Advertisement

Psychopharmacology

, Volume 185, Issue 3, pp 315–326 | Cite as

Effects of methylphenidate on multiple components of attention in children with attention deficit hyperactivity disorder

  • Oliver Tucha
  • Sylvia Prell
  • Lara Mecklinger
  • Christiane Bormann-Kischkel
  • Sabine Kübber
  • Martin Linder
  • Susanne Walitza
  • Klaus W. LangeEmail author
Original Investigation

Abstract

Rationale

Methylphenidate (MPH) has been shown to be effective in the treatment of attention deficits in children with attention deficit hyperactivity disorder (ADHD). Although a variety of studies have been performed, there is little available information as to which components of attentional functioning are disturbed in ADHD.

Objectives

The aim of the present study was to monitor the effect of MPH on various measures of attention in children with ADHD.

Methods

In a double-blind, placebo-controlled, crossover study, the attentional functioning of 58 children diagnosed with ADHD without psychiatric comorbidity was examined. Assessment of attention was performed on their usual MPH treatment and following withdrawal of the drug. Furthermore, the attentional performance of 58 healthy children was assessed. The test battery consisted of reaction time tasks, including measures of alertness, vigilance, divided attention, flexibility, and aspects of selective attention such as focused attention, inhibition, and integration of sensory information.

Results

In comparison to the test performance of healthy children, children with ADHD displayed impairments of vigilance, divided attention, flexibility, and aspects of selective attention including focused attention, inhibition, and integration of sensory information. Statistical comparison of attentional functioning of children with ADHD on and off MPH treatment revealed that the medication resulted in an improved task accuracy regarding vigilance, divided attention, inhibition, focused attention, integration of sensory information, and flexibility.

Conclusion

The present findings indicate that various aspects of attention are markedly impaired in children with ADHD. Treatment with MPH was accompanied by improvements in attention functions of small to moderate sizes. Although MPH-induced improvements were observed in a broad range of attention measures, children with ADHD who were on MPH treatment nevertheless displayed serious deficits in a number of components of attention.

Keywords

ADHD Methylphenidate Alertness Vigilance Selective attention Divided attention Flexibility 

