Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder.
BACKGROUND
Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylphenidate preparation (Medikinet retard, MPH-MR), with equal portions of the immediate-release and the sustained-release active substance, and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology.


METHODS
Eighty five children and adolescents (6-16 years) were investigated in a double-blind, randomized, clinical trial over 5 weeks under a treatment with MPH-MR using symptom checklists for ADHD, oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).


RESULTS
A total of 64.9% of the children showed oppositional defiant disorder/conduct disorder (ODD/CD) symptoms. A statistically significant effect was found in the group treated with MPH (verum-group). On the basis of Cohen's criteria, high effects were found for aggressive symptoms in school (d = 1.0), but not in the afternoon (d = 0.4). There were also lower effect sizes for more severe aggressive symptoms. We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention.


CONCLUSIONS
Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior, especially concerning milder symptoms. The expected correlation between impulsivity and aggressiveness could be confirmed.
Sinzig
Judith
J
Department for Psychiatry and Psychotherapy of Children & Adolescents at the University of Cologne, Köln, Germany. ju.k.sinzig@web.de
Döpfner
Manfred
M
Lehmkuhl
G
G
Uebel
H
H
Schmeck
K
K
Poustka
F
F
Gerber
W D
WD
Günter
M
M
Knölker
U
U
Gehrke
M
M
Hässler
F
F
Resch
F
F
Brünger
M
M
Ose
C
C
Fischer
R
R
D000293:Adolescent; D000374:Aggression / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D019955:Conduct Disorder / Q000150:complications / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005178:Faculty; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D010290:Parents; D012574:Schools