Child ; Child, Preschool ; Enuresis ; drug therapy ; Female ; Humans ; Male ; Methylphenidate ; adverse effects ; therapeutic use

PURPOSE: Methylphenidate (MPH) is an effective medication for the treatment of attention deficit hyperactivity disorder (ADHD). However, about 30% of patients do not respond to or are unable to tolerate MPH. Based on previous findings, we hypothesized that great variability in response time (RT) among Korean children with ADHD on a computerized continuous performance attention test would be related to poor MPH treatment response. MATERIALS AND METHODS: Children (ages 6-18 years) with ADHD were recruited for a prospective 12-week, open-labeled, multicenter study to examine optimal dosage of OROS methylphenidate. Of the 144 subjects selected, 28 dropped out due to adverse events, medication noncompliance, or follow-up loss, and an additional 26 subjects with comorbid disorders were excluded from statistical analyses. We defined 'responders' as subjects who received a score of less than 18 on the attention deficit hyperactivity disorder rating scale (ARS; Korean version, K-ARS) and a score of 1 or 2 on the Clinical Global Impression-Improvement scale (CGI-I). RT variability was assessed with the ADHD diagnostic system (ADS). RESULTS: Fifty-nine (67%) subjects responded to MPH treatment. The non-responders showed greater RT variability at baseline (Mann Whitney U = 577.0, p < 0.01). Baseline RT variability was a significant predictor of MPH response (Nagelkerke R2 = 0.136, p < 0.01). It predicted 94.9% of responder, 17.2% of non-responder and 69.3% of overall group. CONCLUSION: High RT variability may predict poor response to MPH treatment in children with ADHD.
Adolescent ; Attention Deficit Disorder with Hyperactivity/*drug therapy ; Child ; Female ; Humans ; Korea ; Male ; Methylphenidate/*therapeutic use ; *Reaction Time ; Treatment Outcome

OBJECTIVETo investigate influential factors for the tendency to medicate and medication compliance in children with attention deficit hyperactivity disorder (ADHD).

METHODSA total of 188 children aged from 5 to 16 years, who were initially diagnosed with ADHD according to DSM-IV criteria, were included in the study. They underwent symptom assessment and cognitive function test. The compliance of methylphenidate treatment was evaluated.

RESULTSPatients with better emotional state, and fewer oppositional and hyperactive behaviors and those who had a family history of psychiatric diseases and who obtained lower scores in the number cancellation test (NCT), were more prone to medication and/or exhibited better medication compliance. Logistic regression analysis showed that fewer oppositional and hyperactive behaviors and lower NCT scores were the predictive factors for a higher tendency to medicate, and a better emotional state was the predictive factor for better medication compliance. Patients of predominantly inattentive type were more prone to medication and showed better medication compliance, as compared with those of combined type. Gender, age and symptom severity were not associated with the tendency to medicate and/or medication compliance.

CONCLUSIONSThere is a need to enhance medication compliance in children with ADHD who have hyperactive, impulsive and oppositional behaviors, and to improve their long-term social functions.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; drug therapy ; psychology ; Central Nervous System Stimulants ; therapeutic use ; Child ; Child, Preschool ; Emotions ; Female ; Humans ; Logistic Models ; Male ; Medication Adherence ; Methylphenidate ; therapeutic use

Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; etiology ; therapy ; Behavior Therapy ; Central Nervous System Stimulants ; therapeutic use ; Child ; Humans ; Methylphenidate ; therapeutic use ; Young Adult

