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(October 17, 2003) -- Older children treated with methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD) may be adversely affected by drug holidays, according to research presented at the 50th Anniversary Meeting of the American Academy of Child and Adolescent Psychology.
"One of the most interesting findings in this study is that the kids who took drug holidays seemed to do less well in terms of their functioning at home as rated by parents than the kids who did not take the drug holidays, " said Stephen V. Faraone, PhD, lead researcher, Massachusetts General Hospital, Boston, Massachusetts. "To the contrary we found no decrease in efficacy according to teacher ratings and that's consistent with the fact that the drug holidays tend to be taken at home."
For this study, investigators enrolled children between the ages of 6 and 13 years who were diagnosed with ADHD. The children were being treated with Ritalin (methylphenidate) as part of a multicenter, open-label, 12-month study.
Drug holidays were assessed according to self-reported proportion of days that medication was not taken. Predictors of non-compliance with treatment were baseline demographic and clinical variable such as tic history, dose, ADHD subtype and Swanson, Nolan and Pelham Revision IV (SNAP-IV) questionnaire and IOWA Conners rating scale, parent/teacher efficacy ratings, and parent satisfaction.
Researchers found that drug holidays were substantial and were predicted by baseline characteristics such as older age (P=0.02), inattentive subtype ADHD (P=0.0024), and fewer hyperactivity/impulsivity and oppositional defiant disorder symptoms (P<0.05). Lower methylphenidate dose and minority ethnic status also were predictive characteristics (P=0.03 and P=0.004, respectively).
The researchers also noted that drug holidays during follow-up were associated with poorer efficacy at home (P=0.0016) but not at school (P=0.58).
In light of the findings, they recommended caution when considering drug holidays for older ADHD children taking Ritalin.
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