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Event Related Potentials ERPs and other EEG Based Methods for Extracting Biomarkers of Brain Dysfunction: Examples from Pediatric Attention Deficit/Hyperactivity Disorder ADHD
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Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Randomized

Karen Vertessen1,2, Marjolein Luman3,4, Pierre Bet5

  • 1Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. k.vertessen@vu.nl.

Paediatric Drugs
|January 27, 2024
PubMed

Insights

Placebo-controlled methylphenidate titration (PCT) helps identify children with ADHD who do not benefit from medication. This approach may reduce overtreatment of attention-deficit/hyperactivity disorder (ADHD) with methylphenidate (MPH).

Area of Science:

  • Pediatric Psychiatry
  • Neurodevelopmental Disorders
  • Pharmacological Treatments

Background:

  • Rising methylphenidate (MPH) use in attention-deficit/hyperactivity disorder (ADHD) raises concerns.
  • Placebo-controlled methylphenidate titration (PCT) shows promise in experimental settings for optimizing ADHD treatment.
  • This study evaluates the clinical applicability of PCT in ADHD management.

Purpose of the Study:

  • To assess if the benefits of PCT, including improved placebo response detection and symptom improvement, translate to clinical practice.
  • To compare PCT with care as usual (CAU) in managing MPH treatment for children with ADHD.
  • To evaluate the impact of PCT on MPH discontinuation and use of alternative pharmacological treatments.

Main Methods:

  • Children aged 5-13 with ADHD were randomized to PCT or CAU.
  • A 7-week randomized controlled trial was followed by a 6-month open-label follow-up.
  • ADHD symptoms, medication use, and treatment satisfaction were assessed via parent, teacher, and physician ratings.

Main Results:

  • PCT identified a higher rate of MPH non-responders compared to CAU.
  • Significantly more children discontinued MPH and avoided other pharmacological treatments in the PCT group.
  • No significant differences were observed in average MPH dose, ADHD symptom severity, or treatment satisfaction between groups.

Conclusions:

  • PCT effectively identifies children who do not benefit from MPH, potentially reducing overtreatment.
  • The findings support the use of PCT as a clinical tool for optimizing MPH therapy in ADHD.
  • PCT aids in personalized methylphenidate treatment decisions for pediatric ADHD.
Abstract

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