Challenges to determining adolescent medication response in an outpatient clinical setting: Comparing Adderal and methylphenidate for ADHD

Abstract

This study sought to evaluate the utility of employing systematic assessments of stimulant medication response with teenagers with Attention-Deficit/Hyperactivity Disorder (ADHD) in a routine outpatient clinic setting. In doing so, it compared the efficacy of Adderall and methylphenidate (MPH) for this age group. Thirty-five subjects were randomly assigned to and completed treatment within five different drug orders involving two doses of Adderall (5 mg BID & 10 mg BID) and two doses of MPH (5 mg BID & 10 mg BID) and a lactose placebo. Measures consisted of weekly parent and teacher ratings of ADHD and oppositional symptoms, parent, teen, and teacher ratings of side effects, and tests of inhibition and attention. At the group level of analysis, no significant medication effects could be detected on parent or teacher ratings, the latter occurring in part due to poor cooperation of teachers with the protocol. Significant improvements were found for the 10 mg dose of Adderall on the inhibition task but not on the attention task. Only teen self-report ratings of side effects revealed a significant drug effect. This suggested less severe side effects on the 10 mg Adderall dose than the 5 mg dose of MPH. Nevertheless, nonblinded global clinical judgments of improvement indicated that 46% of teens had an optimal response to Adderall, 40% had an optimal response to MPH, and 14% did not respond to either drug. It is concluded that both Adderall and MPH appear to be clinically effective in the treatment of ADHD in teenagers, based on clinician's global impressions. However, numerous logistical problems plague attempts by clinicians to systematically evaluate teen responding to stimulants in a routine outpatient setting using rating scales. Suggestions are offered as to how practitioners can improve the validity and utility of such systematic evaluations in routine office practice.