References

  1. Barkley RA (1991) The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. J Abnorm Child Psychol 19:149–178CrossRefPubMedGoogle Scholar
  2. Barkley RA (1998) Comorbid disorders, social relations, and subtyping. In: Barkley RA (ed) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. Guilford, New York, pp 139–163Google Scholar
  3. Barkley RA, DuPaul GJ, McMurray MB (1990) Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. J Consult Clin Psychol 58:775–789CrossRefPubMedGoogle Scholar
  4. Benton AL, Hamsher KD, Varney NR, Spreen O (1983) Contributions to neuropsychological assessment. Oxford University Press, New YorkGoogle Scholar
  5. Benedict RH, Lockwood AH, Shucard JL, Wack D, Murphy BW (1998) Functional neuroimaging of attention in the auditory modality. Neuroreport 9:121–126PubMedGoogle Scholar
  6. Bezeau S, Graves R (2001) Statistical power and effect sizes of clinical neuropsychology research. J Clin Exp Neuropsychol 23:399–406PubMedGoogle Scholar
  7. Borger N, Van der Meere J, Ronner A, Alberts E, Geuze R, Bogte H (1999) Heart rate variability and sustained attention in ADHD children. J Abnorm Child Psychol 27:25–33CrossRefPubMedGoogle Scholar
  8. Cabeza R, Nyberg L (2000) Imaging cognition II: an empirical review of 275 PET and fMRI studies. J Cogn Neurosci 12:1–47Google Scholar
  9. Carlson CL, Lahey BB, Neeper R (1986) Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity. J Psychopathol Behav Assess 8:69–86CrossRefGoogle Scholar
  10. Castellanos FX, Giedd JN, Marsh WL, Hamburger SD, Vaituzis AC, Dickstein DP, Sarfatti SE, Vauss YC, Snell JW, Lange N, Kaysen D, Krain AL, Ritchie GF, Rajapakse JC, Rapoport JL (1996) Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. Arch Gen Psychiatry 53:607–616PubMedGoogle Scholar
  11. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  12. Cohen RA (1993) The neuropsychology of attention. Plenum, New YorkGoogle Scholar
  13. Cohen NJ, Douglas VI, Morgenstern G (1971) The effect of methylphenidate on attentive behavior and autonomic activity in hyperactive children. Psychopharmacologia 22:282–294CrossRefPubMedGoogle Scholar
  14. Cook EH, Stein MA, Krasowski MD, Cox NJ, Olkon DM, Kieffer JE, Leventhal BL (1995) Association of attention-deficit disorder and the dopamine transporter gene. Am J Hum Genet 56:993–998PubMedGoogle Scholar
  15. Corkum PV, Siegel LS (1993) Is the continuous performance task a valuable research tool for use with children with attention-deficit-hyperactivity disorder? J Child Psychol Psychiatry 34:1217–1239PubMedGoogle Scholar
  16. Döpfner M (1999) Hyperkinetische störungen. In: Petermann F (ed) Lehrbuch der klinischen Kinderpsychologie und -psychotherapie, 4th edn. Hogrefe, Göttingen, pp 151–186Google Scholar
  17. DuPaul GJ, Barkley RA, Connor DF (1998) Stimulants. In: Barkley RA (ed) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. Guilford, New York, pp 510–551Google Scholar
  18. Eliason MJ, Richman LC (1987) The Continuous Performance Test in learning disabled and nondisabled children. J Learn Disabil 20:614–619PubMedGoogle Scholar
  19. Epstein JN, Conners CK, Sitarenios G Erhardt D (1998) Continuous Performance Test results of adults with attention deficit hyperactivity disorder. Clin Neuropsychol 12:155–168Google Scholar
  20. Famularo R, Fenton T (1987) The effect of methylphenidate on school grades in children with attention deficit disorder without hyperactivity: a preliminary report. J Clin Psychiatry 48:112–114PubMedGoogle Scholar
  21. Filipek PA, Semrud-Clikeman M, Steingard RJ, Renshaw PF, Kennedy DN, Biederman J (1997) Volumetric MRI analysis comparing subjects having attention-deficit hyperactivity disorder with normal controls. Neurology 48:589–601PubMedGoogle Scholar
  22. Goodyear P, Hynd GW (1992) Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity: behavioral and neuropsychological differentiation. J Clin Child Psychol 21:273–305CrossRefGoogle Scholar
