Are stimulants effective in the treatment of executive function deficits? Results from a randomized double blind study of OROS-methylphenidate in adults with ADHD
Abstract
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.
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Other stimulant ADHD medications that affect norepinephrine and dopamine levels, such as methylphenidate, have also shown efficacy for improving deficits in some executive functioning categories but not others.
“Other stimulant ADHD medications that affect norepinephrine and dopamine levels, such as methylphenidate, have also shown efficacy for improving deficits in some executive functioning categories but not others [30], [31].”
From Atomoxetine Effects on Executive Function as Measured by the BRIEF-A in Young Adults with ADHD: A Randomized, Double-Blind, Placebo-Controlled Study (2014) · cites this paper as [31]
The BRIEF-A has shown utility in both clinical and non-clinical groups.
“There is support for the convergent and discriminant validity of the BRIEF-A (Roth et al., 2005) and its utility has been demonstrated in studies of clinical (Biederman et al., 2011;Chang, Davies, & Gavin, 2009;Garlinghouse, Roth, Isquith, Flashman, & Saykin, 2010;Kumbhani, Roth, Kuck, Flashman, & McAllister, 2010;Rabin et al., 2006) and non-clinical (Christ, Kanne, & Reiersen, 2010;Koven & Thomas”
From Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function-Adult Version in Healthy Adults and Application to Attention-Deficit/Hyperactivity Disorder (2013) · cites this paper as Biederman et al., 2011
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- Authors
- Biederman, J., Mick, E., Fried, R., Wilner, N., Spencer, T. J., & Faraone, S. V.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- SUNY Upstate Medical University (US)
- Corresponding author
- Biederman, Joseph
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 21
- Issue
- 7
- Pages
- 508-515
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W2066267313
- Cited by
- 67
- References
- 38
- Citations by year
- 2026: 3 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 12 · 2013: 10 · 2012: 2
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- executive dysfunction, adult ADHD, OROS methylphenidate, methylphenidate, BRIEF-A, neuropsychological assessment, treatment moderators
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Delayed-Action Preparations, Double-Blind Method, Female, Humans, Male, Methylphenidate, Placebos, Psychological Tests, Treatment Outcome, Young Adult, Executive Function
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