Effect of methylphenidate on attention in children with attention deficit hyperactivity disorder (ADHD): ERP evidence

Methylphenidate and P300 in attention deficit hyperactivity disorder: A systematic review and meta-analysis

BACKGROUND

Methylphenidate (MPH) is a stimulant medicine often used to treat attention deficit hyperactivity disorder (ADHD), as it may positively affect behaviour and brain activity. This work aims to systematise the current literature about the effects of MPH on the amplitude of P300 in individuals with ADHD.

METHODS

A systematic review and meta-analysis of empirical studies measuring P300 amplitude and comparing MPH administration to either a pre-MPH condition or healthy controls was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Our results revealed no overall (n = 13) significant differences between individuals diagnosed with ADHD and medicated with MPH and controls. Although, a moderation analysis by region found differences between both groups on frontal sites. When comparing the pre- and post-effects of MPH on the same individuals (n = 17), it appears that P300 amplitude tends to increase post-administration in central and posterior regions. In this second meta-analysis, a moderation by task revealed a larger effect size for go/no-go.

DISCUSSION

In general, MPH was found to increase P300 amplitude in ADHD, somewhat normalising this aspect of their brain activity. The main limitations of the included studies are the insufficiently explained dosages and the skewness for male participants. Future research directions are discussed.

ERP-aligned delta transcranial alternating current stimulation modulates the P3 amplitude

The underlying mechanisms of the event-related potential (ERP) generation are still under debate. One popular model considers the ERP as a superposition of phase-resets of ongoing endogenous oscillations of different frequencies. Brain oscillations have been shown to be modulated by transcranial alternating current stimulation (tACS). Thus, it seems feasible, that an ERP could be altered by modulating the contributing oscillations using tACS. One possible approach would be to target a frequency-matched stimulation signal to a specific ERP-component. One possible target for such an approach is the P3, which appears as delta/theta oscillations in the frequency-domain. Thus, an ERP-aligned stimulation in the delta/theta-range might be suitable to force synchronization in the stimulated frequency band and thus increase the amplitude of the P3 component. Building on an existing paradigm, in the present study 21 healthy participants received individualized ERP-aligned delta tACS and control stimulation while performing a visual task. The visual stimulation was matched to the continuous tACS in order to align the tACS peak with the P3 peak. Both the P3 amplitude and the evoked delta power were significantly increased after ERP-aligned tACS but not after control stimulation. The investigated behavioral parameter showed no stimulation dependent effect. Our results may provide new insights into the debate on the contribution of phase-reset mechanisms to the generation of ERPs and offer new opportunities for clinical trials.

Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015.

OBJECTIVES

To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate.

SELECTION CRITERIA

We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life.

DATA COLLECTION AND ANALYSIS

Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach.

MAIN RESULTS

We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias.

PRIMARY OUTCOMES

methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68).

SECONDARY OUTCOMES

methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.

Meta-analysis: Dose-Dependent Effects of Methylphenidate on Neurocognitive Functioning in Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Neurocognitive deficits are at the heart of explanatory models of attention-deficit/hyperactivity disorder (ADHD), and lead to significant impairments in daily life. Determining the dosing effects of methylphenidate (MPH) on a broad range of neurocognitive functions and investigating possible impairing effects of high doses is therefore important.

METHOD

Placebo-controlled trials were included that investigated MPH dosing effects on neurocognitive functions in children and adolescents (aged 5-18 years) diagnosed with ADHD. Effect sizes (standardized mean differences [SMDs]) were calculated for different neurocognitive functions (baseline speed, variability in responding, nonexecutive memory and executive memory, inhibitory control, and cognitive flexibility) and, if available, for ADHD symptoms. Meta-regression analysis were used to investigate linear effects of dose (mg/kg/dose), and separate meta-analyses compared SMDs for 3 MPH dose ranges: low (0.10-0.30 mg/kg/dose), medium (0.31-0.60 mg/kg/dose), and high (0.61-1.00 mg/kg/dose).

RESULTS

A total of 31 studies fulfilled inclusion criteria, comprising 804 children with ADHD. Methylphenidate had beneficial effects on all neurocognitive functions (d = 0.20-0.73). Significant linear dosing effects were found for ADHD symptoms and lower-order neurocognitive functions (baseline speed, variability in responding, nonexecutive memory), with greater enhancement of functioning with increasing dose. No dosing effects were found for higher-order neurocognitive functions (executive memory, inhibitory control, and cognitive flexibility). No detrimental effects of MPH were found on any of the investigated functions.

CONCLUSION

Methylphenidate was superior to placebo in improving ADHD symptoms and a broad range of neurocognitive functions; however, effects sizes regarding the effects of dose vary substantially between functions. Our data highlight the importance of considering both neurocognitive and symptomatic aspects of ADHD in clinical practice.

Applying Spike-density component analysis for high-accuracy auditory event-related potentials in children

OBJECTIVE

Overlapping neurophysiological signals are the main obstacle preventing from using cortical auditory event-related potentials (AEPs) in clinical settings. Children AEPs are particularly affected by this problem, as their cerebral cortex is still maturing. To overcome this problem, we applied a new version of Spike-density Component Analysis (SCA), an analysis method recently developed, to isolate with high accuracy the neural components of auditory responses of 8-year-old children.

METHODS

Electroencephalography was used with 33 children to record AEPs to auditory stimuli varying in spectrotemporal features. Three different analysis approaches were adopted: the standard AEP analysis procedure, SCA with template-match (SCA-TM), and SCA with half-split average consistency (SCA-HSAC).

RESULTS

SCA-HSAC most successfully allowed the extraction of AEPs for each child, revealing that the most consistent components were P1 and N2. An immature N1 component was also detected.

CONCLUSION

Superior accuracy in isolating neural components at the individual level was demonstrated for SCA-HSAC over other SCA approaches even for children AEPs.

SIGNIFICANCE

Reliable methods of extraction of neurophysiological signals at the individual level are crucial for the application of cortical AEPs for routine diagnostic exams in clinical settings both in children and adults.

Sensory processing and P300 event-related potential correlates of stimulant response in children with attention-deficit/hyperactivity disorder: A critical review

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with considerable impairment in psychiatric and functional domains. Although stimulant medication can reduce core symptoms of inattention, hyperactivity, and impulsivity, a subgroup of patients does not respond to this intervention. A precision medicine approach has been proposed, whereby biomarkers are used to identify an effective treatment approach for a given individual. This review synthesizes the existing literature on event-related potential (ERP) correlates of stimulant response in children diagnosed with ADHD, with the goal of evaluating the potential for ERP to inform precision medicine care in this population. Forty-three articles were examined and results tentatively suggest that stimulant medications normalize the amplitude of the P300 component, and this is also associated with behavioral improvement. In contrast, results generally indicate that stimulants do not significantly alter early processing components, although there are some exceptions to this finding. Implications for research, theory, and clinical work are considered and concrete recommendations for future directions are provided. While recognizing limitations of existing literature (e.g., homogenous samples, variable methodologies), we conclude that ERP methods represent a promising approach for precision medicine care of patients with ADHD.

