title: Heterogeneity in the pharmacological treatment of children with ADHD: cognitive, behavioral, and social functioning differences.
abstract: OBJECTIVE
  To investigate the extent to which children with ADHD in various medication statuses (i.e., medication naïve, pure stimulant, stimulant plus another medication, nonstimulants) varied on cognitive or academic, behavioral, and social functioning during a psychoeducational assessment battery.
  
  
  METHODS
  Participants for this study consisted of 66 children (20 girls) with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) diagnosis of ADHD confirmed by a comprehensive clinical diagnostic assessment, including the use of a semistructured interview and Conners' Parent Rating Scales. Standardized cognitive and academic measures along with parent report of medication status, behavioral, and social functioning were collected.
  
  
  RESULTS
  No differences were found among children in the various medication groups in terms of ADHD symptoms severity, academic performance, processing speed, verbal abilities, or perceptual reasoning skills. However, children in the medication-naïve group performed significantly better than the stimulant-plus-another-medication and nonstimulant groups in terms of overall cognitive abilities, working-memory skills, and social adaptability but had similar scores to children in the pure-stimulant group. Children in the pure-stimulant group also had marginally higher working-memory scores compared to children in the nonstimulant group but not compared to the stimulant-plus-another-medication group. The pure-stimulant group also had significantly lower externalizing and internalizing problems and higher social adaptability compared to the stimulant-plus-another-medication group but not compared to the medication-naïve or nonstimulant groups.
  
  
  CONCLUSIONS
  Findings showed evidence for distinct cognitive, behavioral, and social profiles among children with ADHD who are proactively not on medication, as well as differences among children with ADHD who are on only one stimulant versus a nonstimulant or stimulant-plus-another-medication regimen.
authors.affiliation: Department of Psychiatry, University of Florida, P.O. Box 100234, Gainesville, FL 32610, USA. pagrazia@ufl.edu
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Graziano
authors.forename: Gary R
authors.initials: GR
authors.lastname: Geffken
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Lall
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002653:Child Behavior Disorders / Q000523:psychology; D003071:Cognition; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D012919:Social Behavior
chemical_list: D000697:Central Nervous System Stimulants