Tolerance to Psychostimulant Medication Among Children with ADHD: A School-Year Study

Authors

Marcela Ramos, Florida International UniversityFollow

Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Psychology

First Advisor's Name

William E. Pelham, Jr.

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Gregory Fabiano

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Joseph Raiker

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Melissa Baralt

Fourth Advisor's Committee Title

Committee member

Keywords

AHDH, psychostimulant, tolerance

Date of Defense

6-26-2023

Abstract

The current investigation represents the first study designed to evaluate tolerance to stimulant medication among children with Attention-Deficit Hyperactivity Disorder (ADHD) in a school setting. Participants included two-hundred and thirty-seven elementary-aged children (aged 5-12; M_age = 8.1 SD= 1.8). Participants were randomly assigned to receive extended-release methylphenidate (OROS-MPH) either 5-days per week or 7-days per week for the duration of a school year. Monthly teacher ratings of child functioning were used to assess children’s treatment response to pharmacological treatment, and insufficient responders received increased dose adjustments as necessary. The study aimed to investigate (1) whether tolerance developed over the course of the school year (Aim 1); (2) whether randomization to drug holidays (weekend holidays) mitigated the need for dose escalations compared to continuous dosing (7-day-a-week) (Aim 2), and (3) potential individual characteristics as moderators of dose escalation (Aim 3). Tolerance to stimulant medication was observed, as children’s prescribed doses doubled on average by study endpoint. In addition, the group assigned to weekend holidays required fewer dose escalations. Furthermore, children with ADHD and comorbid diagnoses were at an increased risk for requiring higher doses of medication over the school year. These findings support the clinical practice of recommending drug holidays to mitigate tolerance to stimulant medication.

Identifier

FIDC011160

Recommended Citation

Ramos, Marcela, "Tolerance to Psychostimulant Medication Among Children with ADHD: A School-Year Study" (2023). FIU Electronic Theses and Dissertations. 5415.
https://digitalcommons.fiu.edu/etd/5415