Are stimulants effective in the treatment of executive function deficits? Results from a randomized double blind study of OROS-methylphenidate in adults with ADHD

• Published in: European neuropsychopharmacology Vol. 21; no. 7; pp. 508 - 515
• Main Authors: Biederman, Joseph, Mick, Eric, Fried, Ronna, Wilner, Nicole, Spencer, Thomas J., Faraone, Stephen V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2011
• Subjects: ADHD; Adult; Adults; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - psychology; Central Nervous System Stimulants - administration & dosage; Central Nervous System Stimulants - adverse effects; Central Nervous System Stimulants - therapeutic use; Cognitive performance; Delayed-Action Preparations; Double-Blind Method; Executive Function; Female; Humans; Internal Medicine; Male; Methylphenidate - administration & dosage; Methylphenidate - adverse effects; Methylphenidate - therapeutic use; OROS-methylphenidate; Placebos; Psychiatry; Psychological Tests; Treatment Outcome; Young Adult; ADHD; Cognitive performance; Adults; OROS-methylphenidate
• ISSN: 0924-977X; 1873-7862; 1873-7862
• DOI: 10.1016/j.euroneuro.2010.11.005

The objective of this study was to evaluate the association between executive function deficits (EFDs) and response to methylphenidate treatment in ADHD in adults. We conducted a 6-week, parallel design, randomized, placebo controlled study in adults with DSM-IV ADHD. Our psychometric index of executive function used standardized neuropsychological testing. We assessed behaviors reflective of EFDs using the Behavior Rating Inventory of Executive Function — Adult Version (BRIEF-A). Subjects with available measures of executive functioning (OROS-MPH N = 40; Placebo N = 47) were included for analysis. There was no difference in the percent of subjects completing the 6-week acute efficacy Phase I of the trial (100% ( N = 40) vs. 98% ( N = 46), p = 0.4). The mean daily dose at Phase I endpoint was 84.6 ± 31.6 mg (1.04 ± 0.29 mg/kg) OROS-MPH and 100.5 ± 21.9 mg (1.20 ± 0.11 mg/kg) placebo ( p = 0.0007). Based on the neuropsychological testing at the baseline assessment, 40% of the ADHD subjects ( N = 35/87) were considered to have EFDs but 93% ( N = 81) of subjects had ≥ 2 BRIEF-A clinical scale T-scores > 65. Regardless of the definition used, however, EFDs did not impact the clinical response to OROS-MPH. This randomized clinical trial showed that executive function deficits do not moderate the response to methylphenidate and measures of executive function deficits are not associated with response to OROS-MPH.