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Effects of late-afternoon methylphenidate administration on behavior and sleep in attention-deficit hyperactivity
J D Kent1, J C Blader, H S Koplewicz
1Division of Child and Adolescent Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
Insights
Late afternoon methylphenidate (MPH) significantly improved behavior in children with attention-deficit hyperactivity disorder (ADHD) without negatively impacting sleep. This suggests MPH can be safely administered in the late afternoon for evening symptom control.
Area of Science:
- Child Psychiatry
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Stimulant medication, such as methylphenidate (MPH), is commonly prescribed for attention-deficit hyperactivity disorder (ADHD).
- Standard practice often involves morning and noon administration, with clinicians hesitant to prescribe a late-afternoon dose due to concerns about sleep disruption.
Purpose of the Study:
- To evaluate the impact of a 4 PM dose of methylphenidate (MPH) on the behavior and sleep patterns of children diagnosed with attention-deficit hyperactivity disorder (ADHD).
- To determine if a late-afternoon MPH administration offers behavioral benefits without compromising sleep quality or increasing sleep latency.
Main Methods:
- A double-blind, crossover study involving 12 children with ADHD admitted to a psychiatric inpatient service.
- Participants received randomized 4 PM doses of 15 mg MPH, 10 mg MPH, or placebo for 12 consecutive days.
- Behavioral ratings (including ADHD symptoms) and sleep assessments (latency and adequacy) were recorded nightly by hospital staff.
Main Results:
- Methylphenidate (MPH) administration at 4 PM led to significant behavioral improvements compared to placebo, with no discernible difference between the 10 mg and 15 mg doses.
- No adverse effects on sleep latency were observed with MPH compared to placebo.
- Children reported feeling less tired upon waking after receiving 10 mg MPH compared to the 15 mg dose or placebo; weight loss was noted in 83% of patients without changes in dinner intake.
Conclusions:
- A late-afternoon dose of methylphenidate (MPH) can effectively reduce attention-deficit hyperactivity disorder (ADHD) symptoms in children without causing insomnia.
- Clinicians should consider three-times-a-day dosing for children experiencing evening ADHD symptoms, as late-afternoon MPH appears safe and beneficial for behavior.
- While overall sleep latency was not affected, continued monitoring for potential sleep disturbances and weight loss is advisable as part of sound treatment practices.
Objective:
This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD).
Methodology:
Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night.
Results:
MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition.
Conclusions:
Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice.