Impact of methylphenidate delivery profiles on driving performance of adolescents with attention-deficit/hyperactivity disorder: a pilot study
Abstract
Objective Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for driving accidents. One dose of methylphenidate (MPH) improves simulator driving performances of ADHD-diagnosed adolescents at 1.5 hours post-dose. However, little is known about the effects of different MPH delivery profiles on driving performance throughout the day.Method This randomized, crossover, single-blind study compared osmotic, controlled-release oral system (OROS) MPH (Concerta) given q.d. to immediate-release MPH (Ritalin) given in equal doses t.i.d. on driving performance among six male ADHD-diagnosed adolescent drivers aged 16 to 19 years. Under each treatment condition, participants were maintained on their medication dosage for 7 days, then drove a sophisticated driving simulator at 2 p.m., 5 p.m., 8 p.m., and 11 p.m. The primary outcome measure was each participant's computer-quantified Impaired Driving Score (IDS).Results IDS worsened in the evenings for participants receiving MPH t.i.d. but remained stable when they received once-daily OROS MPH. Participants performed significantly better when receiving OROS MPH q.d. compared with MPH t.i.d. (F = 9.3, df = 1, p =.004). When MPH was given t.i.d., IDS significantly worsened beginning at 8 p.m. compared to OROS MPH (p =.01).Conclusions Participants demonstrated significantly less variability and better driving performance when receiving OROS MPH q.d. compared to MPH t.i.d., particularly in the evenings.
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Unlike some previous studies, this study found no associations between adherence and demographic factors such as age, sex, family income, and single-parent status.
“However, unlike some previous studies, we found no associations between adherence and demographic factors such as age, sex, 17,22 family income, and single-parent status 1, 16,18,29,30”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [1]
Physiological adherence findings are consistent with studies that have linked poor adherence to adverse outcomes.
“Despite our high reported adherence rates, our physiological adherence findings are consistent with studies 1, 16,18,29 that have linked poor adherence to adverse outcomes.”
From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [1]
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- Authors
- Cox, D. J., Merkel, R. L., Penberthy, J. K., Kovatchev, B., & Hankin, C. S.
- Affiliations
- University of Virginia Health System (US)
- Corresponding author
- Cox, Daniel J.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2004-03
- Volume
- 43
- Issue
- 3
- Pages
- 269-275
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2010345730
- Cited by
- 120
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 5 · 2014: 3 · 2013: 6 · 2012: 6
- FWCI
- 10.09
- 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
- Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, adolescents, driving performance, impaired driving, osmotic-release oral system, controlled-release formulation, immediate-release formulation, dosing frequency, driving simulator
- MeSH terms
- Adolescent, Adult, Central Nervous System Stimulants, Analysis of Variance, Attention Deficit Disorder with Hyperactivity, Automobile Driving, Delayed-Action Preparations, Humans, Male, Methylphenidate, Pilot Projects, Single-Blind Method, Cross-Over Studies
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