( ADD-H ) were tested on methylpheni date ( 0.3 mg/kg ) and placebo on cognitive , learning , academic and behavioral measures in a double-blind study . Assessment s were carried out in the laboratory and in the children 's regular classrooms . Results indicate methylpheni date -induced improvements on a majority of the measures . Drug-induced changes reflected increased output , accuracy and efficiency and improved learning acquisition . There was also evidence of increased effort and self-correcting behaviours . It is argued that review ers have underestimated the potential of stimulants to improve the performance of ADD-H children on academic , learning and cognitive tasks The present invention is for an improved st and ( 2 ) typically of the music variety . The improvements consist of a stabilizing cam ( 10 ) and a compact , central ly located , adjustable position memory element ( 16 ) . The stabilizing cam ( 10 ) may be used in a variety of structures to micro adjust the level of the st and ( 2 ) to provide better support and stability . The adjustable position memory element ( 16 ) may be used on a variety of devices as well including an articulable support st and such that the support st and can be returned upon reuse to a preselected position from a plurality of preselected available positions OBJECTIVE 1 ) To compare st and ard twice-daily methylpheni date ( MPH ) dosing with a single morning dose of MPH and of Adderall during a typical school-day time period , and 2 ) to conduct a dose-response study of the effects of a late-afternoon ( 3:30 PM ) dose of MPH and Adderall on evening behavior and side effects . DESIGN Within-subject , placebo-controlled , crossover design . SETTING Intensive summer treatment program with a comprehensive behavioral approach . STUDY PARTICIPANTS Twenty-one children with attention-deficit/hyperactivity disorder ( 19 boys and 2 girls ) , between the ages of 6 and 12 years . INTERVENTIONS Children received , in r and om order with daily crossovers , each of the following conditions : 1 ) placebo , 2 ) 0.3 mg/kg of MPH received 3 times , 3 ) 0.3 mg/kg of MPH received twice ( 7:30 AM and 11:30 AM ) with 0.15 mg/kg received at 3:30 PM , 4 ) 0.3 mg/kg of MPH received once in the morning only , 5 ) 0.3 mg/kg of Adderall received at 7:30 AM and at 3:30 PM , 6 ) 0.3 mg/kg of Adderall once in the morning with 0.15 mg/kg received at 3:30 PM , 7 ) 0.3 mg/kg of Adderall received in the morning only . OUTCOME MEASURES Daily rates of behaviors in social and academic setting s , and st and ardized ratings from counselors and teachers , were assessed for the hours between 8:00 AM and 3:30 PM ( a typical school-day ) . Relative sizes of the medication effects were compared hourly between first daily ingestion ( 7:30 AM ) and 4:45 PM to assess the time course of the 2 drugs . Effects of the 3:30 PM doses on functioning in the evenings at home were evaluated using parent ratings of behavioral and side effects . RESULTS A single morning dose of Adderall produced equivalent behavioral effects to those of MPH received twice-daily and behavioral effects of that single morning dose lasted throughout the school-day period . One morning dose of MPH was less effective than either 2 daily doses of MPH or 1 dose of Adderall , and seemed to wear off in the early to mid-afternoon . For some children a single morning dose of MPH maintained their behavior for an entire school day in the context of the summer treatment program . On parent ratings of evening behavior , 0.3 mg/kg of MPH at 3:30 PM was superior to 0.15 mg/kg at 3:30 PM , but there was no difference between the 2 doses of Adderall . Compared with placebo at 3:30 PM , only the 0.3 mg/kg dose of MPH caused significant improvement in parent ratings . In placebo versus Adderall comparisons , all doses , even the condition that consisted of Adderall in the morning and placebo at 3:30 PM , produced a significant change in evening behavior . CONCLUSIONS The results show that , at least in the context of an intensive behavioral intervention , a single morning dose of Adderall had behavioral effects throughout an entire school day period that were equivalent to st and ard twice-daily MPH dosing . These results indicate that Adderall may be used as a long-acting stimulant for children for whom midday dosing is a problem . Further study including dose-response comparisons , effects in regular school setting s , and direct comparisons with comparable doses of MPH and d-amphetamine will help to clarify the time course and relative advantages of Adderall The short-term , dose-response