Switching from immediate- to sustained-release psychostimulants in routine treatment of children with attention-deficit hyperactivity disorder

Abstract

Aims and method: To investigate the effectiveness of switching children with attention-deficit hyperactivity disorder (ADHD) from immediate- to sustained-release psychostimulants (Concerta XL, a novel methylphenidate hydrochloride) and to examine factors associated with treatment success or failure. This was a retrospective study of all such children known to four clinicians in Lincolnshire, over a 2-year period. The initial response to treatment and the response to slow-release psychostimulant as judged by the clinicians were recorded. Data were analysed using the Statistical Package for the Social Sciences version 12. Results: Of the children who were switched (n=97) and on whom clinical judgement was available (n=92), a statistically significant number (32%) responded poorly (P<0.001). In 26 out of the 97 patients, the switching was considered as a treatment failure and they were switched back to the original immediate-release stimulants. There was no significant-difference with possible confounding variables between children who responded well and those who responded poorly after switching to sustained-release drug. Clinical implications: In a real-life clinical situation there is a significant failure rate when a child with ADHD is switched from an immediate- to sustained-release psychostimulant. Further studies are needed.