Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial.
OBJECTIVE
Results of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) were analyzed to determine whether a double-blind, placebo-controlled methylphenidate (MPH) titration trial identified the best MPH dose for each child with attention-deficit/hyperactivity disorder (ADHD).


METHODS
Children with ADHD assigned to MTA medication treatment groups (n = 289) underwent a controlled 28-day titration protocol that administered different MPH doses (placebo, low, middle, and high) on successive days.


RESULTS
A repeated-measures analysis of variance revealed main effects for MPH dose with greater effects on teacher ratings of impairment and deportment (F3 = 100.6, n = 223, p = .0001; effect sizes 0.8-1.3) than on parent ratings of similar endpoints (F3 = 55.61, n = 253, p = .00001; effect sizes 0.4-0.6). Dose did not interact with period, dose order, comorbid diagnosis, site, or treatment group.


CONCLUSIONS
The MTA titration protocol validated the efficacy of weekend MPH dosing and established a total daily dose limit of 35 mg of MPH for children weighing less than 25 kg. It replicated previously reported MPH response rates (77%), distribution of best doses (10-50 mg/day) across subjects, effect sizes on impairment and deportment, as well as dose-related adverse events.
Greenhill
L L
LL
Clinical Psychiatry, Department of Psychiatry, Columbia University, New York, USA. LarryLGreenhill@cs.com
Swanson
J M
JM
Vitiello
B
B
Davies
M
M
Clevenger
W
W
Wu
M
M
Arnold
L E
LE
Abikoff
H B
HB
Bukstein
O G
OG
Conners
C K
CK
Elliott
G R
GR
Hechtman
L
L
Hinshaw
S P
SP
Hoza
B
B
Jensen
P S
PS
Kraemer
H C
HC
March
J S
JS
Newcorn
J H
JH
Severe
J B
JB
Wells
K
K
Wigal
T
T
D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000494:pharmacology; D012044:Regression Analysis
D000697:Central Nervous System Stimulants; D008774:Methylphenidate