title: OROS-methylphenidate efficacy on specific executive functioning deficits in adults with ADHD: a randomized, placebo-controlled cross-over study.
abstract: Attention-deficit/hyperactivity disorder (ADHD) is linked to impaired executive functioning (EF). This is the first study to objectively investigate the effects of a long-acting methylphenidate on neurocognitive test performance of adults with ADHD. Twenty-two adults with ADHD participated in a 6-weeks study examining the effect of osmotic-release oral system methylphenidate (OROS-mph) on continuous performance tests (CPTs; objective measures), and on the self-reported ADHD rating scale (subjective measure) using a randomized, double-blind, placebo-controlled cross-over design. OROS-mph significantly improved reaction time variability (RTV), commission errors (CE) and d-prime (DP) as compared to baseline (Cohen's d>.50), but did not affect hit reaction time (HRT) or omission errors (OE). Compared to placebo, OROS-mph only significantly influenced RTV on one of two CPTs (p<.050). Linear regression analyses showed predictive ability of more beneficial OROS-mph effects in ADHD patients with higher EF severity (RTV: β=.670, t=2.097, p=.042; omission errors (OE): β=-.098, t=-4.759, p<.001), and with more severe ADHD symptoms (RTV: F=6.363, p=.019; HRT: F=3.914, p=.061). Side effects rates were substantially but non-significantly greater for OROS-mph compared to placebo (77% vs. 46%, p=.063). OROS-mph effects indicated RTV as the most sensitive parameter for measuring both neuropsychological and behavioral deficits in adults with ADHD. These findings suggest RTV as an endophenotypic parameter for ADHD symptomatology, and propose CPTs as an objective method for monitoring methylphenidate titration.
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands. Electronic address: a.bron@psyq.nl.
authors: Tannetje I
authors: TI
authors: Bron
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
authors: Denise
authors: D
authors: Bijlenga
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
authors: A Marije
authors: AM
authors: Boonstra
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
authors: Minda
authors: M
authors: Breuk
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
authors: Willem F H
authors: WF
authors: Pardoen
authors: Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Aartjan T F
authors: AT
authors: Beekman
authors: PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
authors: J J Sandra
authors: JJ
authors: Kooij
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D016903:Drug Monitoring; D056344:Executive Function / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009426:Netherlands; D009995:Osmosis; D010044:Outpatient Clinics, Hospital; D010352:Patient Dropouts; D011930:Reaction Time / Q000187:drug effects; D021641:Recognition, Psychology / Q000187:drug effects; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate
keywords: Adults; Attention-Deficit/Hyperactivity Disorder (ADHD); Continuous performance test; Executive functioning (EF); OROS-methylphenidate; Randomized, double blind, placebo-controlled cross-over study