Response to Methylphenidate in Children With ADHD and Comorbid Anxiety
Abstract
Objective To determine whether comorbid anxiety alters response to methylphenidate (MPH) in children with attention-deficit hyperactivity disorder (ADHD). Method Ninety-one children with ADHD were assessed for anxiety. Children were randomly assigned to receive MPH or placebo, titrated to a dose of 0.7 mg/kg, while side effects were minimized. Measures of side effects and behavioral response were obtained from parents and teachers before treatment, after titration to optimal dose, and after 4 months of treatment. These measures, dose of drug, and rate of adherence to assigned medication assignment were compared for nonanxious (ADHD- ANX) and anxious ADHD children (ADHD+ ANX). Results Rates of adherence to original medication assignment did not differ between the groups. ADHD+ ANX on both MPH and placebo titrated to a lower dose at the end of titration, although the dose of drug did not differ among the groups after 4 months of treatment. No differential response to MPH between ADHD+ ANX and ADHD- ANX was noted at end-titration or at 4 months on any side effect or behavioral measures. Conclusions Comorbid anxiety does not appear to influence development of side effects or behavioral response to MPH when dose is titrated as in standard clinical practice.
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A more recent study showed that methylphenidate had moderate beneficial effects on selective aspects of verbal-auditory working memory and on visual-spatial working memory in children with ADHD but showed no such improvements in children with ADHD and anxiety.
“A more recent study showed that MPH had moderate but beneficial effects on selective aspects of verbal–auditory working memory and on a visual-spatial working memory in children with ADHD but showed no such improvements in children with ADHD and anxiety [52].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [52]
There was no evidence that stimulants worsened either behavioral or cognitive responses in participants with ADHD and anxiety.
“However, there was again no evidence that stimulants worsened either behavioral or cognitive responses in participants with ADHD and anxiety [52].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [52]
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“While some studies found a positive effect of medication on ADHD behavioral symptom outcomes in children with ADHD and comorbid anxiety (MTA group 1999), other studies found no effect of medication (Diamond et al. 1999), or even adverse medication effects on anxiety symptoms and cognitive functioning (Bedard and Tanno…”
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- Authors
- DIAMOND, I. R., TANNOCK, R., & SCHACHAR, R. J.
- Affiliations
- Hospital for Sick Children (CA)
- University of Toronto (CA)
- Corresponding author
- SCHACHAR, RUSSELL J.
- ORCID
- SCHACHAR, RUSSELL J.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 1999-04
- Volume
- 38
- Issue
- 4
- Pages
- 402-409
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2095382166
- Cited by
- 132
- References
- 2
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 6 · 2014: 6 · 2012: 3
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, anxiety comorbidity, children, drug response, dose titration, medication adherence, adverse effects, behavioral responses
- MeSH terms
- Central Nervous System Stimulants, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, Methylphenidate, Psychiatric Status Rating Scales
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