Skip to main content

Advertisement

SpringerLink
Log in

Stimulant Treatment Reduces Lapses in Attention among Children with ADHD: The Effects of Methylphenidate on Intra-Individual Response Time Distributions

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Recent research has suggested that intra-individual variability in reaction time (RT) distributions of children with ADHD is characterized by a particularly large rightward skew that may reflect lapses in attention. The purpose of the study was to provide the first randomized, placebo-controlled test of the effects of the stimulant methylphenidate (MPH) on this tail and other RT distribution characteristics. Participants were 49 9- to 12-year-old children with ADHD. Children participated in a 3-day double-blind, placebo-controlled medication assessment during which they received long-acting MPH (Concerta®), with the nearest equivalents of 0.3 and 0.6 mg/kg t.i.d. immediate-release MPH. Children completed a simple two-choice speeded discrimination task on and off of medication. Mode RT and deviation from the mode were used to examine the peak and skew, respectively, of RT distributions. MPH significantly reduced the peak and skew of RT distributions. Importantly, the two medication effects were uncorrelated suggesting that MPH works to improve both the speed and variability in responding. The improvement in variability with stimulant treatment is interpreted as a reduction in lapses in attention. This, in turn, may reflect stimulant enhancement of self-regulatory processes theorized to be at the core of ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. One child exhibited a marked discrepancy between the verbal and performance subscales, limiting the reliability of the brief assessment. Because the estimated IQ of 77 was very near our cutoff, the child was allowed to participate.

  2. Teacher reports were missing from 5 children. Analyses were re-run with these 5 children excluded and results remained the same.Teacher reports were missing from 5 children. Analyses were re-run with these 5 children excluded and results remained the same.

  3. One child met provisional criteria for having a math learning disability (math standard score 1.5 standard deviation below the mean for the child’s age; see Martinussen & Tannock, 2006).

  4. As a result of the relatively small number of girls (n = 10) and children with ADHD-Inattentive (n = 12) and ADHD-Hyperactive/Impulsive subtype (n = 2) we conducted only exploratory tests of sex and subtype differences. Girls were slower and more variable overall, and unpredicted interactions with medication dose suggested that the higher dose of MPH was necessary to achieve similar reductions in mode RT and deviation from the mode in girls compared to the low dose of MPH for boys. Exploratory analyses with subtype (ADHD-C vs. ADHD-I) revealed no reliable differences between subtypes for mode RT and deviation from the mode; of course, the present study was underpowered to detect such effects. It is important to note that 40% of girls (n = 4) but only 22% of males (n = 8) were of the inattentive subtype, further muddying the interpretation of the sex effects above. Future work with larger samples will be necessary to thoroughly evaluate sex and subtype differences.

References

  • Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 Profile. Burlington: University of Vermont Department of Psychiatry.

    Google Scholar 

  • Acheson, A., & de Wit, H. (2008). Bupropion improves attention but does not affect impulsive behavior in healthy young adults. Experimental and Clinical Psychopharmacology, 16, 113–123. doi:10.1037/1064-1297.16.2.113.

    Article  PubMed  Google Scholar 

  • American Academy of Pediatrics. (2001). Clinical practice guideline: Treatment of the school-aged child with Attention-Deficit/Hyperactivity Disorder. Pediatrics, 108, 1033–1044. doi:10.1542/peds.108.4.1033.

    Article  Google Scholar 

  • Aron, A. R., Dowson, J. H., Sahakian, B. J., & Robbins, T. W. (2003). Methylphenidate improves response inhibition in adults with Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry, 54, 1465–1468. doi:10.1016/S0006-3223(03)00609-7.

    Article  PubMed  Google Scholar 

  • Aase, H., & Sagvolden, T. (2006). Infrequent, but not frequent, reinforcers produce more variable responding and deficient sustained attention in young children with attention-deficit/hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 457–471. doi:10.1111/j.1469-7610.2005.01468.x.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2004). Attention-deficit/hyperactivity disorder and self-regulation. In R. F. Baumeister & K. D. Vohs (Eds.), Handbook of Self-Regulation: Research, theory, and applications, pp. 301–323. New York: Guilford.

