Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Human Science, LUMSA University, Rome, Italy.
PLoS One. 2024 Aug 12;19(8):e0299449. doi: 10.1371/journal.pone.0299449. eCollection 2024.
The co-occurrence Oppositional Defiant Disorder (ODD) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has been associated to difficulties in regulating adverse states, elevated functional impairment, deficits in Executive Functions and high risk for psychopathology. Recent studies have shown that ODD is a negative predictor of a positive response to methylphenidate (MPH) treatment for ADHD symptoms in children and adolescents and that patients with a diagnosis of comorbid ADHD and ODD are less likely to respond favorably to pharmacological treatment with MPH. We conducted a naturalistic study to understand the clinical characteristics of drug-naïve children and adolescents with ADHD that influence the response to MPH by measuring the effect on attention. Specifically, we investigated whether a single dose of MPH differently affects the performance of 53 children and adolescents with ADHD with or without ODD comorbidity. In addition, participant characteristics such as symptom severity, functional impairment, and associated behavioral and emotional symptoms at baseline were examined to better understand what aspects affect the response to MPH. We found that a single dose of MPH improved the attention of children and adolescents with ADHD without ODD more than those with comorbid ADHD and ODD, resulting in reduced reaction times. Our findings indicated that children and adolescents with comorbid ADHD and ODD and those with ADHD alone did not exhibit differences in measures of attention prior to taking MPH, nor in demographic variables (age, intelligence quotient, gender), clinical characteristics related to symptom severity, and adaptive behaviors. However, we observed differences between the two groups in certain behavioral aspects, including the Dysregulation Profile and disruptive behaviors. Assessing symptoms in combination with the presence of ADHD can be beneficial in determining which individuals would derive the greatest benefits from treatment.
共病对立违抗性障碍（ODD）与注意缺陷多动障碍（ADHD）患儿和青少年调节不良状态困难、功能损害加重、执行功能缺陷以及精神病理学风险较高有关。最近的研究表明，ODD 是儿童和青少年 ADHD 症状对哌醋甲酯（MPH）治疗反应良好的负面预测指标，并且诊断为共病 ADHD 和 ODD 的患者对 MPH 的药物治疗反应不太可能有利。我们进行了一项自然主义研究，通过测量对注意力的影响来了解影响 MPH 反应的药物-naive ADHD 患儿和青少年的临床特征。具体来说，我们调查了单剂量 MPH 是否会以不同的方式影响 53 名 ADHD 患儿和青少年的表现，无论他们是否有 ODD 共病。此外，还检查了参与者在基线时的症状严重程度、功能损害以及相关的行为和情绪症状等特征，以更好地了解哪些方面会影响对 MPH 的反应。我们发现，单剂量 MPH 改善了无 ODD 共病 ADHD 患儿和青少年的注意力，而对有共病 ADHD 和 ODD 的患儿和青少年的注意力改善较少，从而降低了反应时间。我们的研究结果表明，共病 ADHD 和 ODD 的患儿和青少年与单独患有 ADHD 的患儿和青少年在服用 MPH 之前的注意力测量值以及人口统计学变量（年龄、智商、性别）、与症状严重程度相关的临床特征和适应性行为方面没有差异。然而，我们观察到两组在某些行为方面存在差异，包括失调行为特征和破坏性行为。综合评估症状和 ADHD 的存在可以有助于确定哪些个体将从治疗中获得最大益处。
