Ritalin Paper Database
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Visual Abstract
A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder
How Concerta (OROS Methylphenidate) Dosage Affects ADHD Symptoms
October 17, 2024
author
Stein MA, Sarampote CS, Waldman ID, Robb AS, Conlon C, Pearl PL, Black DO, Seymour KE, Newcorn JH
journal
Pediatrics
Date Published
2003 Nov
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Study Summary
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What They Studied
The researchers studied how different doses of OROS methylphenidate (Concerta) affect ADHD symptoms and side effects in children.
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What They Found
They found that higher doses of OROS methylphenidate (Concerta) improved symptoms in children with ADHD combined type, while lower doses were more effective for those with predominantly inattentive type.
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What This Means
These findings suggest that treatment for ADHD can be more effective when dosages of OROS methylphenidate (Concerta) are tailored to the specific subtype of ADHD a child has, which aligns with current evidence on individualized ADHD treatment.
Study Summary
Study Overview
The study examined how varying doses of OROS methylphenidate (Concerta) affect children with ADHD. Researchers focused on whether higher or lower doses worked better depending on ADHD type. The study found children respond differently to doses, indicating that tailored treatment may be more effective.
Some children improved at higher doses, while others experienced more side effects, particularly in hyperactive versus inattentive ADHD types.
Some children improved at higher doses, while others experienced more side effects, particularly in hyperactive versus inattentive ADHD types.
Abstract: background
OROS methylphenidate HCL (MPH) is a recently developed long-acting stimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD). This study was conducted to examine dosage effects on ADHD symptoms and stimulant side effects and ...more
Study Purpose
"The primary purpose of this study was to determine dosage effects of OROS MPH on ADHD symptoms, impairments, and side effects."
Differential Response
"The finding of differential response based on ADHD subtype are reminiscent of Sprague and Sleator's widely reported study of differential dose effects of immediate-release MPH in hyperactive children."
Medication and ADHD Subtypes
"The goal of the present study was to examine the relationship between OROS MPH dose and ADHD symptoms, impairment, and side effects. A secondary goal was to evaluate the potential moderating effects of ADHD subtype."
Study Summary
Methods
Researchers conducted a placebo-controlled crossover trial involving 47 children with ADHD, aged 5 to 16. These children were given OROS methylphenidate (Ritalin) at three dosage levels in a forced titration design, meaning their doses were adjusted weekly.
Parents and teachers rated ADHD symptoms weekly to assess the drug's effectiveness. In addition, the study tracked vital signs and noted any side effects, such as changes in sleep or appetite, at each dose.
Parents and teachers rated ADHD symptoms weekly to assess the drug's effectiveness. In addition, the study tracked vital signs and noted any side effects, such as changes in sleep or appetite, at each dose.
Abstract: methods
Children with ADHD combined type (ADHD-CT) or predominantly inattentive type (ADHD-PI; n = 47), ages 5 to 16 years, underwent a placebo-controlled, crossover trial using forced titration with weekly switches at 3 dosage levels. Parent and teacher rat...more
Study Summary
Results
The study found that parents were better at noticing improvements than teachers. Children with ADHD-CT showed significant improvements in symptoms, especially at higher doses, with about 70% responding well to 36-54 mg doses.
In contrast, children with ADHD-PI responded better to lower doses, with 60% showing noticeable improvements at 36 mg or less. Mild side effects like insomnia and decreased appetite were reported, especially at higher doses.
In contrast, children with ADHD-PI responded better to lower doses, with 60% showing noticeable improvements at 36 mg or less. Mild side effects like insomnia and decreased appetite were reported, especially at higher doses.
Abstract: results
Parent ratings were more sensitive to treatment effects than teacher ratings. ADHD symptoms and Clinical Global Impressions Severity Index ratings at each dose condition differed significantly from placebo and baseline ratings, which did not differ f...more
Study Summary
Conclusions
Children with ADHD-CT experienced better symptom control with higher doses of OROS methylphenidate (Ritalin), especially for inattention and hyperactivity. However, children with ADHD-PI benefited more from lower doses.
Both groups experienced more insomnia and appetite loss at higher doses, although side effects varied slightly based on age and size, with younger children more prone to sleep disturbances.
Both groups experienced more insomnia and appetite loss at higher doses, although side effects varied slightly based on age and size, with younger children more prone to sleep disturbances.
Abstract: conclusions
In children with ADHD-CT, the most common subtype of ADHD, increasing doses of stimulant medication were associated with increased improvement of inattention and hyperactivity symptoms. In children with ADHD-PI, symptom improvement occurred at lower ...more
Background Information
Patient Guide
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FDA Approval for ADHD Treatment
Methylphenidate is FDA-approved for treating ADHD in children and adults, showcasing its primary therapeutic use.
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Mechanism of Action
Methylphenidate blocks norepinephrine and dopamine reuptake, enhancing their concentration in the synaptic cleft.
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Growth Effects in Children
Long-term use of methylphenidate in children can result in decreased height, weight, and bone marrow density.
Professional Guide
Expert Opinion: How Concerta (OROS Methylphenidate) Dosage Affects ADHD Symptoms
Current guidance supports methylphenidate use when behavioral interventions are insufficient, especially for preschoolers. Stimulants are highly effective in treating ADHD but require careful monitoring for side effects like appetite loss, headaches, and sleep issues.Combining behavioral therapy with medication offers better results, and communication with school and health professionals is essential. Pharmacogenetic tools may help tailor treatments to individual responses.
Evidence Summary
Effectiveness of Combined ADHD Treatments
Combining lower doses of ADHD medication with behavioral strategies might replicate higher dose effects.
The Incredible Years program shows children with ADHD can maintain treatment benefits for a year post-treatment when combining parent training with medication.
Parent training remains effective for children with ADHD even when combined with medication, showing the value of using both approaches together.
The Incredible Years program shows children with ADHD can maintain treatment benefits for a year post-treatment when combining parent training with medication.
Parent training remains effective for children with ADHD even when combined with medication, showing the value of using both approaches together.
Evidence Summary
Evaluating ADHD Treatments: Medication vs. Behavioral Therapy
The paper above highlights how ADHD subtype affects dosage response to OROS methylphenidate.
This comparison examines various treatments for ADHD, mixing medication and behavioral therapies.
Researchers analyzed multiple studies to see which approaches work best.
Both medications and behavioral interventions showed diverse effectiveness across different studies.
This comparison examines various treatments for ADHD, mixing medication and behavioral therapies.
Researchers analyzed multiple studies to see which approaches work best.
Both medications and behavioral interventions showed diverse effectiveness across different studies.
Evidence Summary
Time Perception Challenges in ADHD Children
ADHD children's ability to accurately reproduce time intervals notably declines under distraction and with increasing duration.
Despite varying doses of methylphenidate (MPH), no significant improvements in time perception were observed.
In contrast, control subjects maintained accuracy irrespective of distractions.
This aligns with findings from the paper about dose-response, highlighting challenges in managing ADHD symptoms with medication.
Despite varying doses of methylphenidate (MPH), no significant improvements in time perception were observed.
In contrast, control subjects maintained accuracy irrespective of distractions.
This aligns with findings from the paper about dose-response, highlighting challenges in managing ADHD symptoms with medication.