effects of methylpheni date hydrochloride were evaluated on academic and social classroom measures in 29 children with attention deficit disorder . In a double-blind , cross-over design with order r and omized , children received a placebo for two weeks and three doses of methylpheni date hydrochloride ( 0.15 mg/kg , 0.3 mg/kg , and 0.6 mg/kg ) for one week each . Dependent measures included the output and accuracy of performance in grade -appropriate reading comprehension workbooks and arithmetic problems , spelling word acquisition , and observations of disruptive and on-task behavior . Beneficial drug effects and linear dose-response curves on all dependent measures were found . The results suggest that beneficial methylpheni date effects on classroom behavior may be accompanied by enhanced academic achievement in some hyperactive children OBJECTIVE To evaluate the magnitude and clinical significance of methylpheni date ( MPH ) effects on the classroom behavior and academic performance of 76 children with attention deficit disorder/hyperactivity ( ADDH ) . METHOD A double-blind , placebo controlled , within-subject ( crossover ) experimental design was used to evaluate acute MPH effects at four dose levels ( 5 mg , 10 mg , 15 mg , and 20 mg ) on children 's attention , academic functioning , and behavior in regular classroom setting s. Results were contrasted with a normal control sample . RESULTS St and ard statistical analysis revealed MPH effects on classroom functioning that were primarily linear . Analysis of the clinical significance of effects indicated that large proportions of treated children exhibited significantly improved or normalized classroom functioning ; however , a large subset of them failed to show improved academic functioning . Overall , children failing to respond at lower dose levels have a high probability of improving or becoming normalized as a function of increasing dose . CONCLUSIONS For a majority of children with ADDH , MPH results in significantly improved or normalized attention and classroom behavior . A significant subset , however , fail to realize gains in their academic functioning and will require supplemental interventions The effects of 0.3 mg/kg methylpheni date were compared for 12 ADD boys and 12 ADD girls participating in a summer treatment program for children with behavior and /or learning problems . Previous investigations have suggested that ADD girls may differ from ADD boys in some important respects . No information exists regarding whether the effects of the most common treatment for these children , methylpheni date , has comparable effects on boys and girls . The boys and girls were matched for age and IQ . The results revealed equivalent and beneficial effects of methylpheni date for both boys and girls . Methylpheni date therefore would appear to be as useful a treatment for ADD girls as for ADD boys Daily academic classroom performance was recorded in a day hospital school using a commonly employed reading and math series as part of an 11-week double-blind , placebo controlled , crossover comparison of dextroamphetamine ( d-AMPH ) and methylpheni date ( MPH ) in 33 hyperactive boys . Students attempted more math and reading tasks while on either active drug . The percent correct and the number of attempted problems of the reading series improved with both drugs while the percent correct for the math series occurred with d-AMPH only . No dose-response relationship was found for either stimulant . Moderate , transient adverse effects were common for both drugs
target: Drug treatment benefited children in the amount of school work that they completed , by up to 15 % , and less consistently improved children ’s accuracy in specific types of academic assignments , such as arithmetic .
  Methylpheni date , dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children ’s on-task behaviour and academic work completion .
  These review findings suggest that medication for ADHD has the potential to improve children ’s learning and academic achievement
background: Attention-deficit hyperactivity disorder ( ADHD ) has a significant impact on children ’s classroom behaviour , daily functioning and experience of school life .
  However , the effects of drug treatment for ADHD on learning and academic achievement are not fully understood .
  This review was undertaken to describe the effects of methylpheni date , dexamfetamine , mixed amfetamine salts and atomoxetine on children ’s on-task  behaviour and their academic performance , and to perform a meta- analysis to quantify these effects .