Analog Classroom Assessment of Adderall® in Children With ADHD

SWANSON, JAMES M.; WIGAL, SHARON; GREENHILL, LAURENCE L.; BROWNE, RONALD; WASLIK, BRUCE; LERNER, MARC; WILLIAMS, LILLIE; FLYNN, DAN; AGLER, DAVE; CROWLEY, KENTON; FINEBERG, ERICK; BAREN, MARTIN; CANTWELL, DENNIS P.

doi:10.1097/00004583-199805000-00014

Cited by 218Attention Deficit Hyperactivity DisorderPharmaceutical studies and practicesNeurotransmitter Receptor Influence on Behavior

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Analog Classroom Assessment of Adderall® in Children With ADHD

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SWANSON, JAMES M., WIGAL, SHARON, GREENHILL, LAURENCE L., BROWNE, RONALD, WASLIK, BRUCE, LERNER, MARC, WILLIAMS, LILLIE, FLYNN, DAN, AGLER, DAVE, CROWLEY, KENTON, FINEBERG, ERICK, BAREN, MARTIN, CANTWELL, DENNIS P.·1998·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/00004583-199805000-00014

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Abstract

OBJECTIVE: This was a randomized, double-blind, crossover study of 30 children with attention-deficit/hyperactivity disorder (ADHD) that evaluated the time course effects of four doses of Adderall (5, 10, 15, and 20 mg), an inactive control (placebo), and a positive control (clinical dose of methylphenidate). METHOD: For each treatment condition, a capsule was administered in the morning and assessments were performed in an analog classroom setting every 1.5 hours across the day. Subjective (teacher ratings of deportment and attention) and objective (scores on math tests) measures were obtained for each classroom session, and these measures were used to evaluate time-response and dose response effects of Adderall. RESULTS: For doses of Adderall greater than 5 mg, significant time course effects were observed. Rapid improvements on teacher ratings and math performance were observed by 1.5 hours after administration, and these effects dissipated by the end of the day. The specific pattern of time course effects depended on dose: the time of peak effects and the duration of action increased with dose of Adderall. CONCLUSIONS: This documentation of efficacy in a controlled study supports the addition of Adderall to the armamentarium of psychotropic medications for the treatment of ADHD. The differences in time-response patterns of Adderall and methylphenidate may help tailor treatment to meet specific clinical needs of different children with ADHD.

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The rate of discontinuations related to TEAEs was consistent with those seen for other stimulants in similar settings.
“The rate of discontinuations related to TEAEs was consistent with those seen for other stimulants in similar settings [10,30,31].”
From A 13-hour laboratory school study of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder (2009) · cites this paper as [31]
There is a paucity of studies on the pharmacokinetic and behavioral time course of effects of low-dose amphetamine administration for ADHD.
“In spite of the frequency of use of amphetamine-containing products for the treatment of ADHD, there is a surprising paucity of studies on the pharmacokinetic (PK) and behavioral time course of effects of low-dose amphetamine administration for ADHD (Brown et al., 1979(Brown et al., , 1980;;Pelham et al., 1999;Swanson et al., 1998).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
Swanson et al. (1998) demonstrated a pattern of deterioration on placebo in performance across morning into afternoon assessments.
“It is interesting that the Swanson et al. (1998) report also demonstrated the pattern of deterioration on placebo in performance across morning into afternoon assessments, highlighting the importance of providing appropriate control groups for time-response studies.”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
Each classroom contained two observers who simultaneously rated behaviors using a behavioral observation system described previously.
“In addition, each classroom contained two observers who simultaneously rated the behaviors of one half of the study group, using a behavioral observation system described previously (Swanson et al., 1998(Swanson et al., , 2000)).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
The schedule and procedures for the analog classroom days were based on a modification of well-validated procedures used in previous time-response stimulant studies.
“The schedule and procedures for the analog classroom days were based on a modification of well-validated procedures used in previous timeresponse stimulant studies (Pelham et al., 1995;Swanson et al., 1978Swanson et al., , 1998Swanson et al., , 2000)).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998