Change detection of auditory tonal patterns defined by absolute versus relative pitch information. A combined behavioural and EEG study

The human auditory system often relies on relative pitch information to extract and identify auditory objects; such as when the same melody is played in different keys. The current study investigated the mental chronometry underlying the active discrimination of unfamiliar melodic six-tone patterns by measuring behavioural performance and event-related potentials (ERPs). In a roving standard paradigm, such patterns were either repeated identically within a stimulus train, carrying absolute frequency information about the pattern, or shifted in pitch (transposed) between repetitions, so only relative pitch information was available to extract the pattern identity. Results showed that participants were able to use relative pitch to detect when a new melodic pattern occurred. Though in the absence of absolute pitch sensitivity significantly decreased and behavioural reaction time to pattern changes increased. Mismatch-Negativity (MMN), an ERP indicator of auditory deviance detection, was elicited at approximately 206 ms after stimulus onset at frontocentral electrodes, even when only relative pitch was available to inform pattern discrimination. A P3a was elicited in both conditions, comparable in amplitude and latency. Increased latencies but no differences in amplitudes of N2b, and P3b suggest that processing at higher levels is affected when, in the absence of absolute pitch cues, relative pitch has to be extracted to inform pattern discrimination. Interestingly, the response delay of approximately 70 ms on the behavioural level, already fully manifests at the level of N2b. This is in accordance with recent findings on implicit auditory learning processes and suggests that in the absence of absolute pitch cues a slowing of target selection rather than a slowing of the auditory pattern change detection process causes the deterioration in behavioural performance.

Potential targets for the treatment of ADHD using transcranial electrical current stimulation

Attention deficit hyperactivity disorder (ADHD) is a psychiatric disease with a prevalence of 2%-7.5% among the population. It is characterized by three core symptoms: hyperactivity, impulsivity, and inattention. Although the majority of ADHD patients respond to a combination of psychotherapy and standard pharmacotherapy with Methylphenidate, there is a significant minority of patients that do not respond to these substances. Additionally, the treatment with Methylphenidate can cause a variety of side effects like insomnia, headache, decreased appetite, and xerostomia. It would be favorable to have an alternative treatment-option that could circumnavigate the shortcomings of traditional pharmacological treatments. Recent results show that transcranial electrical stimulation (tES) might offer a promising approach. Since research has shown that ADHD is associated with various alterations in brain activity, brain stimulation methods targeting different facets of neuronal functions are currently under investigation. In this article, we briefly review different tES techniques like transcranial random noise stimulation (tRNS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) and explain the modes of action of these brain stimulations. We will specifically focus on transcranial alternating current stimulation (tACS) as a potential method of treating ADHD.

Catecholaminergic Modulation of Semantic Processing in Sentence Comprehension

Catecholamine (CA) function has been widely implicated in cognitive functions that are tied to the prefrontal cortex and striatal areas. The present study investigated the effects of methylphenidate, which is a CA agonist, on the electroencephalogram (EEG) response related to semantic processing using a double-blind, placebo-controlled, randomized, crossover, within-subject design. Forty-eight healthy participants read semantically congruent or incongruent sentences after receiving 20-mg methylphenidate or a placebo while their brain activity was monitored with EEG. To probe whether the catecholaminergic modulation is task-dependent, in one condition participants had to focus on comprehending the sentences, while in the other condition, they only had to attend to the font size of the sentence. The results demonstrate that methylphenidate has a task-dependent effect on semantic processing. Compared to placebo, when semantic processing was task-irrelevant, methylphenidate enhanced the detection of semantic incongruence as indexed by a larger N400 amplitude in the incongruent sentences; when semantic processing was task-relevant, methylphenidate induced a larger N400 amplitude in the semantically congruent condition, which was followed by a larger late positive complex effect. These results suggest that CA-related neurotransmitters influence language processing, possibly through the projections between the prefrontal cortex and the striatum, which contain many CA receptors.

The Relationship Between Response-Inhibitory Event-Related Potentials and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adult Patients with Major Depressive Disorder

OBJECTIVE

Attention-deficit and poor impulse control have frequently been observed in major depressive disorder (MDD) and attention-deficit and hyperactivity disorder (ADHD). Altered event-related potential (ERP) performance, such as GoNogo tasks, has been regarded as a neurocognitive process associated with attention and behavioral inhibition. The aim of this study was to investigate the association between Nogo ERP and adult ADHD in MDD.

METHODS

A total of 64 participants with MDD (32 comorbid with ADHD) and 32 healthy controls aged 19-45 years were recruited; they performed GoNogo paradigms during electroencephalogram measurement. Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and the Adult ADHD Self-Report Scale (ASRS) were evaluated. Clinical measures and GoNogo ERP were compared between three groups: depression with ADHD, depression without ADHD, and healthy controls.

RESULTS

MDD subjects with ADHD showed significantly decreased Nogo P3 amplitude at frontal electrode, compared with those without ADHD and healthy controls. MDD subjects with ADHD showed significantly longer Nogo N2 latency at frontal and frontocentral electrodes, compared with those without ADHD and healthy controls. In MDD subjects with ADHD, the Nogo P3 amplitude at the frontal electrode was negatively correlated with the ASRS score and inattention. The Nogo N2 latency at the frontal electrode was positively correlated with false alarm rate.

CONCLUSION

The decreased Nogo P3 amplitude in the frontal area might be a potential biological marker for inattention in depressed patients with ADHD.

Methylphenidate treatment increases hippocampal BDNF levels but does not improve memory deficits in hypoxic-ischemic rats

BACKGROUND

Methylphenidate (MPH) is a stimulant drug mainly prescribed to treat cognitive impairments in attention-deficit/hyperactivity disorder (ADHD). We demonstrated that neonatal hypoxia-ischemia (HI) induced attentional deficits in rats and MPH administration reversed these deficits. However, MPH effects on memory deficits after the HI procedure have not been evaluated yet.

AIMS

We aimed to analyze learning and memory performance of young hypoxic-ischemic rats after MPH administration and associate their performance with brain-derived neurotrophic factor (BDNF) levels in the prefrontal cortex and hippocampus.

