New Study In Pediatrics Shows Single Dose Of ADHD Medication Lasts Entire School Day

BUFFALO, N.Y. -- A new University at Buffalo study published in the December issue of Pediatrics comparing the effectiveness over time of Adderall and Ritalin -- two drugs for attention-deficit/hyperactivity disorder (ADHD) -- shows that a single dose of Adderall is effective for a full school day.

The results indicate that one dose of Adderall given at 7:30 a.m. eliminates the need to give medicine during school hours. Twice-daily doses of Ritalin at 7:30 a.m. and 11:30 a.m. have comprised the standard treatment for children with ADHD because Ritalin is absorbed quickly and its effects begin to diminish after three hours.

"This is a unique outcome for ADHD medication," said William Pelham, Ph.D., professor of psychology in the UB College of Arts and Sciences, a specialist in ADHD and lead author on the study. "Fourteen of the 16 kids in the trial who responded to medication could get by on once-a-day doses of Adderall and skip the school-day dose.

"This is very good news," he said, "because problems with compliance and the embarrassment of having to take a dose in school are really pretty bad." Five of the 21 children in the study didn't respond significantly to either medication.

The trial compared various dosing regimens of Adderall, Ritalin and placebo during an eight-week summer treatment program at UB developed by Pelham, head of the university's Attention Deficit Disorder Program. The summer program is structured somewhat like a day-camp, with intensive behavioral treatment carried out in academic, social and recreational settings throughout a nine-hour day.

Most of the children in the current trial already were receiving medication for ADHD. Parents of children in the program also received training in behavioral-modification techniques.

The goals of the trial were two-fold: to compare standard, twice-daily methylpenidate (MPH, the generic name for Ritalin) with a single morning dose of MPH and of Adderall, an amphetamine compound, and to assess the value of a late-afternoon dose of Adderall and Ritalin on evening functioning, the potential side effects of late-afternoon dosing and optimum dose size.

The treatment variations were a) placebo, b) morning-only Adderall, c) morning/late afternoon Adderall, d) morning-only Ritalin, e) morning/noon Ritalin and f) morning/noon/late afternoon Ritalin. The children received one of these treatments each day in random order, with daily crossovers.

Results of the trial -- based on ratings from counselors, teachers, and parents -- found no difference between twice-a-day Ritalin and once-a-day Adderall on any measures assessed during a typical 8 a.m. to 3:30 p.m. day.

"Results showed that a single dose of .3 mg/kg of Adderall given at 7:30 a.m. and .3 mg/kg of MPH given at 7:30 a.m. and 11:30 a.m. had very similar time courses and seemed to be effective until 3:45 p.m. and perhaps longer," Pelham stated. Both were effective in improving children's behavior and performance in the context of the summer treatment program, which spanned a typical school day, he said.

Based on these findings, Pelham recommended that 14 of 16 children who responded to medication be maintained on a single morning dose of Adderall, if eliminating the mid-day dose was a goal.

On the question of whether to give a late-afternoon dose of medication and if so, how much, trial results showed that high doses of both medications in the afternoon increased appetite loss and sleeplessness -- recognized side effects of these stimulant drugs -- although low doses of Adderall did improve evening behavior. Pelham said all parents reported their children generally were doing well in the evening, however, possibly because parents had received behavioral training and the combination of home-based interventions and the long-acting medication produced positive behavior.

In light of these findings and the long-lasting effects of single doses of Adderall, and in a few cases MPH, Pelham said he did not recommend late-afternoon medication for most of the children in the trial. He speculated that the reason single doses of Adderall lasted so much longer into the evening in this study than reported in other studies also may be related to the influence of the program's behavioral interventions, this time on the children.

"For example, a child who experiences rewards for behaving appropriately early in the day may continue on a positive trajectory for the remainder of the day," Pelham noted.

The study was supported by a grant from Shire Richwood, Inc., manufacturer of Adderall. Pelham's research is supported by grants from the National Institute on Alcohol Abuse and Alcoholism, and the National Institute of Mental Health.