  23. Greenhill LL (1992) Pharmacotherapy—stimulants. Child Adolesc Psychiatr Clin N Am 1:411–447Google Scholar
  24. Grodzinsky GM, Diamond R (1992) Frontal lobe functioning in boys with attention-deficit hyperactivity disorder. Dev Neuropsychol 8:427–445Google Scholar
  25. Halperin JM, Sharma V, Greenblatt E, Schwartz ST (1991) Assessment of the Continuous Performance Test: reliability and validity in a nonreferred sample. Psychol Assess 3:603–608CrossRefGoogle Scholar
  26. Heilman KM, Voeller KK, Nadeau SE (1991) A possible pathophysiologic substrate of attention deficit hyperactivity disorder. J Child Neurol 6(Suppl):S76–S81Google Scholar
  27. Hynd GW, Hern KL, Novey ES, Eliopulos D, Marshall R, Gonzalez JJ, Voeller KK (1993) Attention deficit-hyperactivity disorder and asymmetry of the caudate nucleus. J Child Neurol 8:339–347PubMedGoogle Scholar
  28. Jonkman LM, Kemner C, Verbaten MN, Van Engeland H, Kenemans JL, Camfferman G, Buitelaar JK, Koelega HS (1999) Perceptual and response interference in children with attention-deficit hyperactivity disorder, and the effects of methylphenidate. Psychophysiology 36:419–429CrossRefPubMedGoogle Scholar
  29. Kahneman D (1973) Attention and effort. Prentice-Hall, Englewood CliffsGoogle Scholar
  30. Kaufmann AS, Kaufmann NL (1983) Kaufmann Assessment Battery for Children (K-ABC). American Guidance Service, Circle PinesGoogle Scholar
  31. Kavale K (1982) The efficacy of stimulant drug treatment for hyperactivity: a meta-analysis. J Learn Disabil 15:280–289PubMedGoogle Scholar
  32. Keith RW, Engineer P (1991) Effects of methylphenidate on the auditory processing abilities of children with attention deficit-hyperactivity disorder. J Learn Disabil 24:630–636PubMedGoogle Scholar
  33. 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 29:527–538CrossRefPubMedGoogle Scholar
  34. Kupietz SS (1990) Sustained attention in normal and in reading-disabled youngsters with and without ADDH. J Abnorm Child Psychol 18:357–372CrossRefPubMedGoogle Scholar
  35. LaHoste GJ, Swanson JM, Wigal SB, Glabe C, Wigal T, King N, Kennedy JL (1996) Dopamine D4 receptor gene polymorphism is associated with attention deficit hyperactivity disorder. Mol Psychiatry 1:121–124PubMedGoogle Scholar
  36. Lassiter KS, D’Amato RC, Raggio DJ, Whitten JC, Bardos AN (1994) The construct specificity of the Continuous Performance Test: does inattention relate to behavior and achievement? Dev Neuropsychol 10:179–188Google Scholar
  37. Leclercq M, Zimmermann P (2002) Applied neuropsychology of attention. Theory, diagnosis and rehabilitation. Psychology Press, New YorkGoogle Scholar
  38. Lezak MD (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New YorkGoogle Scholar
  39. Loose R, Kaufmann C, Auer DP, Lange KW (2003) Human prefrontal and sensory cortical activity during divided attention tasks. Hum Brain Mapp 18:249–259CrossRefPubMedGoogle Scholar
  40. 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 37:971–987PubMedGoogle Scholar
  41. Marrocco RT, Davidson MC (1998) Neurochemistry of attention. In: Parasuraman R (ed) The attentive brain. MIT Press, Cambridge, pp 35–50Google Scholar
  42. Maurer RG, Stewart M (1980) Attention deficit disorder without hyperactivity in a child psychiatry clinic. J Clin Psychiatry 41:232–233PubMedGoogle Scholar
  43. Mirsky AF, Anthony BJ, Duncan CC, Ahearn MB, Kellam SG (1991) Analysis of the elements of attention: a neuropsychological approach. Neuropsychol Rev 2:109–145CrossRefPubMedGoogle Scholar
  44. Mitrushina MN, Boone KB, D’Elia LF (1999) Handbook of normative data for neuropsychological assessment. Oxford University Press, New YorkGoogle Scholar
  45. 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 36:1407–1415CrossRefPubMedGoogle Scholar
  46. O’Toole K, Abramowitz A, Morris R, Dulcan M (1997) Effects of methylphenidate on attention and nonverbal learning in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 36:531–538CrossRefPubMedGoogle Scholar
