Methylphenidate-induced improvements of various measures of attention in adults with Attention Deficit Hyperactivity Disorder
First Online: 08 August 2006 Received: 02 August 2005 Accepted: 07 December 2005 DOI:
10.1007/s00702-005-0437-7 Cite this article as: Tucha, O., Mecklinger, L., Laufkötter, R. et al. J Neural Transm (2006) 113: 1575. doi:10.1007/s00702-005-0437-7 Summary.
The present study examined the effect of the stimulant medication methylphenidate (MPH) on attentional functioning of adults with ADHD. Sixteen adults with a diagnosed ADHD without comorbidity were assessed twice, at baseline off MPH and following MPH treatment. The assessment battery consisted of reaction time tasks of low complexity, including measures of alertness – subdivided into tonic and phasic alertness, vigilance, divided attention, flexibility and such aspects of selective attention as including focused attention, inhibition and integration of sensory information. In addition, 16 healthy participants who were matched to adults with ADHD according to sex, age, education level and intellectual functions were also assessed twice using the same test battery. The results of the present study suggest that adults with ADHD off stimulant medication are seriously impaired in various components of attention including vigilance, divided attention, selective attention and flexibility. These impairments of attention were observed primarily in regard to reaction time and its variability. Treatment of adults with ADHD using individually tailored doses of MPH has a positive effect on measures of alertness, vigilance, selective attention, divided attention and flexibility. However, even on MPH adults with ADHD displayed considerable deficits in vigilance and integration of sensory information. The present findings indicate that adults with ADHD are not differentially impaired in attentional processes but may suffer from a more global deficit of attention. Although MPH treatment has been found to be effective in the treatment of the attention deficit of adults with ADHD, additional treatment appears to be necessary.
Keywords: ADHD, attentional functioning, adults, methylphenidate. References Arcia, E, Gualtieri, CT 1994 Neurobehavioural performance of adults with closed-head injury, adults with attention deficit, and controls Brain Injury 8 395 404 PubMed Google Scholar Barkley, RA 1977 The effects of methylphenidate on various types of activity level and attention in hyperkinetic children J Abnorm Child Psychol 5 351 369 PubMed CrossRef Google Scholar Barkley, RA 1998Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment2 Guilford Press New York Google Scholar Barkley, RA, Murphy, KR 1998Attention deficit hyperactivity disorder2 Guilford Press New York Google Scholar Barkley, RA, Murphy, KR, Kwasnik, D 1996 Psychological adjustment and adaptive impairments in young adults with ADHD J Attent Disord 1 41 54 Google Scholar Bezeau, S, Graves, R 2001 Statistical power and effect sizes of clinical neuropsychology research J Clin Exp Neuropsychol 23 399 406 PubMed Google Scholar Chapman, LJ, Chapman, JP 1987 The measurement of handedness Brain Cogn 6 175 183 PubMed CrossRef Google Scholar Cohen, J 1988Statistical power analysis for the behavioral sciences2 Erlbaum Hillsdale Google Scholar Cohen, NJ, Douglas, VI, Morgenstern, G 1971 The effect of methylphenidate on attentive behavior and autonomic activity in hyperactive children Psychopharmacologia 22 282 294 PubMed CrossRef Google Scholar Cohen, RA 1993The neuropsychology of attention Plenum Press New York Google Scholar Corbett, B, Stanczak, DE 1999 Neuropsychological performance of adults evidencing attention-deficit hyperactivity disorder Arch Clin Neuropsychol 14 373 387 PubMed CrossRef Google Scholar Dinn, WM, Robbins, NC, Harris, CL 2001 Adult attention-deficit/hyperactivity disorder: psychological test profiles in a clinical population Brain Cogn 46 114 121 PubMed Google Scholar Downey, KK, Stelson, FW, Pomerleau, OF, Giordani, B 1997 Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population J Nerv Ment Dis 185 32 38 PubMed Google Scholar