Cox Daniel J, Merkel R Lawrence, Penberthy Jennifer Kim, Kovatchev Boris, Hankin Cheryl S
Department of Psychiatric Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
J Am Acad Child Adolesc Psychiatry. 2004 Mar;43(3):269-75. doi: 10.1097/00004583-200403000-00007.
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for driving accidents. One dose of methylphenidate (MPH) improves simulator driving performances of ADHD-diagnosed adolescents at 1.5 hours post-dose. However, little is known about the effects of different MPH delivery profiles on driving performance throughout the day.
This randomized, crossover, single-blind study compared osmotic, controlled-release oral system (OROS) MPH (Concerta) given q.d. to immediate-release MPH (Ritalin) given in equal doses t.i.d. on driving performance among six male ADHD-diagnosed adolescent drivers aged 16 to 19 years. Under each treatment condition, participants were maintained on their medication dosage for 7 days, then drove a sophisticated driving simulator at 2 p.m., 5 p.m., 8 p.m., and 11 p.m. The primary outcome measure was each participant's computer-quantified Impaired Driving Score (IDS).
IDS worsened in the evenings for participants receiving MPH t.i.d. but remained stable when they received once-daily OROS MPH. Participants performed significantly better when receiving OROS MPH q.d. compared with MPH t.i.d. (F = 9.3, df = 1, p =.004). When MPH was given t.i.d., IDS significantly worsened beginning at 8 p.m. compared to OROS MPH (p =.01).
Participants demonstrated significantly less variability and better driving performance when receiving OROS MPH q.d. compared to MPH t.i.d., particularly in the evenings.
患有注意力缺陷多动障碍（ADHD）的青少年发生驾驶事故的风险很高。一剂哌甲酯（MPH）可改善被诊断为ADHD的青少年在服药后1.5小时的模拟驾驶表现。然而，关于不同MPH给药方案对全天驾驶表现的影响知之甚少。
这项随机、交叉、单盲研究比较了每日一次给予渗透型控释口服系统（OROS）MPH（康奈达）与等量每日三次给予速释MPH（利他林）对6名年龄在16至19岁、被诊断为ADHD的男性青少年驾驶员驾驶表现的影响。在每种治疗条件下，参与者维持其药物剂量7天，然后在下午2点、5点、8点和晚上11点驾驶一台精密的驾驶模拟器。主要结局指标是每位参与者经计算机量化的驾驶受损评分（IDS）。
接受每日三次MPH的参与者在晚上IDS恶化，但接受每日一次OROS MPH时IDS保持稳定。与每日三次MPH相比，参与者接受每日一次OROS MPH时表现明显更好（F = 9.3，自由度 = 1，p = .004）。当每日三次给予MPH时，与OROS MPH相比，IDS从晚上8点开始显著恶化（p = .01）。
与每日三次MPH相比，参与者接受每日一次OROS MPH时表现出的变异性显著更小且驾驶表现更好，尤其是在晚上。