    Google Scholar 

  • Bedard, A. C., Martinussen, R., Icokwicz, A., & Tannock, R. (2004). Methylphenidate improves visual-spatial memory in children with Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 260–268. doi:10.1097/00004583-200403000-00006.

    Article  PubMed  Google Scholar 

  • Bickel, D. R. (2002). Robust estimators of the mode and skewness of continuous data. Computational Statistics & Data Analysis, 39, 153–163. doi:10.1016/S0167-9473(01)00057-3.

    Article  Google Scholar 

  • Bickel, D. R. (2003). Robust and efficient estimation of the mode of continuous data: The mode as a viable measure of central tendency. Journal of Statistical Computation and Simulation, 73, 899–912. doi:10.1080/0094965031000097809.

    Article  Google Scholar 

  • Boonstra, A., Kooij, J. J., Oosterlaan, J., Sergeant, J., & Buitelaar, J. (2005). Does methylphenidate improve inhibition and other cognitive abilities in adults with childhood-onset ADHD? Journal of Clinical and Experimental Neuropsychology, 27, 278–298. doi:10.1080/13803390490515757.

    Article  PubMed  Google Scholar 

  • Brown, R. T., Borden, K. A., Wynne, M. E., Schlesser, R., & Clingerman, S. R. (1986). Methylphenidate and cognitive therapy with ADD children: A methodological reconsideration. Journal of Abnormal Child Psychology, 14, 481–497. doi:10.1007/BF01260518.

    Article  PubMed  Google Scholar 

  • Castellanos, F. X., & Tannock, R. (2002). Neuroscience of Attention- Deficit/Hyperactivity Disorder: The search for endophenotypes. Nature Reviews. Neuroscience, 3, 617–628.

    PubMed  Google Scholar 

  • Castellanos, F. X., Sonuga-Barke, E. J. S., Milham, M. P., & Tannock, R. (2006). Characterizing cognition in ADHD: Beyond executive dysfunction. Trends in Cognitive Sciences, 10, 117–123. doi:10.1016/j.tics.2006.01.011.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analyses for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.

    Google Scholar 

  • Conners, C. K. (1994). The Conners Continuous Performance Test. Toronto, Canada: Multi-Health Systems.

    Google Scholar 

  • Douglas, V. I. (1999). Cognitive control processes in Attention-Deficit/Hyperactivity Disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of Disruptive Behavior Disorders, pp. 105–137. New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Epstein, J. N., Conners, C. K., Hervey, A. S., Tonev, S. T., Arnold, L. E., Abikoff, H. B., et al. (2006). Assessing medication effects in the MTA study using neuropsychological outcomes. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 446–456. doi:10.1111/j.1469-7610.2005.01469.x.

    Article  PubMed  Google Scholar 

  • Evans, S., Pelham, W., Smith, B., Bukstein, O., Gnagy, E., Greiner, A., et al. (2001). Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Experimental and Clinical Psychopharmacology, 9, 163–175. doi:10.1037/1064-1297.9.2.163.

    Article  PubMed  Google Scholar 

  • Fabiano, G. A., Pelham, W. E., Waschbusch, D. A., Gnagy, E. M., Lahey, B. B., Chronis, A. M., et al. (2006). A practical measure of impairment: Psychometric properties of the impairment rating scale in samples of children with Attention Deficit Hyperactivity Disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385. doi:10.1207/s15374424jccp3503_3.

    Article  PubMed  Google Scholar 

  • Gorman, E., Klorman, F., Thatcher, J., & Borgstedt, A. (2006). Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 808–816. doi:10.1097/01.chi.0000214191.57993.dd.

    Article  PubMed  Google Scholar 

  • Greenhill, S., Pliszka, S., Dulcan, M., Bernet, W., Arnold, V., Beitchman, J., et al. (2002). Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 26S–49S. doi:10.1097/00004583-200210000-00003.