METHODS

Male Wistar rats were divided into four groups (n=11-13/group): control saline (CTS), control MPH (CTMPH), HI saline (HIS) and HIMPH. The HI procedure was conducted at post-natal day (PND) 7 and memory tasks between PND 30 and 45. MPH administration (2.5 mg/kg, i.p.) occurred 30 min prior to each behavioral session and daily, for 15 days, for the BDNF assay (n=5-7/group).

RESULTS

As expected, hypoxic-ischemic animals demonstrated learning and memory deficits in the novel-object recognition (NOR) and Morris water maze (MWM) tasks. However, MPH treatment did not improve learning and memory deficits of these animals in the MWM-and even disrupted the animals' performance in the NOR task. Increased BDNF levels were found in the hippocampus of HIMPH animals, which seem to have been insufficient to improve memory deficits observed in this group.

CONCLUSIONS

The MPH treatment was not able to improve memory deficits resulting from the HI procedure considering a dose of 2.5 mg/kg. Further studies investigating different MPH doses would be necessary to determine a dose-response relationship in this model.

mGlu5 in GABAergic neurons modulates spontaneous and psychostimulant-induced locomotor activity

RATIONALE

A role of group I metabotropic glutamate receptor 5 (mGlu5) in regulating spontaneous locomotion and psychostimulant-induced hyperactivity has been proposed.

OBJECTIVES

This study aims to determine if mGlu5 in GABAergic neurons regulates spontaneous or psychostimulant-induced locomotion.

METHODS

We generated mice specifically lacking mGlu5 in forebrain GABAergic neuron by crossing DLX-Cre mice with mGlu5^flox/flox mice to generate DLX-mGlu5 KO mice. The locomotion of adult mice was examined in the open-field assay (OFA) and home cage setting. The effects of the mGlu5 antagonist 6-methyl-2-(phenylethynyl)pyridine (MPEP), cocaine, and methylphenidate on acute motor behaviors in DLX-mGlu5 KO and littermate control mice were assessed in OFA. Striatal synaptic plasticity of these mice was examined with field potential electrophysiological recordings.

RESULTS

Deleting mGlu5 from forebrain GABAergic neurons results in failure to induce long-term depression (LTD) in the dorsal striatum and absence of habituated locomotion in both novel and familiar settings. In a familiar environment (home cage), DLX-mGlu5 KO mice were hyperactive. In the OFA, DLX-mGlu5 KO mice exhibited initial hypo-activity, and then gradually increased their locomotion with time, resulting in no habituation response. DLX-mGlu5 KO mice exhibited almost no locomotor response to MPEP (40 mg/kg), while the same dose elicited hyperlocomotion in control mice. The DLX-mGlu5 KO mice also showed reduced hyperactivity response to cocaine, while they retained normal hyperactivity response to methylphenidate, albeit with delayed onset.

CONCLUSION

mGlu5 in forebrain GABAergic neurons is critical to trigger habituation upon the initiation of locomotion as well as to mediate MPEP-induced hyperlocomotion and modulate psychostimulant-induced hyperactivity.

Effects of Integrated Brain, Body, and Social (IBBS) intervention on ERP measures of attentional control in children with ADHD

A primary goal of this study was to examine the impact of an Integrated Brain, Body, and Social (IBBS) intervention (multi-faceted treatment consisting of computerized cognitive training, physical exercise, and behavior management) on ERPs of attentional control (P3 & N2) in children with ADHD. The secondary goal was to test the differences between children with and without ADHD on ERP and Go/No-Go behavioral measures. A total of twenty-nine participants (M age = 7.14 years; 52% male; 41.4% white) recruited from the IBBS efficacy study comparing IBBS to Treatment-As-Usual (TAU) completed a Go/No-Go task before and after treatment as brain activity was recorded using EEG. Thirty-four matched healthy controls (HC) completed the same EEG procedures at a single time point. Following treatment, the Go P3 latency was significantly earlier for the IBBS group relative to the TAU group. No treatment effects were found on any behavioral measures. Prior to treatment, there was a significant difference between the ADHD group and HC group for the N2 difference wave. Children with ADHD also showed slower reaction times on behavioral measures. Although this pilot study did not reveal robust treatment effects, it suggests that IBBS may prevent the worsening of attentional systems in the brain and larger studies are needed for replication purposes.

Methylphenidate and alcohol effects on flash-evoked potentials, body temperature, and behavior in Long-Evans rats

Methylphenidate (MPD) is a psychostimulant used to treat attention deficit hyperactivity disorder (ADHD). Most adult ADHD patients use ethanol in combination with MPD. This research examined the effects of MPD and ethanol on flash-evoked potentials (FEPs; cortical responses frequently used to assess neural activity and sensory processing) recorded from the visual cortex (VC) and superior colliculus (SC; a structure involved in attention and orientation) of chronically implanted male Long-Evans rats, and on body temperature and open field behavior. For one group of rats, either saline or ethanol (2.0 g/kg) was given 5 min prior to either saline or MPD (2.9 mg/kg). FEPs were recorded 10 and 20 min later. In the VC, ethanol decreased amplitudes of several components, but increased P2. MPD increased N3, but decreased P3 and P4. Ethanol increased the latency of several components. In the SC, ethanol decreased all three components, while MPD increased P3. Ethanol increased latency of all components. During FEP testing, ethanol decreased body movement while MPD increased movement. In the open field, line crossings were increased but rearings were decreased by ethanol. Both ethanol and MPD produced hypothermia. A second group of rats was given MPD at 11.6 mg/kg. Ethanol decreased several VC amplitudes, but increased P2. MPD increased N3 amplitude but decreased amplitude for other components. MPD also counteracted the effect of ethanol on the amplitude of P2 and N3. Both ethanol and MPD increased the latency of several components. In the SC, ethanol decreased all component amplitudes, while MPD increased P3 but decreased N4. Ethanol increased all component latencies, while MPD increased latency for two components. During FEP testing, ethanol decreased body movement while MPD increased movement. In the open field, line crossings were increased by ethanol and MPD. Rearings were eliminated by ethanol in the open field but increased by MPD, and MPD counteracted the effect of ethanol on rearings. Both ethanol and MPD produced hypothermia. Some of these results might help explain why users take MPD and ethanol in combination in order to enable consuming larger amounts of alcohol.