  47. Oommen A, Kapur M, Shanmugam V (1993) Attention, reaction time and visual-motor integration in hyperkinetic and conduct disordered children. NIMHANS J 11:141–147Google Scholar
  48. Perugini EM, Harvey EA, Lovejoy DW, Sandstrom K, Webb AH (2000) The predictive power of combined neuropsychological measures for attention-deficit/hyperactivity disorder in children. Child Neuropsychol 6:101–114PubMedGoogle Scholar
  49. Posner MI, Boies SJ (1971) Components of attention. Psychol Rev 78:391–408Google Scholar
  50. Posner MI, Rafal RD (1987) Cognitive theories of attention and the rehabilitation of attentional deficits. In: Meier MJ, Benton AL, Diller L (eds) Neuropsychological rehabilitation. Guilford, New York, pp 182–201Google Scholar
  51. Rapport MD, Carlson GA, Kelly KL, Pataki C (1993) Methylphenidate and desipramine in hospitalized children: I. Separate and combined effects on cognitive function. J Am Acad Child Adolesc Psychiatry 32:333–342PubMedGoogle Scholar
  52. Reid MK, Borkowski JG (1984) Effects of methylphenidate (Ritalin) on information processing in hyperactive children. J Abnorm Child Psychol 12:169–185CrossRefPubMedGoogle Scholar
  53. 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 Neuropsychiatry Clin Neurosci 13:326–335PubMedGoogle Scholar
  54. Rosvold HE, Mirsky AF, Sarason J, Bransome ED, Beck LH (1956) A continuous performance test of brain damage. J Consult Psychol 20:343–350PubMedGoogle Scholar
  55. Rubinstein RA, Brown RT (1984) An evaluation of the validity of the diagnostic category of attention deficit disorder. Am J Orthopsychiatry 54:398–414PubMedGoogle Scholar
  56. Rushworth MFS, Hadland KA, Paus T, Sipila PK (2002) Role of the human medial frontal cortex in task switching: a combined fMRI and TMS study. J Neurophysiol 87:2577–2592PubMedGoogle Scholar
  57. Saul RC, Ashby CD (1986) Measurement of whole blood serotonin as a guide for prescribing psychostimulant medication for children with attention deficits. Clin Neuropharmacol 9:189–195PubMedGoogle Scholar
  58. Schachar R, Tannock R (1993) Childhood hyperactivity and psychostimulants: a review of extended treatment studies. J Child Adolesc Psychopharmacol 3:81–97Google Scholar
  59. Sebrechts MM, Shaywitz SE, Shaywitz BA, Jatlow P, Anderson GM, Cohen DJ (1986) Components of attention, methylphenidate dosage, and blood levels in children with attention deficit disorder. Pediatrics 77:222–228PubMedGoogle Scholar
  60. Seeman P, Madras BK (1998) Anti-hyperactivity medication: methylphenidate and amphetamine. Mol Psychiatry 3:386–396CrossRefPubMedGoogle Scholar
  61. Semrud-Clikeman M, Filipek PA, Biederman J, Steingard R, Kennedy D, Renshaw P, Bekken K (1994) Attention-deficit hyperactivity disorder: magnetic resonance imaging morphometric analysis of the corpus callosum. J Am Acad Child Adolesc Psychiatry 33:875–881PubMedGoogle Scholar
  62. Shallice T (1982) Specific impairments of planning. In: Broadbent DE, Weiskrantz L (eds) The neuropsychology of cognitive function. The Royal Society, London, pp 199–209Google Scholar
  63. Shaywitz SE, Shaywitz BA (1991) Attention deficit disorder: diagnosis and the role of ritalin in management. In: Greenhill LL, Osman BB (eds) Ritalin: theory and patient management. Liebert, New York, pp 45–67Google Scholar
  64. Shaywitz BA, Fletcher JM, Shaywitz SE (1997) Attention deficit/hyperactivity disorder. Adv Pediatr 44:331–367PubMedGoogle Scholar
  65. Shue KL, Douglas VI (1992) Attention deficit hyperactivity disorder and the frontal lobe syndrome. Brain Cogn 20:104–124CrossRefPubMedGoogle Scholar
  66. Sohlberg MM, Mateer CA (1987) Effectiveness of an attention training program. J Clin Exp Neuropsychol 9:117–130PubMedGoogle Scholar