Epstein, JN, Conners, CK, Sitarenios, G, Erhardt, D 1998 Continuous performance test results of adults with attention deficit hyperactivity disorder Clin Neuropsychol 23 362 371 Google Scholar Epstein, JN, Johnson, DE, Varia, IM, Conners, CK 2001 Neuropsychological assessment of response inhibition in adults with ADHD J Clin Exp Neuro psychol 23 362 371 Google Scholar Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, AE 2000 Attention-deficit/hyperactivity disorder in adults: an overview Biol Psychiatry 48 9 20 PubMed CrossRef Google Scholar Gansler, DA, Fucetola, R, Krengel, M, Stetson, S, Zimering, R, Makary, C 1998 Are there cognitive subtypes in adult attention deficit/hyperactivity disorder? J Nerv Ment Dis 186 776 781 PubMed CrossRef Google Scholar Greenberg, LM, Waldman, ID 1993 Developmental normative data on the Test of Variables of Attention (TOVA) J Child Adolesc Psychiatry 34 1019 1030 Google Scholar Gualtieri, CT, Ondrusek, MG, Finley, C 1985 Attention deficit disorders in adults Clin Neuropharmacol 8 343 356 PubMed Google Scholar Heiligenstein, E, Conyers, LM, Berns, AR, Miller, MA, Smith, MA 1998 Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college students J Am College Health 46 185 188 Google Scholar Holdnack, JA, Moberg, PJ, Arnold, SE, Gur, RC, Gur, RE 1995 Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorder Neuropsychiatr Neuropsychol Behav Neurol 8 282 292 Google Scholar Hollingsworth, DE, McAuliffe, SP, Knowlton, BJ 2001 Temporal allocation of visual attention in adult attention deficit hyperactivity disorder J Cogn Neurosci 13 298 305 PubMed CrossRef Google Scholar Hopkins, J, Perlman, T, Hechtman, L, Weiss, G 1979 Cognitive style in adults originally diagnosed as hyperactives J Child Psychol Psychiatry 20 209 216 PubMed Google Scholar Horton, AM 1996 Neuropsychological findings in adult attention deficit disorder: a pilot study Appl Neuropsychol 3 181 185 PubMed CrossRef Google Scholar Jenkins, M, Cohen, R, Malloy, P, Salloway, S, Johnson, EG, Penn, J, Marcotte, A 1998 Neuropsychological measures which discriminate among adults with residual symptoms of attention deficit disorder and other attentional complaints Clin Neuropsychol 12 74 83 Google Scholar Johnson, DE, Epstein, JN, Waid, LR, Latham, PK, Voronin, KE, Anton, RF 2001 Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder Arch Clin Neuro psychol 16 587 604 CrossRef Google Scholar Katz, LJ, Wood, DS, Goldstein, G, Auchenbach, RC, Geckle, M 1998 The utility of neuropsychological tests in evaluation of attention-deficit/hyperactivity disorder (ADHD) versus depression in adults Assessment 5 45 52 PubMed Google Scholar Keith, RW, Engineer, P 1991 Effects of methyl phenidate on the auditory processing abilities of children with attention deficit-hyperactivity disorder J Learn Disabil 24 630 636 PubMed Google Scholar Kempton, S, Vance, A, Maruff, P, Luk, E, Costin, J, Pantelis, C 1999 Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children Psychol Med 29 527 538 PubMed CrossRef Google Scholar Kerns, KA, Eso, K, Thomson, J 1999 Investigation of a direct intervention for improving attention in young children with ADHD Dev Neuropsychol 16 273 295 CrossRef Google Scholar Kinsbourne, M, DeQuiros, GB, Tocci Ruffo, D 2001 Adult ADHD. Controlled medication assessment Wasserstein, J Wolf, LE Lefever, FF eds. Adult attention deficit disorder The New York Academy of Science New York 287 296 Google Scholar Klee, SH, Garfinkel, BD, Beauchesne, H 1986 Attention deficits in adults Psychiatr Ann 16 52 56 Google Scholar Kupietz, SS 1990 Sustained attention in normal and in reading-disabled youngsters with and without ADDH J Abnorm Child Psychol 18 357 372 PubMed CrossRef Google Scholar Lehrl, S, Triebig, G, Fischer, B 1995 Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence Acta Neurol Scand 91 335 345 PubMed Google Scholar Lockwood, KA, Marcotte, AC, Stern, C 2001 Differentiation of attention-deficit/hyperactivity disorder subtypes: application of a neuropsychological model of attention J Clin Exp Neuropsychol 23 317 330 PubMed Google Scholar Losier, BJ, McGrath, PJ, Klein, RM 1996 Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: a meta-analytic review J Child Psychol Psychiatry 37 971 987 PubMed Google Scholar Lovejoy, DW, Ball, JD, Keats, M, Stutts, ML, Spain, EH, Janda, L, Janusz, J 1999 Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): diagnostic classification estimates for measures of frontal lobe/executive functioning J Int Neuropsychol Soc 5 222 233 PubMed CrossRef Google Scholar Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M 1993 Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status Arch Gen Psychiatry 50 565 576 PubMed Google Scholar Manor, I, Ebstein, RP, Weizman, A, Tyano, S 2003 Efficacy of single low-dose metylphenidate administration in adult ADHD patients according to psychometric assessment Dynamic Psychiatry 36 75 88 Google Scholar Matochik, JA, Liebenauer, LL, King, AC, Szymanski, HV, Cohen, RM, Zametkin, AJ 1994 Cerebral glucose metabolism in adults with attention deficit hyperactivity disorder after chronic stimulant treatment Am J Psychiatry 151 658 664 PubMed Google Scholar Mattes, JA, Boswell, L, Oliver, H 1984 Methylphe nidate effects on symptoms of attention deficit disorder in adults Arch Gen Psychiatry 41 1059 1063 PubMed Google Scholar Mesulam, MM 1981 A cortical network for directing attention and unilateral neglect Ann Neurol 10 309 325 PubMed CrossRef Google Scholar Millstein, R, Wilens, T, Spencer, T, Biederman, J 1998 Presenting ADHD symptoms and subtypes in clinically referred adults with ADHD J Attent Disord 2 159 165 Google Scholar Musten, LM, Firestone, P, Pisterman, S, Bennett, S, Mercer, J 1997 Effects of metylphenidate on preschool children with ADHD: cognitive and behavioral functions J Am Acad Child Adolesc Psychiatry 36 1407 1415 PubMed CrossRef Google Scholar Nuechterlein, KH 1983 Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children J Abnorm Child Psychol 92 4 28 Google Scholar Rapport, LJ, VanVoorhis, A, Tzelepis, A, Friedman, SR 2001 Executive functioning in adult attention-deficit hyperactivity disorder Clin Neuropsychol 15 479 491 PubMed Google Scholar Reid, MK, Borkowski, JG 1984 Effects of methyl phenidate (Ritalin) on information processing in hyperactive children J Abnorm Child Psychol 12 169 185 PubMed CrossRef Google Scholar Riccio, CA, Waldrop, JJ, Reynolds, CR, Lowe, P 2001 Effects of stimulants on the continuous performance test (CPT): implications for CPT use and interpretation J Neuropsychiatr Clin Neurosci 13 326 335 Google Scholar Riordan, HJ, Flashman, LA, Saykin, AJ, Frutiger, SA, Carroll, KE, Huey, L 1999 Neuropsychological correlates of methylphenidate treatment in adult ADHD with and without depression Arch Clin Neuropsychol 14 217 233 PubMed CrossRef Google Scholar Rosvold, HE, Mirsky, AF, Sarason, J, Bransome, ED, Beck, LH 1956 A continuous performance test of brain damage J Consult Psychol 20 343 350 PubMed CrossRef Google Scholar Roy, BP, Scheele, L, Brinkley, J, Ward, N, Wiatrak, C, Russo, J, Townes, B, Varley, C 1997 Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic Compr Psychiatry 38 133 140 CrossRef Google Scholar Sandson, TA, Bachna, KJ, Morin, MD 2000 Right hemisphere dysfunction in ADHD: visual hemispatial inattention and clinical subtype J Learn Disabil 33 83 90 PubMed Google Scholar Schachar, R, Logan, G, Wachsmuth, R, Chajezyk, D 1988 Attaining and maintaining preparation: a comparison of attention in hyperactive, normal and disturbed control group J Abnorm Child Psychol 16 361 378 PubMed CrossRef Google Scholar Schweitzer, JB, Faber, TL, Grafton, ST, Tube, LE, Hoffman, JM, Kilts, CD 2000 Alterations in the functional anatomy of working memory in adult attention deficit hyperactivity disorder Am J Psychiatry 157 278 280 PubMed CrossRef Google Scholar Seidman, LJ, Biederman, J, Weber, W, Hatch, M, Faraone, SV 1998 Neuropsychological functions in adults with attention-deficit hyperactivity disorder Biol Psychiatry 44 260 268 PubMed CrossRef Google Scholar Semrud-Clikeman, M, Nielsen, KH, Clinton, A, Sylvester, L, Parle, N, Connor, RT 1999 An intervention approach for children with teacher- and parent-identified attentional difficulties J Learn Disabil 32 581 590 PubMed Google Scholar