Effects of methylphenidate on the ERP amplitude in youth with ADHD: A double-blind placebo-controlled cross-over EEG study

Methylphenidate (MPH) is a first line drug for attention-deficit/hyperactivity disorder (ADHD), yet the neuronal mechanisms underlying the condition and the treatment are still not fully understood. Previous EEG studies on the effect of MPH in ADHD found changes in evoked response potential (ERP) components that were inconsistent between studies. These inconsistencies highlight the need for a well-designed study which includes multiple baseline sessions and controls for possible fatigue, learning effects and between-days variability. To this end, we employ a double-blind placebo-controlled cross-over study and explore the effect of MPH on the ERP response of subjects with ADHD during a Go/No-Go cognitive task. Our ERP analysis revealed significant differences in ADHD subjects between the placebo and MPH conditions in the frontal-parietal region at 250ms-400ms post stimulus (P3). Additionally, a decrease in the late 650ms-800ms ERP component (LC) is observed in frontal electrodes of ADHD subjects compared to controls. The standard deviation of response time of ADHD subjects was significantly smaller in the MPH condition compared to placebo and correlated with the increased P3 ERP response in the frontoparietal electrodes. We suggest that mental fatigue plays a role in the decrease of the P3 response in the placebo condition compared to pre-placebo, a phenomenon that is significant in ADHD subjects but not in controls, and which is interestingly rectified by MPH.

Methylphenidate promotes the interaction between motor cortex facilitation and attention in healthy adults: A combined study using event-related potentials and transcranial magnetic stimulation

OBJECTIVE

This study investigated simultaneously the impact of methylphenidate (MPH) on the interaction of inhibitory and facilitative pathways in regions processing motor and cognitive functions.

METHOD

Neural markers of attention and response control (event-related potentials) and motor cortical excitability (transcranial magnetic stimulation) and their pharmacological modulation by MPH were measured simultaneously in a sample of healthy adults (n = 31) performing a cued choice reaction test.

RESULTS

Methylphenidate modulated attentional gating and response preparation processes (increased contingent negative variation) and response inhibition (increased nogo P3). N1, cue- and go-P3 were not affected by MPH. Motor cortex facilitation, measured with long-interval cortical facilitation, was increased under MPH in the nogo condition and was positively correlated with the P3 amplitude.

CONCLUSION

Methylphenidate seems particularly to enhance response preparation processes. The MPH-induced increased motor cortex facilitation during inhibitory task demands was accompanied by increased terminal response inhibition control, probably as a compensatory process.

Weekday-only chronic oral methylphenidate self-administration in male rats: Reversibility of the behavioral and physiological effects

Methylphenidate (MP) is a commonly prescribed psychostimulant for Attention Deficit Hyperactivity Disorder (ADHD). We recently reported behavioral and developmental effects of chronic MP use in healthy rats. The current study investigated how interrupting chronic MP treatment with weekend abstinence altered the behavioral and physiological consequences of chronic MP treatment, and if prolonged abstinence would reverse the observed effects. Male Sprague Dawley rats were assigned to one of three treatment groups: water (W); low dose (LD) MP; and high dose (HD) MP. For 13 weeks, rats had access to drink from a bottle containing 4 mg/kg MP (LD), 30 mg/kg MP (HD) or water (W) for 1 h, and 10 mg/kg MP (LD), 60 mg/kg MP (HD) or water (W) for the next 7 h, each week day. During weekends, all animals received only water as well as throughout the 5-week-long abstinence phase, which immediately followed the treatment phase. Throughout the treatment phase, regardless of weekend abstinence, chronic MP resulted in significant decreased food and fluid intake and body weight. Also, HD MP exposure resulted in the following behavioral effects: increased open field and circadian locomotor activity; increased latency to immobility and decreased time spent immobile in the forced swim test; increased center activity in the open field and percent of time spent in an open arm of the elevated-plus-maze; and increased social affiliation and memory in the Crawley's three chamber sociability test. During the prolonged (5-week) abstinence phase, all these effects were reversed while HD treated rats increased their fluid intake. These results indicated that intermittent brief abstinence periods (weekend's off-treatment) produced the same behavioral and developmental effects as those previously reported with chronic (7 days/week) MP treatment, but were reversible following a prolonged abstinence period (5 weeks).

Monitoring Attention in ADHD with an Easy-to-Use Electrophysiological Index

Attention deficit hyperactivity disorder (ADHD) involves characteristic electroencephalographic (EEG) activity. We developed a single-channel EEG marker for attention: the Brain Engagement Index (BEI'). In this study, we evaluated the use of BEI' for distinguishing between ADHD patients and controls, and for monitoring the effect of pharmacological treatment on ADHD patients. The BEI' values of 20 ADHD patients and 10 controls were measured using a 1-min auditory oddball paradigm and a continuous performance test (CPT) task. We showed that CPT BEI' is trait-specific and separates controls from ADHD patients. At the same time, oddball BEI' is state-specific and identifies differences in attention level within the two groups of ADHD participants and controls. The oddball BEI' also associates with response to treatment, after distinguishing between treatment effect and learning/time effect. The combined use of this marker with common computerized tests holds promise for research and clinical use in ADHD. Further work is required to confirm the results of the present study.

Possible Effects of Copper and Ceruloplasmin Levels on Auditory Event Potentials in Boys with Attention Deficit Hyperactivity Disorder

INTRODUCTION

The aims of the present study were to investigate the relationship between levels of plasma copper (Cu) and ceruloplasmin (Cp) and amplitudes and latencies of P1, N2, and P3 in the parietal and frontal areas of children with attention deficit hyperactivity disorder (ADHD) as well as to compare these Cu levels and event-related potentials (ERPs) indices in controls.

METHODS

Boys (n=41) with ADHD were divided into two subgroups according to a median split of plasma Cu and Cp levels, separately. ERP indices from the parietal and frontal regions were recorded in children with ADHD and 24 normal boys (control group) using an auditory oddball paradigm.

RESULTS

Parietal P3 latency was significantly longer, and parietal P3 amplitude, frontal P3 amplitude, and frontal N2 amplitudes were smaller in children with ADHD than in controls (all p values <0.017). Parietal P1 and frontal P1 latencies were significantly shorter in the higher Cu group than in the lower Cu group (both p values <0.017). Decreased latency of parietal P1 was dependent on plasma levels of Cu (p<0.05). Frontal N2 and parietal N2 amplitudes were significantly lower in the ADHD group with lower Cp levels than in the ADHD group with higher Cp levels (both p values <0.017). Decreased frontal N2 and parietal N2 amplitudes were dependent on plasma levels of Cp (both p values <0.05).

CONCLUSION

Plasma Cu and Cp levels may have an effect on ERPs in ADHD, thus indicating the existence of effects on information processing. Cu levels may have a negative effect on the neuronal encoding of sound, whereas Cp levels may have a positive effect on the processes of cognitive control, conflict monitoring, and stimulus discrimination in children with ADHD.