  67. Spreen O, Strauss E (1991) A compendium of neuropsychological tests: administration, norms, and commentary, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  68. Sroufe LA, Sonies BC, West WD, Wright FS (1973) Anticipatory heart rate deceleration and reaction time in children with and without referral for learning disability. Child Dev 44:267–273PubMedGoogle Scholar
  69. Stein MA, Sarampote CS, Waldman ID, Robb AS, Conlon C, Pearl PL, Black DO, Seymour KE, Newcorn JH (2003) A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics 112:404–413CrossRefGoogle Scholar
  70. Sturm W, de Simone A, Krause BJ, Specht K, Hesselmann V, Radermacher I, Herzog H, Tellmann L, Müller-Gärtner HW, Willmes K (1999) Functional anatomy of intrinsic alertness: evidence for a fronto-parietal-thalamic-brainstem network in the right hemisphere. Neuropsychologia 37:797–805CrossRefPubMedGoogle Scholar
  71. Swanson JM, McBurnett K, Cooper MM (1993) Effects of stimulant medication on children with attention deficit disorder: a “review of reviews”. Except Child 60:154–162Google Scholar
  72. Tannock R, Ickowicz A, Schachar R (1995) Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 34:886–896CrossRefPubMedGoogle Scholar
  73. Trommer BL, Hoeppner JA, Lorber R, Armstrong KJ (1988) The go–no-go paradigm in attention deficit disorder. Ann Neurol 24:610–614CrossRefPubMedGoogle Scholar
  74. Ullmann RK, Sleator EK (1985) Attention deficit disorder children with or without hyperactivity. Which behaviors are helped by stimulants? Clin Pediatr 24:547–551Google Scholar
  75. Vandenberghe R, Duncan J, Dupont P, Ward R (1997) Attention to 1 or 2 features in left-or-right visual field: a positron emission tomography study. J Neurosci 17:3739–3750PubMedGoogle Scholar
  76. 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 40:291–298CrossRefPubMedGoogle Scholar
  77. Van der Meere J, Sergeant JA (1988) Focussed attention in pervasively hyperactive children. J Abnorm Child Psychol 16:627–639CrossRefPubMedGoogle Scholar
  78. Van Zomeren AH, Brouwer WH (1994) Clinical neuropsychology of attention. Oxford University Press, New YorkGoogle Scholar
  79. Wechsler D (1991) Wechsler Intelligence Scale for Children, 3rd edn. Psychological Corporation, San AntonioGoogle Scholar
  80. Whalen CK, Henker B, Buhrmester B, Hinshaw SP, Huber A, Laski K (1989) Does stimulant medication improve the peer status of hyperactive children? J Consult Clin Psychol 57:5435–5449Google Scholar
  81. 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 16:653–667CrossRefPubMedGoogle Scholar
  82. Zametkin AJ, Rapoport JL (1987) Neurobiology of attention deficit disorder with hyperactivity: where have we come in 50 years? J Am Acad Child Adolesc Psychiatry 26:676–686PubMedGoogle Scholar
  83. Zeiner P, Bryhn G, Bjercke C, Truyen K, Strand G (1999) Response to methylphenidate in boys with attention-deficit hyperactivity disorder. Acta Paediatr 88:298–303CrossRefPubMedGoogle Scholar
  84. Zimmermann P, Fimm B (1993) A computerized neuropsychological assessment of attention deficits (manual). PsyTest, HerzogenrathGoogle Scholar
  85. Zimmermann P, Fimm B (2002) A test battery for attentional performance. In: Leclercq M, Zimmermann P (eds) Applied neuropsychology of attention: theory, diagnosis and rehabilitation. Psychology Press, New York, pp 110–151Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Oliver Tucha
    • 1
  • Sylvia Prell
    • 1
  • Lara Mecklinger
    • 1
  • Christiane Bormann-Kischkel
    • 2
  • Sabine Kübber
    • 3
  • Martin Linder
    • 2
  • Susanne Walitza
    • 4
  • Klaus W. Lange
    • 1
    Email author
  1. 1.Department of Experimental PsychologyUniversity of RegensburgRegensburgGermany
  2. 2.Department of Child and Adolescent PsychiatryDistrict Hospital of RegensburgRegensburgGermany
  3. 3.Practice of Child and Adolescent PsychiatryRegensburgGermany
  4. 4.Department of Child and Adolescent PsychiatryUniversity of WürzburgWürzburgGermany

Personalised recommendations