The pattern of individual responses to methylphenidate (10 mg) and factors that predict drug response in 46 children, 6-13 years old, with attention-deficit hyperactivity disorder (ADHD) were examined at the Department of Child and Adolescent Psychiatry, and the Rudolf Magnus Institute for Neurosciences, University of Utrecht, The Netherlands. Methylphenidate (MPH) normalized school behavior in one half the subjects, and behavior at home in one third. Behavior both at school and at home was normalized in 17%. Prediction of response to MPH was only successful when stringent, ie cross-situational, response definitions were used. Predictors were a high IQ, much inattentiveness, young age, low severity of disorder, and low rates of anxiety. Positive behavioral changes, measured by the Abbreviated Conners Rating Scales, after a single dose of MPH were predictive of cross-situational improvement after 4 weeks of MPH treatment. [1]

COMMENT. The clinical judgment of severity of ADHD and improvement observed after a single dose of methylphenidate are useful predictors of a beneficial long-term response.

The importance of a multimodal treatment approach to ADHD is emphasized by The National Institute of Mental Health’s recently initiated 5-year, multisite study. Questions to be answered include the influence of comorbid conditions, gender, family history, home environment, age, nutritional status; and effects of various treatments (stimulants, behavior therapy, parent training, school-based intervention) on different functions (cognitive, academic, behavioral), for how long (short versus long term), to what extent, and why? [2]