    Article  PubMed  Google Scholar 

  • Guevremont, D., & Barkley, R. (1992). Attention deficit-hyperactivity disorder in children. In S. R. Hooper, G. W. Hynd & R. F. Mattison (Eds.), Child Psychopathology: Diagnostic Criteria and Clinical Assessment(pp. 137-178). New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Hausknecht, K. A., Acheson, A., Farrar, A. M., Kieres, A. K., Shen, R., Richards, J. B., et al. (2005). Prenatal alcohol exposure causes attention deficits in male rats. Behavioral Neuroscience, 119, 302–310. doi:10.1037/0735-7044.119.1.302.

    Article  PubMed  Google Scholar 

  • Hedges, S.B., & Shah, P. (2003). Comparison of mode estimation methods and application in molecular clock analysis. BMC Bioinformatics, 4(31).

  • Hervey, A. S., Epstein, J. N., Curry, J. F., Tonev, S., Arnold, L. E., Conners, C. K., et al. (2006). Reaction time distribution analysis of neuropsychological performance in an ADHD sample. Child Neuropsychology, 12, 125–140. doi:10.1080/09297040500499081.

    Article  PubMed  Google Scholar 

  • Kofler, M. J., Rapport, M. D., & Alderson, R. M. (2008). Quantifying ADHD classroom inattentiveness, its moderators, and variability: A meta-analytic review. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49, 59–69.

    Article  PubMed  Google Scholar 

  • Leth-Steensen, C., Elbaz, Z. K., & Douglas, V. I. (2000). Mean response times, variability, and skew in the responding of ADHD children: A response time distributional approach. Acta Psychologica, 104, 1167–1190. doi:10.1016/S0001-6918(00)00019-6.

    Article  Google Scholar 

  • Losier, B. J., McGrath, P. J., & Klein, R. M. (1996). Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: A meta-analytic review. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 37, 971–987. doi:10.1111/j.1469-7610.1996.tb01494.x.

    Article  PubMed  Google Scholar 

  • Luman, M., Oosterlaan, J., & Sergeant, J. A. (2005). The impact of reinforcement contingencies on ADHD: A review and theoretical appraisal. Clinical Psychology Review, 25, 183–213. doi:10.1016/j.cpr.2004.11.001.

    Article  PubMed  Google Scholar 

  • MacDonald, S., Nyberg, L., & Backman, L. (2006). Intra-individual variability in behavior: Links to brain structure, neurotransmission and neuronal activity. Trends in Neurosciences, 29, 474–480. doi:10.1016/j.tins.2006.06.011.

    Article  PubMed  Google Scholar 

  • Martinussen, R., & Tannock, R. (2006). Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal of Clinical and Experimental Neuropsychology, 28, 1073–1094. doi:10.1080/13803390500205700.

    Article  PubMed  Google Scholar 

  • Nigg, J. T. (2006). What Causes ADHD? Understanding what goes wrong and why. New York: Guilford Press.

    Google Scholar 

  • Nigg, J. T., & Casey, B. J. (2005). An integrative theory of attention-deficit/hyperactivity disorder based on the cognitive and affective neurosciences. Development and Psychopathology, 17, 785–806.

    PubMed  Google Scholar 

  • Pelham, W. E. (1993). Pharmacotherapy for children with ADHD. School Psychology Review, 22, 199–227.

    Google Scholar 

  • Pelham, W.E., & Fabiano, G.A. (2008). Evidence-based psychosocial treatment for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37, 184–214.

    Google Scholar 

  • Pelham, W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of Attention-Deficit Hyperactivity Disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 449–476. doi:10.1207/s15374424jccp3403_5.

    Article  PubMed  Google Scholar 

  • Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218. doi:10.1097/00004583-199203000-00006.

    Article  PubMed  Google Scholar 

  • Pelham, W. E., & Waschbusch, D. A. (1999). Behavior intervention in attention deficit/hyperactivity disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders, pp. 255–278. New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 27, 190–205. doi:10.1207/s15374424jccp2702_6.

    Article  Google Scholar 

  • Pietzak, R., Mollica, C., Maruff, P., & Snyder, P. (2006). Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder. Neuroscience and Biobehavioral Reviews, 30, 1225–1245. doi:10.1016/j.neubiorev.2006.10.002.

