Agay Nirit, Yechiam Eldad, Carmel Ziv, Levkovitz Yechiel
From the *Max Wertheimer Minerva Center for Cognitive Studies, Technion-Israel Institute of Technology, Haifa; and †Shalvata Mental Health Center, Hod-Hasharon, Israel; Tel-Aviv University, Ramat-Aviv, Israel.
J Clin Psychopharmacol. 2014 Apr;34(2):261-5. doi: 10.1097/JCP.0000000000000076.
We compare the view that the effect of methylphenidate (MPH) is selective to individuals with attention-deficit/hyperactivity disorder (ADHD) with an alternative approach suggesting that its effect is more prominent for individuals with weak baseline capacities in relevant cognitive tasks. To evaluate theses 2 approaches, we administered sustained attention, working memory, and decision-making tasks to 20 ADHD adults and 19 control subjects, using a within-subject placebo-controlled design. The results demonstrated no main effects of MPH in the decision-making tasks. In the sustained attention and working-memory tasks, MPH enhanced performance of both ADHD and non-ADHD adults to a similar extent compared with placebo. Hence, the effect of MPH was not selective to ADHD adults. In addition, those benefitting most from MPH in all 3 task domains tended to be individuals with poor task performance. However, in most tasks, individuals whose performance was impaired by MPH were not necessarily better (or worse) performers. The findings suggest that the administration of MPH to adults with ADHD should consider not only clinical diagnosis but also their functional (performance-based) profile.
我们将哌甲酯（MPH）的作用对注意力缺陷多动障碍（ADHD）个体具有选择性这一观点，与另一种观点进行了比较，后者认为其作用对于在相关认知任务中基线能力较弱的个体更为显著。为了评估这两种方法，我们采用受试者内安慰剂对照设计，对20名ADHD成年人和19名对照受试者进行了持续注意力、工作记忆和决策任务测试。结果表明，MPH在决策任务中没有主要效应。在持续注意力和工作记忆任务中，与安慰剂相比，MPH在相似程度上提高了ADHD和非ADHD成年人的表现。因此，MPH的作用对ADHD成年人没有选择性。此外，在所有三个任务领域中从MPH中获益最多的往往是任务表现较差的个体。然而，在大多数任务中，因MPH而表现受损的个体不一定是表现更好（或更差）的人。研究结果表明，给患有ADHD的成年人使用MPH时，不仅应考虑临床诊断，还应考虑他们的功能（基于表现）特征。