Perseveration by NK1R-/- ('knockout') mice is blunted by doses of methylphenidate that affect neither other aspects of their cognitive performance nor the behaviour of wild-type mice in the 5-Choice Continuous Performance Test

The underlying cause(s) of abnormalities expressed by patients with attention deficit hyperactivity disorder (ADHD) have yet to be delineated. One factor that has been associated with increased vulnerability to ADHD is polymorphism(s) of TACR1, which is the human equivalent of the rodent NK1 (substance P-preferring) receptor gene (Nk1r). We have reported previously that genetically altered mice, lacking functional NK1R (NK1R-/-), express locomotor hyperactivity, which was blunted by the first-line treatment for ADHD, methylphenidate. Here, we compared the effects of this psychostimulant (3, 10 and 30 mg/kg, intraperitoneally) on the behaviour of NK1R-/- mice and their wild types in the 5-Choice Continuous Performance Test, which emulates procedures used to study attention and response control in ADHD patients. Methylphenidate increased total trials (a measure of 'productivity') completed by wild types, but not by NK1R-/- mice. Conversely, this drug reduced perseveration by NK1R-/- mice, but not by wild types. Other drug-induced changes in key behaviours were not genotype dependent, especially at the highest dose: for example, % omissions (an index of inattentiveness) was increased, whereas % false alarms and % premature responses (measures of impulsivity) declined in both genotypes, indicating reduced overall response. These findings are discussed in the context of the efficacy of methylphenidate in the treatment of ADHD. Moreover, they lead to several testable proposals. First, methylphenidate does not improve attention in a subgroup of ADHD patients with a functional deficit of TACR1. Second, these patients do not express excessive false alarms when compared with other groups of subjects, but they do express excessive perseveration, which would be ameliorated by methylphenidate.

Effects of methylphenidate on executive functioning in attention-deficit/hyperactivity disorder across the lifespan: a meta-regression analysis

Attention-deficit/hyperactivity disorder (ADHD) in childhood and adulthood is often treated with the psychostimulant methylphenidate (MPH). However, it is unknown whether cognitive effects of MPH depend on age in individuals with ADHD, while animal studies have suggested age-related effects. In this meta-analysis, we first determined the effects of MPH on response inhibition, working memory and sustained attention, but our main goal was to examine whether these effects are moderated by age. A systematic literature search using PubMed, PsycINFO, Web of Science and MEDLINE for double-blind, placebo-controlled studies with MPH resulted in 25 studies on response inhibition (n = 775), 13 studies on working memory (n = 559) and 29 studies on sustained attention (n = 956) (mean age range 4.8-50.1 years). The effects of MPH on response inhibition [effect size (ES) = 0.40, p < 0.0001, 95% confidence interval (CI) 0.22-0.58], working memory (ES = 0.24, p = 0.053, 95% CI 0.00-0.48) and sustained attention (ES = 0.42, p < 0.0001, 95% CI 26-0.59) were small to moderate. No linear or quadratic age-dependencies were observed, indicating that effects of MPH on executive functions are independent of age in children and adults with ADHD. However, adolescent studies are lacking and needed to conclude a lack of an age-dependency across the lifespan.

Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms.

OBJECTIVES

To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD.

SEARCH METHODS

In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life.

DATA COLLECTION AND ANALYSIS

Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias.

MAIN RESULTS

The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2).

SECONDARY OUTCOMES

Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence).

AUTHORS' CONCLUSIONS

The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.

Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis

AIMS

Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls.

METHODS

The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately.

RESULTS

Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction.

CONCLUSIONS

The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.

Comprehensive analysis suggests simple processes underlying EEG/ERP - demonstration with the go/no-go paradigm in ADHD

BACKGROUND

Current basic or more advanced methods for analysis of averaged EEG/ERP are based on assumptions on the underlying processes, which are not necessarily precise.

NEW METHOD

In this work we present the findings of a method which obviates such assumptions and aims at a comprehensive analysis of the averaged EEG/ERP signal.

RESULTS

For the sake of demonstration we chose the established go/no-go paradigm in the context of ADHD. Our analysis method characterized two spatiotemporally distinct neurophysiologic processes which underlie the sampled signal: one which may be related to attention and the other which may be more related to perception.

COMPARISON WITH EXISTING METHOD(S)

We show how these processes accord with and provide insight on the waveforms reported in the literature.

CONCLUSIONS

Finally we suggest that application of our method on averaged EEG/ERP data sampled from other paradigms may point at a similarly parsimonious set of underlying neurophysiologic processes which underlie the signal.

Effects of methylphenidate on cognitive functions in children and adolescents with attention-deficit/hyperactivity disorder: evidence from a systematic review and a meta-analysis

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of neuropsychological impairments. The relationship between these neuropsychological deficits and the defining symptoms of ADHD seems more complex than originally thought. Methylphenidate (MPH) is an effective treatment for ADHD symptoms, but its impact on cognition is less clearly understood.

METHODS

With a common systematic search strategy and a rigorous coding and data extraction strategy across domains, we searched electronic databases to identify published placebo controlled trials that compared MPH and placebo on executive and nonexecutive memory, reaction time, reaction time variability and response inhibition in children and adolescents (5-18 years) with a formal diagnosis of ADHD.

RESULTS

Sixty studies were included in the review, of which 36 contained sufficient data for meta-analysis. Methylphenidate was superior to placebo in all five meta-analyses: executive memory, standardized mean difference (SMD) .26, 95% confidence interval (CI): -.39 to -.13; non-executive memory, SMD .60, 95% CI: -.79 to -.41; reaction time, SMD .24, 95% CI: -.33 to -.15; reaction time variability, SMD .62, 95% CI: -.90 to -.34; response inhibition, SMD .41, 95% CI: -.55 to -.27.

CONCLUSIONS

These data support the potentially important effects of MPH on various aspects of cognition known to be associated with ADHD. Consideration should be given to adding cognitive outcomes to the assessment of treatment outcome in ADHD, considering the complexity of the relationship between ADHD symptoms and cognition.

The spontaneously hypertensive rat/Izm (SHR/Izm) shows attention deficit/hyperactivity disorder-like behaviors but without impulsive behavior: therapeutic implications of low-dose methylphenidate

The spontaneously hypertensive rat (SHR) has been used as a genetic animal model of attention deficit/hyperactivity disorder (ADHD). SHR/Izm is derived from stroke-resistant SHR as SHR/NIH and SHR/NCrl but from 22nd to 23rd generation descendants of the SHR/NIH ancestor and therefore may show different behavioral phenotypes compared to other SHR sub-strains. In this study, ADHD-like behaviors in SHR/Izm were evaluated compared to Wistar rats. SHR/Izm showed high locomotor activity in the habituation phase in a novel environment, although locomotor activity in the initial exploratory phase was low. In a behavioral test for attention, spontaneous alternation behavior in the Y-maze test was impaired in SHR/Izm. However, impulsive behavior in the elevated-plus maze test, which is designed to detect anxiety-related behavior but also reflects impulsivity for novelty seeking, was comparable to Wistar rats. Hyperactivity and inattention, detected as ADHD-like behaviors in SHR/Izm, were ameliorated with methylphenidate at a low dose (0.05mg/kg, i.p.). Therefore, SHR/Izm represents a unique animal model of ADHD without anxiety-related impulsive behavior.

