title: Do phenotypic characteristics, parental psychopathology, family functioning, and environmental stressors have a role in the response to methylphenidate in children with attention-deficit/hyperactivity disorder? A naturalistic study from a developing country.
abstract: Little is known about the effect of clinical characteristics, parental psychopathology, family functioning, and environmental stressors in the response to methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD) followed up in a naturalistic setting. Data from cultures outside the United States are extremely scarce. This is a longitudinal study using a nonrandom assignment, quasi-experimental design. One hundred twenty-five children with ADHD were treated with methylphenidate according to standard clinical procedures, and followed up for 6 months. The severity of ADHD symptoms was assessed by the Swanson, Nolan, and Pelham rating scale. In the final multivariate model, ADHD combined subtype (P < 0.001) and comorbidity with oppositional defiant disorder (P = 0.03) were both predictors of a worse clinical response. In addition, the levels of maternal ADHD symptoms were also associated with worse prognosis (P < 0.001). In the context of several adverse psychosocial factors assessed, only undesired pregnancy was associated with poorer response to methylphenidate in the final comprehensive model (P = 0.02). Our study provides evidence for the involvement of clinical characteristics, maternal psychopathology, and environmental stressors in the response to methylphenidate. Clinicians may consider adjuvant strategies when negative predictors are present to increase the chances of success with methylphenidate treatment.
authors.affiliation: ADHD Outpatient Clinic, Child and Adolescent Psychiatric Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Chazan
authors.forename: Carolina
authors.initials: C
authors.lastname: Borowski
authors.forename: Thiago
authors.initials: T
authors.lastname: Pianca
authors.forename: Henrique
authors.initials: H
authors.lastname: Ludwig
authors.forename: Luis Augusto
authors.initials: LA
authors.lastname: Rohde
authors.forename: Guilherme
authors.initials: G
authors.lastname: Polanczyk
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005195:Family Relations; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D010290:Parents / Q000523:psychology*; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D016903:Drug Monitoring
chemical_list: D008774:Methylphenidate