Silverstein, SM, Como, PG, Palumbo, DR, West, LL, Osborn, LM 1995 Multiple sources of attentional dysfunction in adults with Tourette’s syndrome: comparison with attention deficit-hyperactivity disorder Neuropsychology 9 157 164 CrossRef Google Scholar Sohlberg, MM, Mateer, CA 2001 Improving attention and managing attentional problems. Adapting rehabilitation techniques to adults with ADD Wasserstein, J Wolf, LE Lefever, FF eds. Adult attention deficit disorder The New York Academy of Sciences New York 359 375 Google Scholar Spencer, T, Wilens, T, Biederman, J, Faraone, SV, Ablon, JS, Lapey, K 1995 A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder Arch Gen Psychiatry 52 434 443 PubMed Google Scholar Sykes, DH, Douglas, VI, Morgenstern, G 1972 The effect of methylphenidate (Ritalin) on sustained attention in hyperactive children Psychopharmacologia 25 262 274 PubMed CrossRef Google Scholar Tannock, R, Schachar, RJ, Carr, RP, Chajczyk, D, Logan, GD 1989 Effects of methylphenidate on inhibitory control in hyperactive children J Abnorm Child Psychol 17 473 491 PubMed CrossRef Google Scholar Taylor, CJ, Miller, DC 1997 Neuropsychological assessment of attention in ADHD adults J Attent Disord 2 77 88 Google Scholar Trommer, BL, Hoeppner, JA, Zecker, SG 1991 The go-no go test in attention deficit disorder is sensitive to methylphenidate J Child Neurol 6 S128 S131 PubMed CrossRef Google Scholar Tucha, O, Lange, KW 2004 Handwriting in attention deficit hyperactivity disorder Motor Control 8 461 471 PubMed Google Scholar Vaidya, CJ, Austin, G, Kirkorian, G, Ridlehuber, HW, Desmond, JE, Glover, GH, Gabrieli, JD 1998 Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study Proc Natl Acad Sci 95 14494 14499 PubMed CrossRef Google Scholar Van der Meere, J, Gunning, B, Stemerdink, N 1999 The effect of methylphenidate and clonidine on response inhibition and state regulation in children with ADHD J Child Psychol Psychiatry 40 291 298 PubMed CrossRef Google Scholar Van der Meere, J, Sergeant, J 1988 Controlled processing and vigilance in hyperactivity: time will tell J Abnorm Child Psychol 16 641 655 PubMed CrossRef Google Scholar Van Zomeren, AH, Brouwer, WH 1994Clinical neuropsychology of attention Oxford University Press New York Google Scholar Walker, AJ, Shores, EA, Trollor, JN, Lee, T, Sachdev, PS 2000 Neuropsychological functioning of adults with attention deficit hyperactivity disorder J Clin Exp Neuropsychol 22 115 124 PubMed CrossRef Google Scholar Wender, P 1997 Attention deficit hyperactivity disorder in adults: a wide view of a widespread condition Psychiatr Ann 27 556 562 Google Scholar Wender, PH, Reimherr, FW, Wood, D, Ward, M 1985 A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults Am J Psychiatry 142 547 552 PubMed Google Scholar Weyandt, LL, Rice, JA, Linterman, I, Mitzlaff, L, Emert, E 1998 Neuropsychological performance of a sample of adults with ADHD, developmental reading disorder, and controls Dev Neuropsychol 14 643 656 CrossRef Google Scholar Wilens, TE, Spencer, TJ, Biederman, J 2001 Pharmacotherapy of adult ADHD Wasserstein, J Wolf, LE Lefever, FF eds. Adult attention deficit disorder The New York Academy of Science New York 592 606 Google Scholar Wood, DR, Reimherr, FW, Wender, PH, Johnson, GE 1976 Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report Arch Gen Psychiatry 33 1453 1460 PubMed Google Scholar Woods, SP, Lovejoy, DW, Ball, JD 2002 Neuropsychological characteristics of adults with ADHD: a comprehensive review of initial studies Clin Neuropsychol 16 12 34 PubMed Google Scholar Zakzanis, KK 2001 Statistics to tell the truth, the whole truth, and nothing but the truth: formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers Arch Clin Neuropsychol 16 653 667 PubMed CrossRef Google Scholar
Zimmermann P, Fimm B (1993) A computerized neuropsychological assessment of attention deficits (Manual). PsyTest, Herzogenrath, Germany
Zimmermann, P, Fimm, B 2002 A test battery for attentional performance Leclercq, M Zimmermann, P eds. Applied neuropsychology of attention: theory, diagnosis and rehabilitation Psychology Press New York 110 151 Google Scholar