Should immediate release methylphenidate be the treatment of choice for initiation of ADHD treatment?

Objective: To assess the Conners’ Teacher Rating Scale-Revised Short in evaluating improvement in symptomatology with immediaterelease methylphenidate (MPH-IR), methylphenidate extended release (OROS MPH) or atomoxetine (ATX) in attention deficit hyperactivity disorder (ADHD) of children patients.

Method: In a clinical sample, over a period of 12 months, all drug-naive patients with ADHD (n=128; boys, n=92; girls, n=36) were evaluated retrospectively. Patients between 7 and 17 years of age were consecutively selected and diagnosed for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), by a Child and Adolescent Psychiatrist. The treatment of MPHIR, OROS MPH, ATX was started at 0.5mg/kg/day for 1 week. The dose was increased to 1mg/kg/day at 1 week after treatment initiation till 8 weeks. Efficacy measures were evaluated by Conners’ Teacher Rating Scale. We assessed 107 children that completed the first and second teacher scale. Eleven patients used a combination of OROS MPH and MPH-IR. All cases were evaluated between January 2013 and January 2014. The Teachers’ Scale was completed before the treatment began and two months after the initiation of treatment. Conners’ Teacher Rating Scale (CTRS): Turkish translations of the 28-item Conners’ Teacher Rating Scale (CTRS) was calculated with good internal consistency as indicated by Cronbach’s alpha coefficients. Factor analytical data from the normal sample studies tested the construct validity of parent and teacher Turkish Conners’ rating scales (CRS) despite non-differentiation of the conduct factor from the hyperactivity factor on the teacher scale. The clinical criteria scores proposed the necessity of adapting the item content of all the subscales, except the hyperactivity subscale. The adapted and original subscales of the CRS Turkish forms revealed such psychometric properties that they could be employed in assessing attention deficit and disruptive behavior disorders in Turkish children.

Results: The mean age of 117 patients included in this study was 10.78±2.7 years. Stable daily doses were 1 mg/kg/day for ATX, OROSMPH and IR-MPH. All efficacy parameters were significantly improved with the use of the above-mentioned three drugs in respect to baseline.

Conclusion: In the treatment of ADHD, once-daily OROS-MPH produces significant improvements in hyperactivity. But IR-MPH improves hyperactivity, attention deficit and behavioral disorder. ATX treatment is found less effective than other two treatment groups. MPH-IR might be the initial treatment of choice in ADHD treatment during the first 8 weeks of treatment