To observe the clinical efficacy of dopamine modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) augmentation of ongoing fluvoxamine treatment in refractory obsessive-compulsive disorder (OCD) and its effects on patient's anxiety and sleep quality.
 Methods: A pilot randomized, placebo-controlled, and double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor treatment-refractory OCD and they received a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. The 44 patients were randomly assigned into a study group and a control group, with 22 patiencs in each group. Fluvoxamine and MPH-ER were given to the study group, while fluvoxamine and placebo were given to the control group, with 8 weeks of the treatment course. Y-BOCS, Hamilton Anxiety Scale (HAMA) were used to assess the efficacy, Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality, and Treatment Emergent Symptom Scale (TESS) was used to evaluate the side effects. Data were analyzed in the intention-to-treat sample.
 Results: The improvement in the Y-BOCS total score, Y-BOCS obsession subscale score and HAMA score were more prominent in the study group than those in the control group (P<0.001). There was no significant difference in PSQI score and TESS score between the two groups. MPH-ER was well tolerated.
 Conclusion: Fluvoxamine combined with MPH-ER is effective in the treatment of refractory obsessive-compulsive disorder. It can improve anxiety and has no adverse effect on sleep quality.
Adult ; Double-Blind Method ; Drug Therapy, Combination ; Fluvoxamine ; therapeutic use ; Humans ; Methylphenidate ; therapeutic use ; Obsessive-Compulsive Disorder ; drug therapy ; Psychiatric Status Rating Scales ; Treatment Outcome

OBJECTIVETo explore the effect of Jiangqian granule (JQG) in treating children attention deficit hyperactivity disorder (ADHD) and its mechanism.

METHODSEighty children with ADHD were randomly divided into two groups, the treated group treated with JQG and the control group treated with Ritalin. Blood lead concentration and Conners' scoring were measured before and after 3 months treatment and the therapeutic effects were assessed. Besides, blood lead concentration and Conners' scoring in 60 healthy children were also determined for control.

RESULTSThe total effective rate in the treated group and the control group was 92.5% and 72.5% respectively, significant difference existed between the two groups. Blood lead level and Conners' scores in ADHD patients were significantly higher than those in the healthy control (P < 0.01). The two parameters decreased after treatment in both groups, but the lowering was more significant in the treated group (P < 0.05, P < 0.01).

CONCLUSIONBlood lead concentration raised in ADHD patients, JQG could enhance the clinical therapeutic effect by means of reducing the blood lead.

Attention Deficit Disorder with Hyperactivity ; blood ; drug therapy ; Central Nervous System Stimulants ; therapeutic use ; Child ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Lead ; blood ; Male ; Methylphenidate ; therapeutic use ; Phytotherapy

OBJECTIVETo seek for a good therapy for childhood hyperkinetic syndrome (CHS).

METHODSTwo hundred and ten patients of CHS were randomly divided into three groups, the Yizhi mixture (YZM) group, the Ritalin group and the combined treated group, 70 in each group. They were treated with YZM alone, Ritalin alone and combined YZM and Ritalin respectively for 12 weeks. The effect was assessed by Conners' questionnaire for hyperkinetic scoring, Achenbach's questionnaire for behavior estimation, clinical general image questionnaire and Tess's questionnaire before and after treatment.

RESULTSThe total effective rate in the YZM group, Ritalin group and combined treated group was 75.7%, 74.2% and 82.8% respectively, and the markedly effective rate in the three groups was 44.3%, 45.7% and 80.0% respectively. By chi 2 test, comparison among the three groups showed that the difference of the total effective rate was insignificant, while that of the markedly effective rate was significant (chi 2 = 23.31, P < 0.01). Further analysis conducted by partitioning method to make comparison between each two groups showed that the markedly effective rate was significantly higher in the combined treated group than that in the YZM group (chi 2 = 18.98, P < 0.01) and in the Ritalin group (chi 2 = 17.62, P < 0.01). The low hyperkinetic score, behavior score, achievement of Chinese and mathematics in the CHS patients were improved after treatment, the improvements were significantly higher in the combined treated group than those in the other two groups (P < 0.05, by q-test). Moreover, the soft nerve signs and abnormal encephalogram were significantly improved in the combined treated and the YZM groups, and the side-effect occurred in the two groups was less than that in the Ritalin group (P < 0.01).

