Abstract | OBJECTIVE: METHODS: Ninety-four children and adolescents (ages 8-18 years) who had been treated in regular care with methylphenidate for more than 2 years were randomly assigned to double-blind continuation of treatment for 7 weeks (36 or 54 mg/day of extended-release methylphenidate) or gradual withdrawal over 3 weeks, to 4 weeks of placebo. The primary outcome measure was the investigator-rated ADHD Rating Scale ( ADHD-RS); secondary outcome measures were the investigator-rated Clinical Global Impressions improvement scale (CGI-I) and the Conners' Teacher Rating Scale-Revised: Short Form (CTRS-R:S). Continuous ratings were analyzed with mixed model for repeated measures analyses, and the CGI-I with a chi-square test. RESULTS: The mean ADHD-RS scores at baseline for the continuation and discontinuation groups, respectively, were 21.4 (SD=9.7) and 19.6 (SD=8.9); after 7 weeks, the mean scores were 21.9 (SD=10.8) and 24.7 (SD=11.4), with a significant between-group difference in change over time of -4.6 (95% CI=-8.7, -0.56) in favor of the group that continued methylphenidate treatment. The ADHD-RS inattention subscale and the CTRS-R:S ADHD index and hyperactivity subscale also deteriorated significantly more in the discontinuation group. The CGI-I indicated worsening in 40.4% of the discontinuation group, compared with 15.9% of the continuation group. CONCLUSIONS: Continued treatment with methylphenidate remains effective after long-term use. Some individual patients may, however, be withdrawn from methylphenidate without deterioration. This finding supports guideline recommendations that patients be assessed periodically to determine whether there is a continued need for methylphenidate treatment.
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Authors | Anne-Flore M Matthijssen, Andrea Dietrich, Margreet Bierens, Renee Kleine Deters, Gigi H H van de Loo-Neus, Barbara J van den Hoofdakker, Jan K Buitelaar, Pieter J Hoekstra |
Journal | The American journal of psychiatry
(Am J Psychiatry)
Vol. 176
Issue 9
Pg. 754-762
(09 01 2019)
ISSN: 1535-7228 [Electronic] United States |
PMID | 31109200
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Central Nervous System Stimulants
- Delayed-Action Preparations
- Methylphenidate
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Topics |
- Adolescent
- Attention Deficit Disorder with Hyperactivity
(drug therapy)
- Central Nervous System Stimulants
(administration & dosage, therapeutic use)
- Child
- Delayed-Action Preparations
- Double-Blind Method
- Female
- Humans
- Male
- Methylphenidate
(administration & dosage, therapeutic use)
- Treatment Outcome
- Withholding Treatment
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