Fenfluramine and methylphenidate in children with mental retardation and ADHD: clinical and side effects
M G Aman1, R A Kern, D E McGhee
1Nisonger Center for Mental Retardation and Developmental Disabilities, Ohio State University, Columbus 43210-1296.
Insights
Methylphenidate and fenfluramine both improved behavior in children with ADHD and mental retardation. Methylphenidate targeted inattention, while fenfluramine addressed irritability and speech issues, showing distinct clinical benefits.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Attention-deficit hyperactivity disorder (ADHD) and mental retardation often co-occur in children.
- Effective pharmacological interventions for this dual diagnosis require careful consideration.
Purpose of the Study:
- To compare the efficacy and side effects of methylphenidate and fenfluramine in nonautistic children with ADHD and mental retardation.
Main Methods:
- A double-blind, crossover study involving 28 children.
- Treatment periods included placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (up to 1.5 mg/kg/day) over 4 weeks each.
- Evaluations used teacher and parent ratings, alongside Conners' Abbreviated Symptom Questionnaire.
Main Results:
- Both methylphenidate and fenfluramine improved conduct problems, hyperactivity, and irritability based on teacher and parent reports.
- Methylphenidate uniquely improved inattention, while fenfluramine improved irritability and inappropriate speech.
- Fenfluramine led to significant weight reduction, and both drugs had contrasting effects on heart rate and blood pressure.
Conclusions:
- Methylphenidate and fenfluramine offer distinct therapeutic benefits for children with ADHD and mental retardation.
- Treatment response may be influenced by IQ, with higher IQ children showing better outcomes with methylphenidate.
- Further research is needed to delineate optimal treatment strategies for this population.
Abstract:
Each of 28 nonautistic children with attention-deficit hyperactivity disorder and mental retardation received placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (gradually increased to 1.5 mg/kg/day) for 4 weeks each in a double-blind, crossover design. Teacher ratings indicated significant improvements with both active drugs on subscales designated as Conduct Problem, Hyperactivity, and Irritability, but methylphenidate alone produced improvements on an Inattention subscale. Parent ratings indicated significant improvements with both drugs on subscales labeled Hyperactivity, Motor Excess, and Conduct Problem. Fenfluramine alone caused improved parent ratings on Irritability and Inappropriate Speech, and on Conners' Abbreviated Symptom Questionnaire. Unlike a previous study, subgroup analyses failed to show a significantly better clinical response to methylphenidate for subjects with higher mental ages, although children with higher IQs responded better than those with IQs less than 45. The active drugs had contrasting effects on heart rate and blood pressure. Fenfluramine caused significant weight reductions relative to both placebo and methylphenidate. These findings suggest that both methylphenidate and fenfluramine have useful, but somewhat different, clinical effects in certain children with attention-deficit hyperactivity disorder and mental retardation.
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To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.