Predicting the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a go/no-go test

BACKGROUND

We searched for predictors of the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder (ADHD), emphasizing variables from quantitative electroencephalography, event-related potentials (ERPs), and behavioral data from a visual go/no-go test.

METHODS

Nineteen-channel electroencephalography (EEG) was recorded during the resting state in eyes-open and eyes-closed conditions and during performance of the cued go/no-go task in 98 medication-naïve ADHD patients aged 7-17 years and in 90 controls with the same age and sex distribution as the patients. For patients, the recording was followed by a systematic trial on stimulant medication lasting at least 4 weeks. Based on data from rating scales and interviews, two psychologists who were blind to the electrophysiological results independently rated the patients as responders (REs) (N=74) or non-responders (non-REs) (N=24). Using a logistic regression model, comparisons were made between REs and non-REs on the EEG spectra, ERPs (cue P3, contingent negative variation, and P3 no-go of the ERP waves and independent components [ICs] extracted from these waves), reaction time, reaction time variability, number of commission and omission errors, intelligence quotient, age, sex, ADHD subtype, and comorbidities.

RESULTS

The two groups differed significantly on eight of the variables, with effect sizes (Cohen's d) ranging from 0.49 to 0.76. In the multivariate logistic regression analysis, only three of these variables were significantly associated with clinical outcome. The amplitude of the IC cue P3, which has a parietal-occipital distribution, was normal in REs but significantly smaller in non-REs, whereas the centrally distributed IC P3 no-go early was smaller in REs than in non-REs and controls. In addition, the REs had more power in the EEG theta band. A quartile-based index was calculated using these three variables. The group with the lowest scores comprised only 36% REs; response rates in the three other groups were 83%, 86%, and 89%.

CONCLUSION

The clinical outcome of stimulant medication was best predicted by electrophysiological parameters. The brain dysfunctions of the REs appear to be primarily associated with prefrontal lobe hypoactivation. The non-REs were deviant from the controls in parietal-occipital functions.

Thorough specification of the neurophysiologic processes underlying behavior and of their manifestation in EEG - demonstration with the go/no-go task

In this work we demonstrate the principles of a systematic modeling approach of the neurophysiologic processes underlying a behavioral function. The modeling is based upon a flexible simulation tool, which enables parametric specification of the underlying neurophysiologic characteristics. While the impact of selecting specific parameters is of interest, in this work we focus on the insights, which emerge from rather accepted assumptions regarding neuronal representation. We show that harnessing of even such simple assumptions enables the derivation of significant insights regarding the nature of the neurophysiologic processes underlying behavior. We demonstrate our approach in some detail by modeling the behavioral go/no-go task. We further demonstrate the practical significance of this simplified modeling approach in interpreting experimental data - the manifestation of these processes in the EEG and ERP literature of normal and abnormal (ADHD) function, as well as with comprehensive relevant ERP data analysis. In-fact we show that from the model-based spatiotemporal segregation of the processes, it is possible to derive simple and yet effective and theory-based EEG markers differentiating normal and ADHD subjects. We summarize by claiming that the neurophysiologic processes modeled for the go/no-go task are part of a limited set of neurophysiologic processes which underlie, in a variety of combinations, any behavioral function with measurable operational definition. Such neurophysiologic processes could be sampled directly from EEG on the basis of model-based spatiotemporal segregation.

A Single-Dose, Two-Way Crossover, Bioequivalence Study of Dexmethylphenidate HCl with and without Food in Healthy Subjects

Attention deficit hyperactivity disorder (ADHD) in children is effectively treated by racemic oral methylphenidate (dl-MPH). The d-isomer (d-MPH) has been developed as an improved treatment for ADHD since only half the racemic dose is used. This study, performed in healthy subjects, assessed the effect of food on the pharmacokinetics of dexmethylphenidate hydrochloride (d-MPH HCl) in a single dose (2 x 10-mg tablets), two-way crossover with d-MPH administered to subjects in both a fasting state or after a high-fat breakfast. There were no serious or unexpected adverse events during the course of this study, with most events reported in comparable numbers of fed and fasted subjects. The bioequivalence of d-MPH was similar with or without food, with 90% confidence intervals of 88.2% to 104.6% and 105.9% to 118.2% for ln(C(max)) and ln[(AUC(0-infinity))], respectively. There was a marginal but statistically significant 1-hour increase in t(max) in the fed versus fasted state, reflecting an absorption delay. The rate of formation of the major metabolite, d-ritalinic acid (d-RA), was marginally decreased ( approximately 14%) after food. The extent of exposure to d-RA was similar (within 1.2%) between both treatments. There was a marginal but statistically significant difference in mean t(max) for d-RA between fed and fasted conditions, with peak concentration occurring 1.5 hours later after d-MPH administration with food. There was no measurable in vivo chiral inversion of d-MPH to l-MPH in plasma. In addition, the metabolism of d-MPH was stereospecific as d-MPH only produced d-RA. In summary, food had no substantial effect on the bioavailability of d-MPH, with an equivalent rate and extent of exposure obtained. Therefore, d-MPH can be administered without regard to food intake.

Methylphenidate induces lipid and protein damage in prefrontal cortex, but not in cerebellum, striatum and hippocampus of juvenile rats

The use of psychostimulant methylphenidate has increased in recent years for the treatment of attention-deficit hyperactivity disorder in children and adolescents. However, the behavioral and neurochemical changes promoted by its use are not yet fully understood, particularly when used for a prolonged period during stages of brain development. Thus, the aim of this study was to determine some parameters of oxidative stress in encephalic structures of juvenile rats subjected to chronic methylphenidate treatment. Wistar rats received intraperitoneal injections of methylphenidate (2.0 mg/kg) once a day, from the 15th to the 45th day of age or an equivalent volume of 0.9% saline solution (controls). Two hours after the last injection, animals were euthanized and the encephalic structures obtained for determination of oxidative stress parameters. Results showed that methylphenidate administration increased the activities of superoxide dismutase and catalase, but did not alter the levels of reactive species, thiobarbituric acid reactive substances levels and sulfhydryl group in cerebellum of rats. In striatum and hippocampus, the methylphenidate-treated rats presented a decrease in the levels of reactive species and thiobarbituric acid reactive substances, but did not present changes in the sulfhydryl groups levels. In prefrontal cortex, methylphenidate promoted an increase in reactive species formation, SOD/CAT ratio, and increased the lipid peroxidation and protein damage. These findings suggest that the encephalic structures respond differently to methylphenidate treatment, at least, when administered chronically to young rats. Notably, the prefrontal cortex of juvenile rats showed greater sensitivity to oxidative effects promoted by methylphenidate in relation to other encephalic structures analyzed.

