Individual Participant Data Meta-Analysis: Moderators of Response to Stimulants for Preschool
Luis C Farhat1, Luisa Shiguemi Sugaya2, Michael H Bloch3
1Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil; School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.
Journal of the American Academy of Child and Adolescent Psychiatry
|September 20, 2025
Summary
Stimulants may be more effective for White children with attention-deficit/hyperactivity disorder (ADHD) compared to Black children. Race, not age or symptom severity, might influence stimulant effectiveness in preschoolers with ADHD.
Area of Science:
- Pediatric Psychiatry
- Neurodevelopmental Disorders
- Pharmacological Treatments
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in preschool children.
- Stimulant medications are frequently prescribed for ADHD, but individual responses can vary.
- Identifying moderators of treatment efficacy is crucial for personalized medicine.
Purpose of the Study:
- To identify factors that predict the effectiveness of stimulant medications versus placebo in preschoolers with ADHD.
- To inform personalized treatment recommendations for young children diagnosed with ADHD.
Main Methods:
- Individual participant data from two randomized placebo-controlled trials (MAPPA and SPD489-347) were analyzed.
- Moderator effects of baseline demographic and clinical characteristics on ADHD symptom severity were evaluated.
- Meta-analyses pooled subgroup data from additional studies (PATS) where possible.
Main Results:
- Stimulant efficacy was greater in White children compared to Black children in US-based studies.
- Older age did not moderate stimulant efficacy and was not linked to worse outcomes.
- Higher baseline ADHD symptom severity predicted greater endpoint severity, irrespective of treatment.
Conclusions:
- Race appears to be a potential moderator of stimulant efficacy in preschool ADHD.
- Age and baseline symptom severity did not emerge as significant moderators in this analysis.
- Findings are exploratory and require confirmation in future research.
More Related Videos
05:48The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients
Published on: June 12, 2020
6.3K
13:09Using Brain Activation nir-HEG/Q-EEG and Execution Measures CPTs in a ADHD Assessment Protocol
Published on: April 1, 2018
10.9K
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
787
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
787
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
790
CNS stimulants, such as cocaine, amphetamines, and cannabinoids, have varying structures and mechanisms of action that lead to different therapeutic effects and side effects. Cocaine, with its molecular formula C17H21NO4, is a tropane alkaloid and a tertiary amino compound. It has two chemical forms: the hydrochloride salt and the "freebase." The former is in powder form, while the latter involves removing the hydrochloride salt to create a form that can be smoked. Cocaine exerts its...
790
01:29Stimulants
842
Stimulants are substances that enhance neural activity and elevate dopamine levels in the brain, leading to their highly addictive nature. These drugs include cocaine, amphetamines, MDMA, caffeine, and nicotine, each with distinct mechanisms of action and varied health implications.
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
842
01:28Adrenergic Agonists: Mixed-Action Agents
1.4K
Mixed-action adrenergic agonists, like ephedrine and pseudoephedrine, directly and indirectly affect adrenergic receptors. These agents stimulate adrenoceptors and indirectly release stored neurotransmitters, amplifying the adrenergic response.
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
1.4K
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
560
Cognitive enhancers, also known as "smart drugs," are substances used to enhance memory, mental alertness, and concentration. These can be natural or synthetic and improve cognition in conditions like Alzheimer's disease (AD) and other neurodegenerative diseases. Some common examples include caffeine, amphetamines, methylphenidate, modafinil, arecoline, donepezil, vortioxetine, and piracetam. These enhancers work on the principle of synaptic plasticity and altered circuit function.
560
01:25Adrenergic Agonists: Indirect-Acting Agents
2.6K
Indirect-acting adrenergic agonists potentiate the effects of endogenous catecholamines through different mechanisms without directly binding to adrenoceptors.
One mechanism involves depleting stored catecholamines by displacing them from synaptic vesicles. These agents, known as "displacers," are transported into vesicles at the expense of noradrenaline. Examples include amphetamine and tyramine, which lack a catechol moiety, resulting in prolonged action, improved oral...
One mechanism involves depleting stored catecholamines by displacing them from synaptic vesicles. These agents, known as "displacers," are transported into vesicles at the expense of noradrenaline. Examples include amphetamine and tyramine, which lack a catechol moiety, resulting in prolonged action, improved oral...
2.6K