The use of an N-of-1 randomised clinical trial in resolving therapeutic doubt. The case of a patient with an 'attention disorder'.
OBJECTIVE
To describe the use of an N-of-1 randomised clinical trial (N-of-1 RCT) in general practice as illustrated by the case of a 16 year old boy with a learning and attention problem whose parents were convinced that amphetamines were necessary.


METHODS
The N-of-1 RCT with a double blind technique was used in which a single patient served as his own control in testing whether amphetamine had any advantage over placebo.


RESULTS
No difference was noted in the boy's teachers' behavioural assessment scores nor in his own self reported ability to concentrate when taking either amphetamine or placebo.


CONCLUSIONS
This study showed that this patient obtained no objective improvement from amphetamine and the result was well accepted by his parents. N-of-1 RCTs are a relatively easy technique for tackling any area of therapeutic doubt. They can help the thoughtful GP to feel 'more like a scientist and less like a quack'.
Dept of General Practice, University of WA, Claremont.
M
M
Kamien
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D018592:Cross-Over Studies; D003913:Dextroamphetamine / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
D018765:Dopamine Uptake Inhibitors; D003913:Dextroamphetamine