Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T08:14:21.579Z Has data issue: false hasContentIssue false

An Open-Label Trial of OROS Methylphenidate in Adults with Late-Onset ADHD

Published online by Cambridge University Press:  07 November 2014

Abstract

Introduction

Many adults with current impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) do not report an age at onset before 7 years of age and cannot, therefore, be assigned the full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of ADHD. We hypothesized that treatment with oral-release osmotic system (OROS) methylphenidate (MPH) will be safe and efficacious for the treatment of adults with late-onset ADHD.

Method

This was a 6-week, open-label, prospective treatment study of OROS MPH monotherapy in 36 adult patients with late-onset ADHD (onset later than the required 7 years of age) using standardized instruments for diagnosis and a robust oral daily dose of up to 1.3 mg/kg/day. Symptom severity was assessed with the Adult ADHD Investigator Symptom Report Scale (AISRS) and the Clinical Global Impression (CGI) scale.

Results

Subjects reported robust current symptoms of ADHD at pre-treatment baseline (11.1±2.8 DSM-IV symptoms), but had an atypical mean age at onset of 14.2±8.6 years. Treatment with OROS MPH at an average daily dose of 78.2±29.4 mg was associated with a statistically and clinically significant reduction in ADHD symptoms relative to baseline as assessed through the AISRS (−16.4±10.5; P<.001). Using a categorical definition of response (CGI-I much or very much improved), a majority (n=26; 72%) of subjects were rated as improved at endpoint.

Conclusion

These results extend previous findings in adults with full ADHD to adults meeting criteria for late-onset ADHD and support the need for further controlled clinical trials in this population.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Spencer, T. Adult attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27:XIXII.CrossRefGoogle ScholarPubMed
2.Kessler, RC, Adler, L, Barkley, R, et al.The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication. Am J Psychiatry. In press.Google Scholar
3.Biederman, J, Faraone, SV, Monuteaux, MC, et al.Gender effects of attention deficit hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55:692700.Google Scholar
4.Biederman, J, Faraone, SV, Spencer, T, Mick, E, Monuteaux, M, Aleardi, M. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1,000 adults in the community. J Clin Psychiatry. In press.Google Scholar
5.Faraone, SV. Genetics of adult attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27:303321.Google Scholar
6.Seidman, LJ, Valera, E, Bush, G. Brain function and structure in adults with attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27:323347.Google Scholar
7.Spencer, T, Wilens, T, Biederman, J, et al.A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder. Arch Gen Psychiatry. 1995;52:434443.Google Scholar
8.Spencer, T, Biederman, J, Wilens, T, et al.A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:456463.Google Scholar
9.Biederman, J, Mick, E, Surman, C, et al.A randomized placebo controlled trial of OROS-methylphenidate in adults with ADHD. Biol Psychiatry. In press.Google Scholar
10.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version. Washington, DC: American Psychiatric Press; 1997.Google Scholar
11.Orvaschel, H. Schedule for Affective Disorder and Schizophrenia for School-Age Children Epidemiologic Version. 5th Edition ed. Ft. Lauderdale, FL: Nova Southeastern University, Center for Psychological Studies: 1994.Google Scholar
12.National Institute of Mental Health. CGI (Clinical Global Impression) Scale - NIMH. Psychopharmacol Bull. 1985;21:839844.Google Scholar
13.Spencer, T, Adler, L. Diagnostic approaches to adult attention-deficit/hyperactivity disorder. Primary Psychiatry. 2004;11:4953.Google Scholar
14.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, D.C.: American Psychiatric Association Press; 1994.Google Scholar
15.Rapport, MD, Jones, JT, DuPaul, GJ, et al.Attention deficit disorder and methylphenidate: Group and single-subject analyses of dose effects on attention in clinic and classroom settings. J Clin Child Psychol. 1987;16:329338.Google Scholar
16.Barkley, R, DuPaul, G, McMurray, M. Attention deficit disorder with and without hyperactivity: Clinical response to three dose levels of methylphenidate. Pediatrics. 1991;87:519531.Google Scholar
17.Wood, DR, Reimherr, FW, Wender, PH, Johnson, GE. Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report. Arch Gen Psychiatry. 1976;33:14531460.Google Scholar
18.Mattes, JA, Boswell, L, Oliver, H. Methylphenidate effects on symptoms of attention deficit disorder in adults. Arch Gen Psychiatry. 1984;41:10591063.Google Scholar
19.Wender, PH, Reimherr, FW, Wood, DR, Ward, M. A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults. Am J Psychiatry. 1985;142:547552.Google Scholar
20.Gualtieri, CT, Ondrusek, MG, Finley, C. Attention deficit disorders in adults. Clin Neuropharmacol. 1985;8:343356.Google Scholar
21.Bouffard, R, Hechtman, L, Minde, K, Iaboni-Kassab, F. The efficacy of 2 different dosages of methylphenidate in treating adults with attention-deficit hyperactivity disorder. Can J Psychiatry. 2003;48:546554.Google Scholar
22.Spencer, T, Biederman, J, Ciccone, P, et al.A PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short and long-acting orally administered formulations of methylphenidate in adults. Am J Psychiatry. 2006;163:387395.Google Scholar