Cincinnati Children's Hospital, 3333 Burnet Ave, MLC 4002, Cincinnati, OH 45229.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Clin Psychiatry. 2018 Mar/Apr;79(2). doi: 10.4088/JCP.17m11553.
To examine whether sluggish cognitive tempo (SCT) symptomatology moderates dose response to methylphenidate and whether the impact of SCT on medication response is distinct from attention-deficit/hyperactivity disorder (ADHD) subtype effects.
Stimulant-naive children with ADHD predominantly inattentive type (ADHD-I; n = 126) or ADHD combined type (ADHD-C; n = 45) aged 7-11 years were recruited from the community from September 2006 to June 2013 to participate in a prospective, randomized, double-blind, 4-week crossover trial of long-acting methylphenidate. ADHD diagnosis and subtype were established according to DSM-IV criteria using a structured interview and teacher ADHD symptom ratings. SCT symptoms were assessed using a teacher-rated scale with 2 factors (Sluggish/Sleepy and Daydreamy). Primary outcomes included (1) categorization of children as methylphenidate responders, methylphenidate nonresponders, or placebo responders by 2 blinded physicians and (2) parent and teacher ratings of child behavior on the Vanderbilt ADHD Diagnostic Rating Scales while subjects were on treatment with placebo or 1 of 3 methylphenidate dosages (low, medium, high).
Increased SCT Sluggish/Sleepy factor scores were associated with being a methylphenidate nonresponder or placebo responder rather than a methylphenidate responder (P = .04). Sluggish/Sleepy factor scores were also linked to diminished methylphenidate dose response for parent- and teacher-rated inattention symptoms (Sluggish/Sleepy factor × dose P = .004). SCT Daydreamy symptoms and ADHD subtype (ADHD-I vs ADHD-C) were not associated with methylphenidate responder status and did not moderate methylphenidate dose response for inattention symptoms.
SCT Sluggish/Sleepy symptoms, but not SCT Daydreamy symptoms or ADHD subtype, predicted methylphenidate nonresponse. This novel finding, if replicated, may have important implications for assessing SCT as part of ADHD care.
ClinicalTrials.gov identifier: NCT01727414.
研究迟钝认知时相（SCT）症状是否会调节哌甲酯的剂量反应，以及 SCT 对药物反应的影响是否与注意缺陷多动障碍（ADHD）亚型效应不同。
从 2006 年 9 月至 2013 年 6 月，我们从社区招募了年龄在 7-11 岁的、未使用过兴奋剂的 ADHD 单纯注意力不集中型（ADHD-I；n = 126）或 ADHD 混合型（ADHD-C；n = 45）儿童，参与一项前瞻性、随机、双盲、4 周交叉试验，以评估长效哌甲酯的疗效。根据 DSM-IV 标准，使用结构访谈和教师 ADHD 症状评定对 ADHD 诊断和亚型进行评估。使用 2 个因子（Sluggish/Sleepy 和 Daydreamy）的教师评定量表评估 SCT 症状。主要结局包括：（1）2 位盲法医师将儿童分为哌甲酯反应者、哌甲酯无反应者或安慰剂反应者；（2）在使用安慰剂或 3 种哌甲酯剂量（低、中、高）治疗期间，父母和教师根据 Vanderbilt ADHD 诊断评定量表对儿童行为进行评定。
SCT Sluggish/Sleepy 因子评分增加与哌甲酯无反应者或安慰剂反应者而非哌甲酯反应者相关（P =.04）。Sluggish/Sleepy 因子评分也与父母和教师评定的注意力不集中症状的哌甲酯剂量反应减弱有关（Sluggish/Sleepy 因子×剂量，P =.004）。SCT Daydreamy 症状和 ADHD 亚型（ADHD-I 与 ADHD-C）与哌甲酯反应者状态无关，也不能调节注意力不集中症状的哌甲酯剂量反应。
SCT Sluggish/Sleepy 症状，但不是 SCT Daydreamy 症状或 ADHD 亚型，可预测哌甲酯无反应。如果这一发现得到证实，它可能对评估 SCT 作为 ADHD 护理的一部分具有重要意义。
ClinicalTrials.gov 标识符：NCT01727414。
