Utility of objective measures of activity and attention in the assessment of therapeutic response to stimulants in children with attention-deficit/hyperactivity disorder.
OBJECTIVE
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder that can respond dramatically to medication, if dose is appropriately titrated. Studies suggest that computer measures of attention cannot be used for titration as they show improvement on doses too low to produce clinical benefits. We assessed whether measures of motor activity and attention using the McLean Motion Attention Test (M-MAT) could identify doses associated with optimal clinical response.


METHODS
Eleven boys (9.6 +/- 1.8 years), receiving treatment with methylphenidate, and meeting DSM-IV criteria for ADHD, participated in this triple-blind (parent, child, rater), within-subject, efficacy study. Subjects received 1 week each of placebo, low (0.4 mg/kg), medium (0.8 mg/kg), and high (1.5 mg/kg) daily doses of methylphenidate. Parents rated response using an index of clinical global improvement.


RESULTS
In 9/11 subjects, the dose that produced the best improvement on M-MAT measures was also the dose that produced the best clinical outcome (p < 10(5)). Parents rated response to this dose significantly better than response to previously prescribed treatment. Objective measures of primarily activity and secondarily attention responded to treatment in a manner concordant with clinical ratings, suggesting that these measures have ecological validity, and the potential to facilitate medication management and titration.
Teicher
Martin H
MH
Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA. martin_teicher@hms.harvard.edu
Polcari
Ann
A
McGreenery
Cynthia E
CE
D001288:Attention / Q000187:drug effects* / Q000502:physiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000187:drug effects* / Q000502:physiology; D010287:Parent-Child Relations; D012107:Research Design
D000697:Central Nervous System Stimulants