Journal of Neural Transmission

, 113:1575

Methylphenidate-induced improvements of various measures of attention in adults with Attention Deficit Hyperactivity Disorder

  • O. Tucha
  • L. Mecklinger
  • R. Laufkötter
  • H. E. Klein
  • S. Walitza
  • K. W. Lange
Article

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

  1. Arcia, E, Gualtieri, CT 1994Neurobehavioural performance of adults with closed-head injury, adults with attention deficit, and controlsBrain Injury8395404PubMedGoogle Scholar
  2. Barkley, RA 1977The effects of methylphenidate on various types of activity level and attention in hyperkinetic childrenJ Abnorm Child Psychol5351369PubMedCrossRefGoogle Scholar
  3. Barkley, RA 1998Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment2Guilford PressNew YorkGoogle Scholar
  4. Barkley, RA, Murphy, KR 1998Attention deficit hyperactivity disorder2Guilford PressNew YorkGoogle Scholar
  5. Barkley, RA, Murphy, KR, Kwasnik, D 1996Psychological adjustment and adaptive impairments in young adults with ADHDJ Attent Disord14154Google Scholar
  6. Bezeau, S, Graves, R 2001Statistical power and effect sizes of clinical neuropsychology researchJ Clin Exp Neuropsychol23399406PubMedGoogle Scholar
  7. Chapman, LJ, Chapman, JP 1987The measurement of handednessBrain Cogn6175183PubMedCrossRefGoogle Scholar
  8. Cohen, J 1988Statistical power analysis for the behavioral sciences2ErlbaumHillsdaleGoogle Scholar
  9. Cohen, NJ, Douglas, VI, Morgenstern, G 1971The effect of methylphenidate on attentive behavior and autonomic activity in hyperactive childrenPsychopharmacologia22282294PubMedCrossRefGoogle Scholar
  10. Cohen, RA 1993The neuropsychology of attentionPlenum PressNew YorkGoogle Scholar
  11. Corbett, B, Stanczak, DE 1999Neuropsychological performance of adults evidencing attention-deficit hyperactivity disorderArch Clin Neuropsychol14373387PubMedCrossRefGoogle Scholar
  12. Dinn, WM, Robbins, NC, Harris, CL 2001Adult attention-deficit/hyperactivity disorder: psychological test profiles in a clinical populationBrain Cogn46114121PubMedGoogle Scholar
  13. Downey, KK, Stelson, FW, Pomerleau, OF, Giordani, B 1997Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical populationJ Nerv Ment Dis1853238PubMedGoogle Scholar
  14. Epstein, JN, Conners, CK, Sitarenios, G, Erhardt, D 1998Continuous performance test results of adults with attention deficit hyperactivity disorderClin Neuropsychol23362371Google Scholar
  15. Epstein, JN, Johnson, DE, Varia, IM, Conners, CK 2001Neuropsychological assessment of response inhibition in adults with ADHDJ Clin Exp Neuro psychol23362371Google Scholar
  16. Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, AE 2000Attention-deficit/hyperactivity disorder in adults: an overviewBiol Psychiatry48920PubMedCrossRefGoogle Scholar
