Predicting methylphenidate response in children with ADHD: theoretical, empirical, and conceptual models.

OBJECTIVE

To evaluate the theoretical merit and empirical validity of models designed to predict response to methylphenidate (MPH) among children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Seventy-six children with ADHD received each of 4 counterbalanced doses of MPH (5, 10, 15, and 20 mg) in the context of a double-blind, placebo-controlled, within-subject (crossover) experimental design. Logical and conceptual foundations of 3 models of MPH response were subjected to critical scrutiny, and patterns of relationship anticipated on the basis of these models were subjected to empirical analysis.

RESULTS

The conceptual foundations of all reviewed models were found to be substantially flawed, and none provided an adequate empirical basis for predicting response to MPH among children with ADHD.

CONCLUSIONS

The observed pattern of relationships suggests that magnitudes of response to MPH in domains of classroom attention and behavioral disinhibition are correlated and differentially predictive of response on measures of academic performance and teacher-rated behavior.