Research conducted in our clinic and investigations in other university centers clearly indicate that Attention-Deficit Hyperactivity Disorder (ADHD) is a common behavioral concomitant of Tourette syndrome (TS) in child patients. For many individuals, ADHD symptoms are a greater impediment to social and academic success than their tics, particularly during the elementary school years. Unfortunately, the most safe, effective, and widely used pharmacological treatment for ADHD, namely methylphenidate, is widely thought to exacerbate TS symptoms and therefore to be contraindicated in such patients. Because (a) the pharmacological alternatives to methylphenidate are often associated with increased risk of adverse reactions (e.g., neuroleptics) or are less efficacious for extended use (e.g., imipramine) and (b) there is very little research on methylphenidate in TS patients, we believe that a compelling need exists to examine the safety and efficacy of methylphenidate for ADHD and TS symptoms and to develop drug evaluation procedures for clinical application. Further, such research may provide insight into the neurophysiology of TS. For the proposed study, 20 boys between 6 and 12 years of age and diagnosed as having both ADHD and TS will be entered into an eight-week placebo controlled, double-blind crossover study of methylphenidate. Drug conditions will consist of placebo and .1, .3, and .5 mg/kg of methylphenidate administered twice daily, each for two weeks. Medication will be dispenced in dated envelopes, and patients will be randomly assigned to counterbalanced dosage sequences. Drug responsivity of both ADHD and TS symptoms will be assessed using direct observation procedures in the school and in the clinic playroom, laboratory performance tests, and clinician, teacher, and parent rating scales. A placebo controlled, double-blind event-related potential (ERP) study will be conducted immediately following the medication evaluation to examine drug related changes in brain function. Ongoing ERP studies in our laboratory will permit comparisons between the study sample and normal and ADHD children. The final phase of the proposed study is a six-month followup during which time ADHD and TS symptoms will be routinely assessed to determine changes over time.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH045358-05
Application #
2246526
Study Section
Child Psychopathology and Treatment Review Committee (CPT)
Project Start
1991-02-01
Project End
1999-08-31
Budget Start
1995-09-01
Budget End
1996-08-31
Support Year
5
Fiscal Year
1995
Total Cost
Indirect Cost
Name
State University New York Stony Brook
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804878247
City
Stony Brook
State
NY
Country
United States
Zip Code
11794
Gadow, Kenneth D; Guttmann-Steinmetz, Sarit; Rieffe, Carolien et al. (2012) Depression symptoms in boys with autism spectrum disorder and comparison samples. J Autism Dev Disord 42:1353-63
Volpe, Robert J; Briesch, Amy M; Gadow, Kenneth D (2011) The efficiency of behavior rating scales to assess inattentive-overactive and oppositional-defiant behaviors: applying generalizability theory to streamline assessment. J Sch Psychol 49:131-55
Gadow, Kenneth D; Nolan, Edith E (2011) Methylphenidate and comorbid anxiety disorder in children with both chronic multiple tic disorder and ADHD. J Atten Disord 15:246-56
Guttmann-Steinmetz, Sarit; Gadow, Kenneth D; DeVincent, Carla J et al. (2010) Anxiety symptoms in boys with autism spectrum disorder, attention-deficit hyperactivity disorder, or chronic multiple tic disorder and community controls. J Autism Dev Disord 40:1006-16
Gadow, Kenneth D; DeVincent, Carla J; Schneider, Jayne (2009) Comparative study of children with ADHD only, autism spectrum disorder + ADHD, and chronic multiple tic disorder + ADHD. J Atten Disord 12:474-85
Guttmann-Steinmetz, Sarit; Gadow, Kenneth D; Devincent, Carla J (2009) Oppositional defiant and conduct disorder behaviors in boys with autism spectrum disorder with and without attention-deficit hyperactivity disorder versus several comparison samples. J Autism Dev Disord 39:976-85
Schneider, Jayne; Gadow, Kenneth D; Crowell, Judith A et al. (2009) Anxiety in boys with attention-deficit/hyperactivity disorder with and without chronic multiple tic disorder. J Child Adolesc Psychopharmacol 19:737-48
Gadow, Kenneth D; Nolan, Edith E; Sverd, Jeffrey et al. (2008) Methylphenidate in children with oppositional defiant disorder and both comorbid chronic multiple tic disorder and ADHD. J Child Neurol 23:981-90
Gadow, Kenneth D; Sverd, Jeffrey; Nolan, Edith E et al. (2007) Immediate-release methylphenidate for ADHD in children with comorbid chronic multiple tic disorder. J Am Acad Child Adolesc Psychiatry 46:840-8
Gadow, Kenneth D; Sverd, Jeffrey (2006) Attention deficit hyperactivity disorder, chronic tic disorder, and methylphenidate. Adv Neurol 99:197-207

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