A Randomised Open-Label Comparison of Dexamphetamine and Methylphenidate in Children With Attention Deficit
Alison Poulton1,2, Sharon Ng2, Hoang Cuc Do2
1Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Kingswood, New South Wales, Australia.
Aim:
Stimulant medications dexamphetamine and methylphenidate are well-established for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), but few studies directly compare their efficacy. We aimed to compare the therapeutic and adverse effects of immediate-release formulations of dexamphetamine and methylphenidate during the initial treatment of children with ADHD.
Methods:
This open-label study was conducted in public and private specialist paediatric clinics in New South Wales, Australia, between 2016 and 2020. One hundred stimulant-naïve children and adolescents with DSM-5-confirmed ADHD were randomised 1:1 to dexamphetamine or methylphenidate. ADHD diagnosis was based on detailed clinical assessment supported by parent and teacher DSM-5-based ratings. Dose titration followed a standardised 4-week weight-based protocol monitored with weekly school-based IOWA Conners ratings, after which dose adjustment or switching was made as clinically indicated. Participants were followed for 12 months.
Results:
Study participants (mean age 9.08 [SD 2.87] years; range 4.5-16.4 years; 73% male) showed significant ADHD symptom improvement on either medication at all time periods (p = 0.001), with no significant between-group difference on repeated-measures ANOVA. At 12 months, 62 participants remained on their allocated medication, with no apparent preference between methylphenidate and dexamphetamine (34/50 [68%] vs. 28/50 [56%], p = 0.15). Both medications were associated with weight loss which was greater on dexamphetamine at 3 months (-1.44 [SD 2.42] kg vs. -0.31 [SD 0.97] kg; p = 0.005).
Conclusions:
Stimulant medications dexamphetamine and methylphenidate appear comparable in short-term symptom response and 12-month persistence after initial randomised allocation, but dexamphetamine may be associated with greater weight loss.
Trial Registration:
Australian New Zealand Clinical Trials Registry number: ACTRN12616000569404.
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