CONCLUSIONThe therapeutic effect of combined treatment of YZM and Ritalin was better than that of YZM or Ritalin alone.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; drug therapy ; Central Nervous System Stimulants ; therapeutic use ; Child ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Methylphenidate ; therapeutic use ; Phytotherapy

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical

BACKGROUNDAttention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great burden on children themselves, their families and the society. Osmotic release oral system methylphenidate (OROS-MPH) is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate (IR-MPH). It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles. The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting.

METHODSThis 6-week, multi-center, prospective, open-label study enrolled 1447 ADHD children to once-daily OROS-MPH (18 mg, 36 mg or 54 mg) treatment. The effectiveness measures were parent-rated Inattention and Overactivity With Aggression (IOWA) Conners I/O and O/D subscales, physician-rated CGI-I and parent-rated global efficacy assessment scale. Blood pressure, pulse rate measurement, adverse events (AEs) and concomitant medications and treatment review were conducted by the investigator and were served as safety measures.

RESULTSA total of 1447 children with ADHD (mean age (9.52 ± 2.36) years) were enrolled in this trial. Totally 96.8% children received an OROS-MPH modal dose of 18 mg, 3.1% with 36 mg and 0.1% with 54 mg at the endpoint of study. The parent IOWA Conners I/O score at the end of week 2 showed statistically significant (P < 0.001) improvement with OROS-MPH (mean: 6.95 ± 2.71) versus the score at baseline (10.45 ± 2.72). The change in the parent IOWA Conners O/D subscale, CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment. Fewer than half of 1447 patients (511(35.3%)) reported AEs, and the majority of the events reported were mild (68.2%). No serious adverse events were reported during the study.

CONCLUSIONThis open-label, naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice.

Adolescent ; Attention Deficit Disorder with Hyperactivity ; drug therapy ; Child ; Delayed-Action Preparations ; Female ; Humans ; Male ; Methylphenidate ; administration & dosage ; adverse effects ; therapeutic use ; Prospective Studies ; Treatment Outcome

We examined short- and long-term medication compliance among youth with attention-deficit hyperactivity disorder (ADHD), using data from the National Health Insurance database in Korea. Of the 5,699,202 6-14-year-old youth in 2008, we chose those with at least 1 medical claim containing an ICD-10 code for diagnosis of ADHD (F90.0) and no prescription for ADHD within the previous 365 days. We tracked the data every 6 months between 2008 and 2011, to determine treatment compliance among newly diagnosed, medicated patients. Further, we checked every 1 month of the 6 months after treatment commencement. Treatment continuity for each patient was calculated by sequentially counting the continuous prescriptions. For measuring compliance, we applied the medication possession ratio (MPR) as 0.6, 0.7, and 0.8, and the gap method as 15- and 30-days' intervals. There were 15,133 subjects; 11,934 (78.86%) were boys. Overall 6-month treatment compliance was 59.0%, 47.3%, 39.9%, 34.1%, 28.6%, and 23.1%. Monthly drop-out rates within the first 6 months were 20.6%, 6.5%, 4.7%, 3.7%, 3.0%, and 2.5%, respectively. When applying MPR more strictly or shorter gap days, treatment compliance lessened. This is the first nationwide report on 36-month treatment compliance of the whole population of 6-14-year-olds with ADHD. We found the beginning of the treatment, especially the first month, to be a critical period in pharmacotherapy. These results also suggest the importance of setting appropriate treatment adherence standards for patients with ADHD, considering the chronic course of ADHD.
Adolescent ; Attention Deficit Disorder with Hyperactivity/diagnosis/*drug therapy ; Central Nervous System Stimulants/*therapeutic use ; Child ; Databases, Factual ; Female ; Humans ; Male ; *Medication Adherence ; Methylphenidate/*therapeutic use ; Republic of Korea ; Retrospective Studies