Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment

Pietro De Rossi; Italo Pretelli; Deny Menghini; Barbara D'Aiello; Silvia Di Vara; Stefano Vicari

doi:10.1007/s00406-022-01386-9

Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment

Eur Arch Psychiatry Clin Neurosci. 2022 Dec;272(8):1437-1442. doi: 10.1007/s00406-022-01386-9. Epub 2022 Feb 24.

Authors

Pietro De Rossi¹, Italo Pretelli¹, Deny Menghini¹, Barbara D'Aiello^{1

2}, Silvia Di Vara¹, Stefano Vicari^{3

4

5}

Affiliations

¹ Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy.
² Department of Human Science, LUMSA University, Rome, Italy.
³ Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy. stefano.vicari@opbg.net.
⁴ Department of Life Sciences and Public Health, Catholic University, Rome, Italy. stefano.vicari@opbg.net.
⁵ Centro di Riabilitazione, Casa San Giuseppe, Opera Don Guanella, Rome, Italy. stefano.vicari@opbg.net.

PMID: 35211779
DOI: 10.1007/s00406-022-01386-9

Abstract

Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed in the scholar age. It is associated with significant impairment in global functioning, and in moderate/severe presentations the outcome is critically dependent on pharmacological optimization of the multi-modal treatment. Methylphenidate (MPH) is the first-choice pharmacological treatment in children and adolescents with ADHD, with substantial evidence of significant efficacy and effectiveness on global functioning and symptoms' severity. There is some evidence supporting a few clinical and socio-demographic variables as predictors of pharmacological treatment prescription in children with ADHD independently of ADHD symptoms severity. However, it is warranted to investigate clinical and general psychopathological characteristics potentially associated with negative outcomes and the need for pharmacological treatment to inform appropriate prescription strategies. In this context, we compared 268 children and adolescents who were prescribed MPH (ADHD/MPH) for the first time after their first diagnostic assessment at our center, and 444 children and adolescents with ADHD (ADHD/noMPH) who were recommended non-pharmacological evidence-based interventions alone. ADHD/MPH group had higher severity of non-ADHD psychopathological symptoms compared to the ADHD/noMPH group, as documented by higher scores on the Child Behavior Checklist (CBCL) subscales, higher severity of ADHD symptoms, lower average IQ and lower adaptive levels independently of IQ. More specifically, beside externalizing symptoms, also internalizing symptoms were significantly higher in the ADHD/MPH group. The presence of significant non-ADHD psychopathology should be considered as a clinical factor associated with the need for MPH prescription in children and adolescents with ADHD.

Keywords: ADHD; Early intervention; Methylphenidate; Psychopathology; Treatment predictors.

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / drug therapy
Central Nervous System Stimulants* / therapeutic use
Child
Humans
Methylphenidate* / therapeutic use
Prescriptions
Treatment Outcome

Substances

Methylphenidate
Central Nervous System Stimulants