First Trial Comparing Adderall to Ritalin For ADHD Shows It to Be Longer-Lasting, Equally As Effective

BUFFALO, N.Y. -- The first trial of comparable doses of Ritalin, the standard treatment for children with attention deficit/hyperactivity disorder (ADHD), and Adderall, another drug used to treat ADHD, has shown that Adderall lasts longer than Ritalin and is at least as effective.

In addition, staff supervising and observing the children during the trial, who were blinded to the treatment regimen, preferred Adderall three-to-one over Ritalin as a continuing treatment.

Results of the study, led by William R. Pelham, Ph.D., professor of psychology in the University at Buffalo College of Arts and Sciences and director of UB's Attention Deficit Disorder Program, appear in the April issue of Pediatrics.

Pelham concluded that, based on the trial findings, Adderall should be added to the repertoire of effective treatments for ADHD, especially for children in which Ritalin dissipates rapidly and who need a longer-acting medication.

The first studies of Adderall's action had suggested that its effect lasts longer than Ritalin's, raising the possibility of eliminating a mid-day dose of ADHD medication in school, a requirement that is intrusive, potentially stigmatizing and often results in poor compliance, Pelham said. Ritalin is absorbed quickly, and its effects begin to diminish after three hours. This study was designed to compare the ability of the two drugs to control ADHD symptoms over time.

The trial involved 25 children -- 21 boys and five girls -- who took part in an eight-week ADHD summer treatment program developed by Pelham and conducted at UB. The program is structured somewhat like a day-camp, with intensive behavioral treatment using a point system carried out in academic, social and recreational settings. The children spent nine hours a day in the program.

Each child received one of the following medications twice a day, every day, in random order: 10 mg of Ritalin, 17.5 mg of Ritalin, 7.5 mg of Adderall, 12.5 mg of Adderall, or placebo. All children in the study were already taking Ritalin.

Each child was rated throughout the day by counselors, teachers and additional trained observers on their success in meeting targeted behavioral goals, and each received a daily report card. These adult supervisors also indicated daily if they thought the child was medicated that day or receiving placebo, and if medicated, whether that medication should be part of the child's continued treatment, based on the child's behavior. Parents also rated the child's behavior at the end of each day.

Analysis of behavioral measures and medications at the end of the trial showed that:

o Both doses of Adderall and Ritalin produced substantial and significant improvements in the social behavior of ADHD children in recreational group settings and in achievement during most classroom activities.

o Adderall was at least as effective as Ritalin in improving behavior and academic performance of children with ADHD

o Adderall was generally more effective than Ritalin four-to-five hours after ingestion, a time when Ritalin is expected to have worn off.

o Staff recommended Adderall specifically as the medication of choice for 52 percent of the children, with 85 percent recommending the low dose, while Ritalin was the treatment of choice for 12 percent of the children. Sixteen percent did equally well on either medication.

o Both medications had minimal side effects at low doses.

The trial was funded by Shire Laboratories, makers of Adderall.