  17. Gansler, DA, Fucetola, R, Krengel, M, Stetson, S, Zimering, R, Makary, C 1998Are there cognitive subtypes in adult attention deficit/hyperactivity disorder?J Nerv Ment Dis186776781PubMedCrossRefGoogle Scholar
  18. Greenberg, LM, Waldman, ID 1993Developmental normative data on the Test of Variables of Attention (TOVA)J Child Adolesc Psychiatry3410191030Google Scholar
  19. Gualtieri, CT, Ondrusek, MG, Finley, C 1985Attention deficit disorders in adultsClin Neuropharmacol8343356PubMedGoogle Scholar
  20. Heiligenstein, E, Conyers, LM, Berns, AR, Miller, MA, Smith, MA 1998Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college studentsJ Am College Health46185188Google Scholar
  21. Holdnack, JA, Moberg, PJ, Arnold, SE, Gur, RC, Gur, RE 1995Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorderNeuropsychiatr Neuropsychol Behav Neurol8282292Google Scholar
  22. Hollingsworth, DE, McAuliffe, SP, Knowlton, BJ 2001Temporal allocation of visual attention in adult attention deficit hyperactivity disorderJ Cogn Neurosci13298305PubMedCrossRefGoogle Scholar
  23. Hopkins, J, Perlman, T, Hechtman, L, Weiss, G 1979Cognitive style in adults originally diagnosed as hyperactivesJ Child Psychol Psychiatry20209216PubMedGoogle Scholar
  24. Horton, AM 1996Neuropsychological findings in adult attention deficit disorder: a pilot studyAppl Neuropsychol3181185PubMedCrossRefGoogle Scholar
  25. Jenkins, M, Cohen, R, Malloy, P, Salloway, S, Johnson, EG, Penn, J, Marcotte, A 1998Neuropsychological measures which discriminate among adults with residual symptoms of attention deficit disorder and other attentional complaintsClin Neuropsychol127483Google Scholar
  26. Johnson, DE, Epstein, JN, Waid, LR, Latham, PK, Voronin, KE, Anton, RF 2001Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorderArch Clin Neuro psychol16587604CrossRefGoogle Scholar
  27. Katz, LJ, Wood, DS, Goldstein, G, Auchenbach, RC, Geckle, M 1998The utility of neuropsychological tests in evaluation of attention-deficit/hyperactivity disorder (ADHD) versus depression in adultsAssessment54552PubMedGoogle Scholar
  28. Keith, RW, Engineer, P 1991Effects of methyl phenidate on the auditory processing abilities of children with attention deficit-hyperactivity disorderJ Learn Disabil24630636PubMedGoogle Scholar
  29. Kempton, S, Vance, A, Maruff, P, Luk, E, Costin, J, Pantelis, C 1999Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in childrenPsychol Med29527538PubMedCrossRefGoogle Scholar
  30. Kerns, KA, Eso, K, Thomson, J 1999Investigation of a direct intervention for improving attention in young children with ADHDDev Neuropsychol16273295CrossRefGoogle Scholar
  31. Kinsbourne, M, DeQuiros, GB, Tocci Ruffo, D 2001