    Article  Google Scholar 

  • Pliszka, S. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894–921. doi:10.1097/chi.0b013e318054e724.

    Article  PubMed  Google Scholar 

  • Riccio, C. A., Waldrop, J., Reynolds, C., & Lowe, P. (2001). Effects of stimulants on the continuous performance test (CPT): Implications for CPT use and interpretation. The Journal of Neuropsychiatry and Clinical Neurosciences, 13, 326–335. doi:10.1176/appi.neuropsych.13.3.326.

    PubMed  Google Scholar 

  • Rosvold, H. E., Mirsky, A. F., Sarason, I., Bransome, E. D., & Beck, L. H. (1956). A continuous performance test of brain damage. Journal of Consulting Psychology, 20, 343–250. doi:10.1037/h0043220.

    Article  PubMed  Google Scholar 

  • Russell, V. A., Oades, R. D., Tannock, R., Killeen, P. R., Auerbach, J. G., Johansen, E. B., et al. (2006). Response variability in Attention-Deficit/Hyperactivity Disorder: A neuronal and glial energetic hypothesis. Behavioral and Brain Functions, 2, 30. doi:10.1186/1744-9081-2-30.

    Article  PubMed  Google Scholar 

  • Sabol, K. E., Richards, J. B., Broom, S. L., Roach, J. T., & Hausknecht, K. (2003). Effects of stimulus salience and methamphetamine on choice reaction time in the rat: Central tendency versus distribution skew. Behavioural Pharmacology, 14, 489–500. doi:10.1097/00008877-200311000-00001.

    Article  PubMed  Google Scholar 

  • Schachar, R., Tannock, R., Cunningham, C., & Corkum, P. (1997). Behavioural, situational and temporal effects of treatment of ADHD children with methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 754–763. doi:10.1097/00004583-199706000-00011.

    Article  PubMed  Google Scholar 

  • Scheres, A., Oosterlaan, J., & Sergeant, J. A. (2001). Response execution and inhibition in children with ADHD and other disruptive disorders: The role of behavioral activation. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 347–357. doi:10.1111/1469-7610.00728.

    Article  PubMed  Google Scholar 

  • Sergeant, J. A. (2005). Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biological Psychiatry, 57(11), 1248–1255. doi:10.1016/j.biopsych.2004.09.010.

    Article  PubMed  Google Scholar 

  • Sergeant, J. A., Oosterlaan, J., & Van der Meere, J. (1999). Information processing and energetic factors in attention-deficit/hyperactivity disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of Disruptive Behavior Disorders, pp. 75–104. New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38. doi:10.1097/00004583-200001000-00014.

    Article  PubMed  Google Scholar 

  • Shea, T., & Fisher, B. E. (1996). Self ratings of mood levels and mood variability as predictors of Junior I-6 impulsivity and ADHD classroom behaviors. Personality and Individual Differences, 20, 209–214.

    Article  Google Scholar 

  • Shiels, K., Hawk, L. W,. Jr, Lysczek, C., Pelham, W. E,. Jr, Spencer, S. V., Gangloff, B., et al. (2008). The effects of incentives on working memory in children with Attention-Deficit Hyperactivity Disorder. Journal of Abnormal Child Psychology, 36, 903–913. doi:10.1007/s10802-008-9221-0.

    Article  PubMed  Google Scholar 

  • Smith, B. H., Barkley, R. A., & Shapiro, C. J. (2006). Attention-Deficit/Hyperactivity Disorder. In E. J. Mash & R. A. Barkley (Eds.), Treatment of Childhood Disorders (3  rd ed, pp. 65–120. New York: Guilford Press.

    Google Scholar 

  • Sonuga-Barke, E. J. (2005). Casual models of attention-deficit/hyperactivity disorder: From common simple deficits to multiple developmental pathways. Biological Psychiatry, 57, 1231–1238. doi:10.1016/j.biopsych.2004.09.008.