Differential effects of methylphenidate and atomoxetine on attentional processes in children with ADHD: an event-related potential study using the Attention Network Test

Methylphenidate (MPH) and atomoxetine (ATX) are effective medications in the treatment of attention deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate differential effects of MPH and ATX on attentional functions at the performance and the neuronal level in children with ADHD. Using the Attention Network Test (ANT), differential effects of both medications on the noradrenergic alerting network and the dopaminergic executive attention network were considered. Nineteen children with ADHD performed the ANT three times while event-related potentials (ERPs) were recorded. The baseline testing was conducted without medication. In two medication blocks of 8 weeks each, medication was individually titrated for each child (cross-over design, balanced order). At the end of the medication blocks the testing was repeated. While both medications comparably reduced ADHD symptomatology, MPH had some advantages over ATX with regard to performance measures on the ANT and the underlying neuronal mechanisms. Compared with ATX, MPH led to a larger reduction in reaction time variability, which was accompanied by an MPH-related increase in the contingent negative variation (CNV) compared to the baseline testing. Contrary to our expectations, specific alerting network effects were not observed with ATX. Due to the chosen study design, it remains unresolved to what extent e.g. shortened reaction times and smaller conflict scores that were observed with both medications reflect practice or medication effects. The differential pattern of MPH vs. ATX effects on attentional functions in children with ADHD may be explained by the dopaminergic effects of MPH within the cortico-striato-thalamo-cortical circuit.

Within-subject variability during spatial working memory in children with ADHD: an event-related potentials study

Working memory (WM) dysfunction and increased within-subject variability are known issues in attention deficit/hyperactivity disorder (ADHD) patients. Little is known about the electrophysiological characteristics of this variability. We evaluated behavioral and electrophysiological within-subject variability taking developmental aspects into account in a group of ADHD patients. Multichannel (n = 31) event-related potentials (ERP) were measured during a visuo-spatial backmatching task; 44 children (8-16 years old) were tested: 22 children with ADHD, combined (n = 17) and inattentive (n = 5) type, and 22 age- and intelligence-matched control children. One-backmatching (BM1) and two-backmatching (BM2) tasks were performed. Classical behavioral parameters and target and nontarget ERP were compared between groups. In addition, motor response variability and ERP amplitude variability were studied. Age-related changes in both motor response and ERP amplitude variability were analyzed in each group. Attention deficit/hyperactivity disorder children made more commission errors, which was more pronounced in the difficult (BM2) task. No difference between groups was found in ERP amplitude and in motor response variability. However, ADHD patients had higher ERP amplitude variability, which was again more pronounced in the difficult WM task. A delayed maturation of amplitude variability was seen in ADHD patients with a slower than in controls decrease in variability with age. This amplitude variability was correlated with the number of commissions, but in an opposite way for ADHD and control children. Our findings indicate an impaired visuo-spatial WM processing in ADHD children with greater ERP amplitude variability compared to controls. Our results also support the view of a delayed cortical development of visuo-spatial WM circuits in this disorder.

Modulation of attention-deficit/hyperactivity disorder symptoms by short- and long-acting methylphenidate over the course of a day

The purpose of this study was to investigate whether a long-acting methylphenidate formulation (MPH-ret) is as effective as two doses of immediate-release methylphenidate (MPH-IR) in reducing attention-deficit/hyperactivity disorder (ADHD) symptoms including inattention, impulsivity, and hyperactivity during the course of the day. Two groups of children (n=18 each) with ADHD aged between 8 and 12 years completed a continuous performance test in combination with a motion-tracking system four times a day within 8 hours. Inattention (standard deviation of reaction time), impulsivity (commission error rate), and hyperactivity (path length of the headband) were simultaneously measured. We included a control group (n=20) to rule out circadian fluctuations of attentional performance and motor activity. We observed a postlunch dip in attentional performance and an increasing trend of motor activity throughout the day whereas impulsivity remained stable in controls. The MPH-ret and MPH-IR groups had comparable treatment effects on measures of hyperactivity and inattention and normalized participant performance to control levels. In contrast, MPH-IR seems to have an advantage over MPH-ret in impulsivity treatments. Thus, our data suggest that it is crucial to assess the different domains of ADHD symptoms precisely over the course of a day to determine the optimal titration and stimulant formulation for a person with ADHD.

Evaluating vigilance deficits in ADHD: a meta-analysis of CPT performance

We meta-analytically review 47 between-groups studies of continuous performance test (CPT) performance in children with attention-deficit/hyperactivity disorder (ADHD). Using a random effects model and correcting for both sampling error and measurement unreliability, we found large effect sizes (δ) for overall performance, but only small to moderate δ for performance over time in the handful of studies that reported that data. Smaller δs for performance over time are likely attributable, in part, to the extensive use of stimuli for which targets and distractors are quite easily differentiated. Artifacts accounted for a considerable proportion of variance among observed δs. Effect sizes reported in previous reviews were significantly attenuated because of the presence of uncorrected artifacts and highlight the necessity of accounting for artifactual variance in future work to determine the amount of true neurocognitive heterogeneity within ADHD. Signal detection theory and diffusion modeling analyses indicated that the ADHD-related deficits were because of decreased perceptual sensitivity (d') and slower drift rates (v). Results are interpreted the context of several recent models of ADHD.

Methylphenidate lacks genotoxic effects in mouse peripheral blood erythrocytes

Methylphenidate (MPH; Ritalin®; Novartis Pharmaceuticals, Inc., Basel, Switzerland) has been prescribed to treat attention deficit/hyperactivity disorder (ADHD) since its approval by the U.S. Food and Drug Administration over 50 years ago. Due to concerns that MPH might induce cytogenetic alterations in children, treatment with this drug has been a controversial issue. In the present study, we assessed the frequency of micronucleated erythrocytes (MNEs), micronucleated polychromatic erythrocytes (MNPCEs), and polychromatic erythrocytes (PCEs) in peripheral blood samples from mice treated with three different doses of MPH (30, 60, or 125 mg/kg). We found no evidence of increased MNEs or MNPCEs, nor did PCEs decline. These results add to the accumulating evidence that MPH does not induce genotoxic or cytotoxic damage.

Electroencephalography in children with and without sensory processing disorders during auditory perception

OBJECTIVE

We sought to determine whether children with sensory processing disorder (SPD) differ from typically developing children on a neurophysiological measure, the P300 component of event-related potentials produced in response to brief auditory stimulation.