A previous analog classroom pharmacodynamic study of Adderall documented behavioral effects up to approximately 5 to 7 hours postdose for the highest dose condition (5 to 20 mg).
“A previous analog classroom pharmacodynamic study of Adderall documented the time course of behavioral and classroom performance effects across a dose range of 5 to 20 mg given once, with behavioral effects evident up to approximately 5 to 7 hours postdose for the highest dose condition (Swanson et al., 1998).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
Adderall XR showed excellent efficacy and tolerability and displayed a time course of action that extended beyond that of immediate-release Adderall at the 10-mg q.d. dose used as a positive control, and by comparison to prior reports of the pharmacodynamic time course for Adderall as assessed by similar measures, even for doses as high as 20 mg q.a.m.
“Overall, Adderall XR showed excellent efficacy and tolerability and displayed a time course of action that extended beyond that of immediate-release Adderall at the 10-mg q.d.dose used as a positive control in this study, and by comparison to prior reports of the pharmacodynamic time course for Adderall as assessed by similar measures (Swanson et al., 1998), even for doses as high as 20 mg q.a.m.”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
The SKAMP and PERMP measures have been shown to be sensitive to both dosage and time effects in prior stimulant research.
“These measures have been shown to be sensitive to both dosage and time effects in prior stimulant research (Swanson et al., 1998).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al., 1998
The placebo data replicate the deterioration in classroom behavior and performance across most of the 12-hour period observed over a shorter timeframe by Swanson et al. (1998).
“Our placebo data replicate the deterioration in classroom behavior and performance across most of the 12-hour period, which was also observed over a shorter timeframe by Swanson et al. (1998).”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al. (1998)
Arnold (2000), Swanson et al. (1998), and others (Elia et al., 1991) have stated that head-to-head comparisons of amphetamine agents versus methylphenidate suggest nearly equivalent group effects, although Arnold (2000) has raised the question of differential benefits in some symptom domains.
“Arnold (2000), Swanson et al. (1998), and others (Elia et al., 1991) have stated that head-to-head comparisons of amphetamine agents versus methylphenidate suggest nearly equivalent group effects, although Arnold (2000) has raised the question of differential benefits in some symptom domains.”
From Analog Classroom Assessment of a Once-Daily Mixed Amphetamine Formulation, SLI381 (ADDERALL XR), in Children With ADHD (2003) · cites this paper as Swanson et al. (1998)

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Authors: SWANSON, J. M., WIGAL, S., GREENHILL, L. L., BROWNE, R., WASLIK, B., LERNER, M., WILLIAMS, L., FLYNN, D., AGLER, D., CROWLEY, K., FINEBERG, E., BAREN, M., & CANTWELL, D. P.
Affiliations: University of California, Irvine (US)
Corresponding author: SWANSON, JAMES M.
ORCID: SWANSON, JAMES M.
GREENHILL, LAURENCE L.
CROWLEY, KENTON
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 1998-05
Volume: 37
Issue: 5
Pages: 519-526
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/00004583-199805000-00014
OpenAlex: W2127442552
Cited by: 218
References: 32
Citations by year: 2026: 2 · 2025: 3 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 4 · 2017: 7 · 2016: 4 · 2015: 5 · 2014: 4 · 2013: 2 · 2012: 9
FWCI: 11.22
Type: journal article
Language: en
Open access: hybrid
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Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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creativecommons.org/licenses/by-nc-nd/4.0/ (vor, 4266 d)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords: Adderall, amphetamine, attention deficit hyperactivity disorder, children, methylphenidate, dose-response relationship, time course of drug effects, duration of action, classroom assessment, teacher ratings, mathematics achievement, psychotropic drugs
MeSH terms: Adolescent, Amphetamines, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Methylphenidate, Personality Assessment, Social Environment, Treatment Outcome, Cross-Over Studies

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Analog Classroom Assessment of Adderall® in Children With ADHD

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