    Adult ADHD. Controlled medication assessment

    Wasserstein, JWolf, LELefever, FF eds. Adult attention deficit disorderThe New York Academy of ScienceNew York287296
    Google Scholar
  32. Klee, SH, Garfinkel, BD, Beauchesne, H 1986Attention deficits in adultsPsychiatr Ann165256Google Scholar
  33. Kupietz, SS 1990Sustained attention in normal and in reading-disabled youngsters with and without ADDHJ Abnorm Child Psychol18357372PubMedCrossRefGoogle Scholar
  34. Lehrl, S, Triebig, G, Fischer, B 1995Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligenceActa Neurol Scand91335345PubMedGoogle Scholar
  35. Lockwood, KA, Marcotte, AC, Stern, C 2001Differentiation of attention-deficit/hyperactivity disorder subtypes: application of a neuropsychological model of attentionJ Clin Exp Neuropsychol23317330PubMedGoogle Scholar
  36. Losier, BJ, McGrath, PJ, Klein, RM 1996Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: a meta-analytic reviewJ Child Psychol Psychiatry37971987PubMedGoogle Scholar
  37. Lovejoy, DW, Ball, JD, Keats, M, Stutts, ML, Spain, EH, Janda, L, Janusz, J 1999Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): diagnostic classification estimates for measures of frontal lobe/executive functioningJ Int Neuropsychol Soc5222233PubMedCrossRefGoogle Scholar
  38. Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M 1993Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric statusArch Gen Psychiatry50565576PubMedGoogle Scholar
  39. Manor, I, Ebstein, RP, Weizman, A, Tyano, S 2003Efficacy of single low-dose metylphenidate administration in adult ADHD patients according to psychometric assessmentDynamic Psychiatry367588Google Scholar
  40. Matochik, JA, Liebenauer, LL, King, AC, Szymanski, HV, Cohen, RM, Zametkin, AJ 1994Cerebral glucose metabolism in adults with attention deficit hyperactivity disorder after chronic stimulant treatmentAm J Psychiatry151658664PubMedGoogle Scholar
  41. Mattes, JA, Boswell, L, Oliver, H 1984Methylphe nidate effects on symptoms of attention deficit disorder in adultsArch Gen Psychiatry4110591063PubMedGoogle Scholar
  42. Mesulam, MM 1981A cortical network for directing attention and unilateral neglectAnn Neurol10309325PubMedCrossRefGoogle Scholar
  43. Millstein, R, Wilens, T, Spencer, T, Biederman, J 1998Presenting ADHD symptoms and subtypes in clinically referred adults with ADHDJ Attent Disord2159165Google Scholar
  44. Musten, LM, Firestone, P, Pisterman, S, Bennett, S, Mercer, J 1997Effects of metylphenidate on preschool children with ADHD: cognitive and behavioral functionsJ Am Acad Child Adolesc Psychiatry3614071415PubMedCrossRefGoogle Scholar
  45. Nuechterlein, KH 1983Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive childrenJ Abnorm Child Psychol92428Google Scholar
  46. Rapport, LJ, VanVoorhis, A, Tzelepis, A, Friedman, SR 2001Executive functioning in adult attention-deficit hyperactivity disorderClin Neuropsychol15479491PubMedGoogle Scholar
  47. Reid, MK, Borkowski, JG 1984Effects of methyl phenidate (Ritalin) on information processing in hyperactive childrenJ Abnorm Child Psychol12169185PubMedCrossRefGoogle Scholar
  48. Riccio, CA, Waldrop, JJ, Reynolds, CR, Lowe, P 2001Effects of stimulants on the continuous performance test (CPT): implications for CPT use and interpretationJ Neuropsychiatr Clin Neurosci13326335Google Scholar
  49. Riordan, HJ, Flashman, LA, Saykin, AJ, Frutiger, SA, Carroll, KE, Huey, L 1999Neuropsychological correlates of methylphenidate treatment in adult ADHD with and without depressionArch Clin Neuropsychol14217233PubMedCrossRefGoogle Scholar
  50. Rosvold, HE, Mirsky, AF, Sarason, J, Bransome, ED, Beck, LH 1956A continuous performance test of brain damageJ Consult Psychol20343350PubMedCrossRefGoogle Scholar
  51. Roy, BP, Scheele, L, Brinkley, J, Ward, N, Wiatrak, C, Russo, J, Townes, B, Varley, C 1997Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinicCompr Psychiatry38133140CrossRefGoogle Scholar
  52. Sandson, TA, Bachna, KJ, Morin, MD 2000Right hemisphere dysfunction in ADHD: visual hemispatial inattention and clinical subtypeJ Learn Disabil338390PubMedGoogle Scholar
  53. Schachar, R, Logan, G, Wachsmuth, R, Chajezyk, D 1988Attaining and maintaining preparation: a comparison of attention in hyperactive, normal and disturbed control groupJ Abnorm Child Psychol16361378PubMedCrossRefGoogle Scholar
  54. Schweitzer, JB, Faber, TL, Grafton, ST, Tube, LE, Hoffman, JM, Kilts, CD 2000Alterations in the functional anatomy of working memory in adult attention deficit hyperactivity disorderAm J Psychiatry157278280PubMedCrossRefGoogle Scholar
  55. Seidman, LJ, Biederman, J, Weber, W, Hatch, M, Faraone, SV 1998Neuropsychological functions in adults with attention-deficit hyperactivity disorderBiol Psychiatry44260268PubMedCrossRefGoogle Scholar
  56. Semrud-Clikeman, M, Nielsen, KH, Clinton, A, Sylvester, L, Parle, N, Connor, RT 1999An intervention approach for children with teacher- and parent-identified attentional difficultiesJ Learn Disabil32581590PubMedGoogle Scholar
  57. Silverstein, SM, Como, PG, Palumbo, DR, West, LL, Osborn, LM 1995Multiple sources of attentional dysfunction in adults with Tourette’s syndrome: comparison with attention deficit-hyperactivity disorderNeuropsychology9157164CrossRefGoogle Scholar
  58. Sohlberg, MM, Mateer, CA 2001

    Improving attention and managing attentional problems. Adapting rehabilitation techniques to adults with ADD