METHOD

We used electroencephalographic measures (i.e., N200 and P300 components) to examine auditory processing in 20 children with SPD and 71 typically developing children, ages 5-10 yr.

RESULTS

Children with SPD demonstrated significantly smaller P300 amplitudes and shorter N200 latencies than typically developing children. Brain activity correctly distinguished children with SPD from typically developing children with 77% accuracy. We also found a significant relationship between the neurophysiological measures and functional performance on sensory and motor tasks.

CONCLUSION

This study presents empirical evidence that children with SPD display unique brain processing mechanisms compared with typical children and, therefore, provide further evidence for the neural deviations associated with SPD.

Effects of motivation and medication on electrophysiological markers of response inhibition in children with attention-deficit/hyperactivity disorder

BACKGROUND

Theories of attention-deficit/hyperactivity disorder (ADHD) posit either executive deficits and/or alterations in motivational style and reward processing as core to the disorder. Effects of motivational incentives on electrophysiological correlates of inhibitory control and relationships between motivation and stimulant medication have not been explicitly tested.

METHODS

Children (9-15 years) with combined-type ADHD (n = 28) and matched typically developing children (CTRL) (n = 28) performed a go/no-go task. Electroencephalogram data were recorded. Amplitude of two event-related potentials, the N2 and P3 (markers of response conflict and attention), were measured. The ADHD children were all stimulant responders tested on and off their usual dose of methylphenidate; CTRLs were never medicated. All children performed the task under three motivational conditions: reward; response cost; and baseline, in which points awarded/deducted for inhibitory performance varied.

RESULTS

There were effects of diagnosis (CTRL > ADHD unmedicated), medication (on > off), and motivation (reward and/or response cost > baseline) on N2 and P3 amplitude, although the N2 diagnosis effect did not reach statistical significance (p = .1). Interactions between motivation and diagnosis/medication were nonsignificant (p > .1).

CONCLUSIONS

Motivational incentives increased amplitudes of electrophysiological correlates of response conflict and attention in children with ADHD, towards the baseline (low motivation) amplitudes of control subjects. These results suggest that, on these measures, motivational incentives have similar effects in children with ADHD as typically developing CTRLs and have additive effects with stimulant medication, enhancing stimulus salience and allocation of attentional resources during response inhibition.

Increased glutamate-stimulated release of dopamine in substantia nigra of a rat model for attention-deficit/hyperactivity disorder--lack of effect of methylphenidate

Attention-deficit/hyperactivity disorder (ADHD) is a behavioural disorder that has been associated with dysfunction of the dopaminergic system. Abnormal dopamine function could be the result of a primary defect in dopamine neurons (neuronal firing, dopamine transporter, synthesis, receptor function) or an indirect result of impaired glutamate and/or noradrenergic regulation of dopamine neurons. There is considerable evidence to suggest that dopamine release is impaired at mesolimbic and nigrostriatal dopaminergic terminals. However, it is not known whether dysregulation occurs at the level of the cell bodies in the ventral tegmental area of the midbrain (VTA) and substantia nigra (SN). An in vitro superfusion technique was used to measure dopamine release in a widely used model of ADHD, the spontaneously hypertensive rat (SHR), and its normotensive Wistar-Kyoto (WKY) control. At approximately 30 days of age, rats were analysed for behavioural differences in the open field in response to acute treatment with methylphenidate (0.5 to 2 mg/kg in condensed milk, oral self-administration). In addition, rats were treated chronically with methylphenidate (2 mg/kg, oral self-administration, twice daily for 14 days from postnatal day 21 to 34) before the VTA and the SN were analysed for glutamate-stimulated and depolarization-evoked release of dopamine in these areas. In support of its use as an animal model for ADHD, SHR were more active in the open field and displayed less anxiety-like behaviour than WKY. Neither strain showed any effect of treatment with methylphenidate. A significant difference was observed in glutamate-stimulated release of dopamine in the SN of SHR and WKY, with SHR releasing more dopamine, consistent with the hypothesis of altered glutamate regulation of dopamine neurons in SHR.

The effect of ADHD symptoms on performance monitoring in a non-clinical population

Recent studies suggested deficits in error processing in patients with Attention Deficit Hyperactivity Disorder (ADHD), but some inconsistencies are still present. Using the ADHD screening questionnaire, the Adult ADHD Self-Report Scale, we investigated the association between the amount of inattention and hyperactivity/impulsivity symptoms in a non-clinical population of healthy students (n=56) and the neural correlates of error processing measured with event-related potentials. We found reduced amplitudes of error-positivity (Pe) with increasing symptoms of inattention, but no correlation with error-related negativity. These results suggest that attention deficits reduce the conscious evaluation of an error as reflected by reduced Pe amplitudes.

Efficacy and safety of dexmethylphenidate extended-release capsules administered once daily to children with attention-deficit/hyperactivity disorder

OBJECTIVE

This 5-week, multicenter, double-blind, placebo-controlled, parallel-group investigation is the first fixed-dose study to evaluate efficacy and tolerability of three doses of (10, 20, or 30 mg, once daily [o.d.]) dexmethylphenidate hydrochloride (HCl) extended-release (d-MPH XR; Focalin XR) across multiple settings to treat pediatric attention-deficit/hyperactivity disorder (ADHD).

RESULTS

ADHD pediatric outpatients (n = 253) diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition, criteria were randomized (1:1:1:1) to receive d-MPH XR (10, 20, or 30 mg o.d.) or placebo. Treatment with d-MPH XR significantly (p < 0.001) reduced the mean score (change from baseline) on Conners'-ADHD/DSM-IV Scales (CADS) as assessed by the teacher CADS-T (dose [mean];10 mg [18], 20 mg [16.9], 30 mg [20.7]) and parents, CADS-P (dose [mean];10 mg [15.8]; 20 mg [17.8]; 30 mg [20.5]) compared to placebo (mean CADS-T [5.7]; CADS-P [4.6]). A significant (p < 0.001) proportion of patients in the three d-MPH XR treatment groups showed improvement on the clinician-rated, Clinical Global Impressions-Improvement (CGI-I) scales (10 mg [73.8%]; 20 mg [71.2%]; 30 mg [77.2 %]) and severity ratings (CGI-S) compared to the placebo group (CGI-I, 22.2%). Adverse events were mild to moderate in severity and similar to previous observations for this class of neurostimulants.

CONCLUSION

All three doses of d-MPH XR (10, 20, or 30 mg o.d), were significantly more effective than placebo in improving ADHD symptoms as confirmed by the teacher, parent and clinician. Additionally, d-MPH XR was well tolerated and demonstrated a consistent safety profile.