Safety and tolerability of methylphenidate in preschool children with ADHD
Tim Wigal1, Laurence Greenhill2, Shirley Chuang1
1Drs. T. Wigal, S. Wigal, Stehli, Thorp, and Swanson are with the University of California, Irvine; Dr. Abikoff is with the New York University Child Study Center, New York; Drs. McCracken and McGough are with the University of California, Los Angeles; Dr. Riddle is with Johns Hopkins University, Baltimore; Dr. Kollins is with Duke University Medical Center; Durham, NC; Drs. Greenhill, Chuang, and Posner, Ms. Skrobala, and Mr. Davies are with New York State Psychiatric Institute/Columbia University, New York; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; and Dr. Ghuman is with the University of Arizona, Tucson.
Insights
Methylphenidate (MPH) treatment for attention-deficit/hyperactivity disorder (ADHD) in preschoolers showed common side effects like sleep issues and appetite loss. Over 11% of children discontinued treatment due to intolerable adverse events.
Area of Science:
- Pediatric Psychiatry
- Pharmacology
- Child Psychology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children.
- Methylphenidate (MPH) is a commonly prescribed stimulant medication for ADHD.
- Limited data exists on the long-term safety and tolerability of MPH in very young children (preschoolers).
Discussion:
- The study assessed the safety and tolerability of MPH in 3- to 5-year-old children with ADHD over one year.
- Adverse events (AEs) were monitored through parent/teacher reports and clinical assessments.
- The incidence and nature of AEs were analyzed across different treatment phases.
Key Insights:
- Thirty percent of parents reported moderate to severe AEs, including emotional outbursts, sleep difficulties, repetitive behaviors, appetite decrease, and irritability.
- MPH was associated with statistically significant increases in decreased appetite, trouble sleeping, and weight loss compared to placebo during titration.
- Eleven percent of preschoolers discontinued MPH treatment due to intolerable adverse events.
Outlook:
- While MPH can be effective for ADHD in preschoolers, careful monitoring for adverse events is crucial.
- Further research may explore alternative treatments or optimized dosing strategies for this age group.
- Individualized treatment approaches are necessary to balance efficacy and tolerability in young children with ADHD.
Objective:
To report on the safety and tolerability of methylphenidate (MPH) 3- to 5-year-old children with attention-deficit/hyperactivity disorder (ADHD) during 1 year of treatment.
Method:
Exactly 183 children (3-5 years old) entered a treatment study of MPH, consisting of a 1-week open-label lead-in (n=183); a 5-week placebo-controlled, double-blind phase (n=165); a 5-week double-blind, parallel phase (n=114); and 10 months of open-label maintenance (n=140 entered, 95 completed). Mean total daily MPH doses rose from the titration trial best dose, 14.1 (+/-8.1) mg/day, to 20.5 (+/-9.7) mg/day mean total daily dose at the end of maintenance. Pulse, blood pressure, and the presence of treatment emergent adverse events (AEs), parent and teacher AE ratings, and vital signs were recorded in each phase.
Results:
Thirty percent of parents spontaneously reported moderate to severe AEs in all study phases after baseline. These included emotional outbursts, difficulty falling asleep, repetitive behaviors/thoughts, appetite decrease, and irritability. During titration, decreased appetite (chi=5.4, p<.03), trouble sleeping (chi=5.4, p<.03), and weight loss (chi=4.0, p<.05) occurred statistically more often on MPH than on placebo. During maintenance, trouble sleeping and appetite loss persisted and other MPH-related AEs decreased. There were transient, one-time pulse and blood pressure elevations in five children. Twenty-one children (11%) discontinued because of drug-attributed AEs.
Conclusions:
Eleven percent of preschoolers discontinued treatment because of intolerable MPH AEs. Of the serious AEs reported, one occurred in baseline, two in lead-in, three in titration, one in parallel, and one in maintenance. Only one was possibly related to MPH.
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