    Wasserstein, JWolf, LELefever, FF eds. Adult attention deficit disorderThe New York Academy of SciencesNew York359375
    Google Scholar
  59. Spencer, T, Wilens, T, Biederman, J, Faraone, SV, Ablon, JS, Lapey, K 1995A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorderArch Gen Psychiatry52434443PubMedGoogle Scholar
  60. Sykes, DH, Douglas, VI, Morgenstern, G 1972The effect of methylphenidate (Ritalin) on sustained attention in hyperactive childrenPsychopharmacologia25262274PubMedCrossRefGoogle Scholar
  61. Tannock, R, Schachar, RJ, Carr, RP, Chajczyk, D, Logan, GD 1989Effects of methylphenidate on inhibitory control in hyperactive childrenJ Abnorm Child Psychol17473491PubMedCrossRefGoogle Scholar
  62. Taylor, CJ, Miller, DC 1997Neuropsychological assessment of attention in ADHD adultsJ Attent Disord27788Google Scholar
  63. Trommer, BL, Hoeppner, JA, Zecker, SG 1991The go-no go test in attention deficit disorder is sensitive to methylphenidateJ Child Neurol6S128S131PubMedCrossRefGoogle Scholar
  64. Tucha, O, Lange, KW 2004Handwriting in attention deficit hyperactivity disorderMotor Control8461471PubMedGoogle Scholar
  65. Vaidya, CJ, Austin, G, Kirkorian, G, Ridlehuber, HW, Desmond, JE, Glover, GH, Gabrieli, JD 1998Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance studyProc Natl Acad Sci951449414499PubMedCrossRefGoogle Scholar
  66. Van der Meere, J, Gunning, B, Stemerdink, N 1999The effect of methylphenidate and clonidine on response inhibition and state regulation in children with ADHDJ Child Psychol Psychiatry40291298PubMedCrossRefGoogle Scholar
  67. Van der Meere, J, Sergeant, J 1988Controlled processing and vigilance in hyperactivity: time will tellJ Abnorm Child Psychol16641655PubMedCrossRefGoogle Scholar
  68. Van Zomeren, AH, Brouwer, WH 1994Clinical neuropsychology of attentionOxford University PressNew YorkGoogle Scholar
  69. Walker, AJ, Shores, EA, Trollor, JN, Lee, T, Sachdev, PS 2000Neuropsychological functioning of adults with attention deficit hyperactivity disorderJ Clin Exp Neuropsychol22115124PubMedCrossRefGoogle Scholar
  70. Wender, P 1997Attention deficit hyperactivity disorder in adults: a wide view of a widespread conditionPsychiatr Ann27556562Google Scholar
  71. Wender, PH, Reimherr, FW, Wood, D, Ward, M 1985A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adultsAm J Psychiatry142547552PubMedGoogle Scholar
  72. Weyandt, LL, Rice, JA, Linterman, I, Mitzlaff, L, Emert, E 1998Neuropsychological performance of a sample of adults with ADHD, developmental reading disorder, and controlsDev Neuropsychol14643656CrossRefGoogle Scholar
  73. Wilens, TE, Spencer, TJ, Biederman, J 2001

    Pharmacotherapy of adult ADHD

    Wasserstein, JWolf, LELefever, FF eds. Adult attention deficit disorderThe New York Academy of ScienceNew York592606
    Google Scholar
  74. Wood, DR, Reimherr, FW, Wender, PH, Johnson, GE 1976Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary reportArch Gen Psychiatry3314531460PubMedGoogle Scholar
  75. Woods, SP, Lovejoy, DW, Ball, JD 2002Neuropsychological characteristics of adults with ADHD: a comprehensive review of initial studiesClin Neuropsychol161234PubMedGoogle Scholar
  76. Zakzanis, KK 2001Statistics 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 researchersArch Clin Neuropsychol16653667PubMedCrossRefGoogle Scholar
  77. Zimmermann P, Fimm B (1993) A computerized neuropsychological assessment of attention deficits (Manual). PsyTest, Herzogenrath, GermanyGoogle Scholar
  78. Zimmermann, P, Fimm, B 2002

    A test battery for attentional performance

    Leclercq, MZimmermann, P eds. Applied neuropsychology of attention: theory, diagnosis and rehabilitationPsychology PressNew York110151
    Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • O. Tucha
    • 1
  • L. Mecklinger
    • 1
  • R. Laufkötter
    • 2
  • H. E. Klein
    • 2
  • S. Walitza
    • 3
  • K. W. Lange
    • 1
  1. 1.Department of Experimental PsychologyUniversity of RegensburgRegensburgGermany
  2. 2.Department of PsychiatryUniversity of RegensburgRegensburgGermany
  3. 3.Department of Child and Adolescent PsychiatryUniversity of WürzburgWürzburgGermany

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