Barkley R A, DuPaul G J, McMurray M B
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655.
Pediatrics. 1991 Apr;87(4):519-31.
The response of 23 children with attention deficit disorder (ADD) with hyperactivity (+H) and 17 children with ADD without hyperactivity (-H) to three doses of methylphenidate (5, 10, and 15 mg twice a day) was evaluated in a triple-blind, placebo-controlled cross-over design using parent and teacher ratings of behavior, laboratory tests of ADD symptoms, and behavioral observations during academic performance. Results indicated that the children with ADD+H were rated as having more pervasive behavioral problems at home and more pervasive and severe conduct problems at school than the children with ADD-H. Laboratory tests found the children with ADD+H to be impaired in behavioral inhibition and vigilance whereas children with ADD-H were more impaired in the consistent retrieval of verbally learned material Drug effects were noted on the parent and teacher ratings and on most laboratory measures, with all three doses typically producing significant changes but rarely differing among themselves in effectiveness. The groups were not found to differ significantly on any measures in their response to methylphenidate. However, more children with ADD-H were clinically judged as having either no clinical response (24%) or responding best to the low dose (35%) of medication. In contrast, most ADD+H (95%) children were judged to be positive responders and most were recommended to receive the moderate to high dose (71%).
采用家长和教师行为评分、注意力缺陷症状实验室测试以及学业表现行为观察，在三盲、安慰剂对照交叉设计中，评估了23名患有多动性注意力缺陷障碍（ADD+H）的儿童和17名无多动性注意力缺陷障碍（ADD-H）的儿童对三剂哌甲酯（每天两次，剂量分别为5、10和15毫克）的反应。结果表明，与ADD-H儿童相比，ADD+H儿童在家中被评为存在更多普遍行为问题，在学校存在更普遍、更严重的品行问题。实验室测试发现，ADD+H儿童在行为抑制和警觉方面受损，而ADD-H儿童在言语学习材料的连贯检索方面受损更严重。在家长和教师评分以及大多数实验室指标上都注意到了药物效果，所有三种剂量通常都会产生显著变化，但在有效性方面彼此之间很少有差异。未发现两组在对哌甲酯的反应的任何指标上有显著差异。然而，更多ADD-H儿童在临床上被判定为要么无临床反应（24%），要么对低剂量药物反应最佳（35%）。相比之下，大多数ADD+H儿童（95%）被判定为阳性反应者，大多数被建议接受中高剂量（71%）。