    Article  PubMed  Google Scholar 

  • Tannock, R. (1998). Attention deficit hyperactivity disorder: advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 39, 65–99. doi:10.1017/S0021963097001777.

    Article  PubMed  Google Scholar 

  • Tannock, R., Carr, R., Chajczyk, D., & Logan, G. (1989). Effects of methylphenidate on inhibitory control in hyperactive children. Journal of Abnormal Child Psychology, 17, 473–491. doi:10.1007/BF00916508.

    Article  PubMed  Google Scholar 

  • Tannock, R., Schachar, R., & Logan, G. (1995). Methylphenidate and cognitive flexibility: Dissociated dose effects in hyperactive children. Journal of Abnormal Child Psychology, 23, 235–266. doi:10.1007/BF01447091.

    Article  PubMed  Google Scholar 

  • Van der Molen, M. W. (1996). Energetics and the reaction process: Running threads Through experimental psychology. In O. Neumann & A. F. Sanders (Eds.), Handbook of Perception & Action, Vol. 3, pp. 229–275. London: Academic Press.

    Google Scholar 

  • Verbruggen, F., & Logan, G. (2008). Response inhibition in the stop-signal paradigm. Trends in Cognitive Sciences, 12, 418–424. doi:10.1016/j.tics.2008.07.005.

    Article  PubMed  Google Scholar 

  • Wagenmakers, E., & Brown, S. (2007). On the linear relation between the mean and the standard deviation of a response time distribution. Psychological Review, 114, 830–841. doi:10.1037/0033-295X.114.3.830.

    Article  PubMed  Google Scholar 

  • Wechsler, D., Kaplan, E., Fein, D., Kramer, J., Morris, R., Delis, D., et al. (2004). Wechsler Intelligence Scale for Children-Fourth Edition-Integrated, technical and interpretive manual. San Antonio, TX: Harcourt Assessment, Inc.

    Google Scholar 

  • Williams, B. R., Strauss, E. H., Hultsch, D. F., Hunter, M. A., & Tannock, R. (2007). Reaction time performance in adolescents with attention deficit/hyperactivity disorder: Evidence of inconsistency in the fast and slow portions of the RT distribution. Journal of Clinical and Experimental Neuropsychology, 29, 277–289. doi:10.1080/13803390600678020.

    Article  PubMed  Google Scholar 

  • Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346. doi:10.1016/j.biopsych.2005.02.006.

    Article  PubMed  Google Scholar 

  • Woodcock, R. W., McGrew, K. S., & Mather, N. (2001)). Woodcock-Johnson III Tests of Achievement. Itasca, IL: Riverside Publishing.

    Google Scholar 

Download references

Acknowledgements

We thank Mark Kutgowski for programming assistance, Rosemary Tannock for comments on the design of the study, and all of the families that participated in the Summer Research Camp. This research was supported by grant MH069434 from the National Institute of Mental Health.

Author information

Authors and Affiliations

  1. Department of Psychology, University at Buffalo, SUNY, Park Hall, Box 604110, Buffalo, NY, 14260-4110, USA

    Sarah V. Spencer, Larry W. Hawk Jr., Keri Shiels & William E. Pelham Jr.

  2. Research Institute on Addictions, University at Buffalo, SUNY, Buffalo, NY, USA

    Jerry B. Richards

  3. Department of Pediatrics, University at Buffalo, SUNY, Buffalo, NY, USA

    William E. Pelham Jr.

  4. Department of Psychiatry, University at Buffalo, SUNY, Buffalo, NY, USA

    William E. Pelham Jr. & James G. Waxmonsky

Authors
  1. Sarah V. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry W. Hawk Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerry B. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keri Shiels
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William E. Pelham Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James G. Waxmonsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Larry W. Hawk Jr..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spencer, S.V., Hawk, L.W., Richards, J.B. et al. Stimulant Treatment Reduces Lapses in Attention among Children with ADHD: The Effects of Methylphenidate on Intra-Individual Response Time Distributions. J Abnorm Child Psychol 37, 805–816 (2009). https://doi.org/10.1007/s10802-009-9316-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-009-9316-2

Keywords

Search

Navigation