Online Resource 1

How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis.

Vibhore Prasad, Ellen Brogan, Caroline A. Mulvaney, Matthew J. Grainge, Wendy Stanton, Kapil Sayal

Division of Primary Care

University of Nottingham

University Park

Nottingham

NG7 2RD

E-mail:

V. Prasad - Division of Primary Care, University of Nottingham

E. Brogan - East Midlands Healthcare Workforce Deanery

C.A. Mulvaney - School of Nursing/Division of Primary Care, University of Nottingham

M. J. Grainge - Division of Epidemiology and Public Health, University of Nottingham

W. Stanton - Information Services, University of Nottingham

K. Sayal - Developmental Psychiatry, University of Nottingham
Online Resource 1: Summary of included studies

Author / Population and setting / Diagnostic criteria / Intervention / Duration / Outcomes (relevant to review) / Follow up / Included in meta analysis
Ajibola 1995 / N=6
Age: 9 to 12 years
Sex: male
Setting: Elementary school classroom
(USA) / Score 15 or above on Conners’ Teacher Rating Scale (CTRS) /
  1. Placebo + non-contingent reinforcer
  2. Low dose (0.3mg/kg) methylphenidate + non-contingent reinforcer
  3. High dose (0.7mg/kg) MPH + non-contingent reinforcer
  4. Low dose (0.3mg/kg) MPH + self reinforcement
  5. High dose (0.7mg/kg) MPH + self reinforcement
  6. Placebo + self-reinforcement.
/ 65 days:
5 day baseline
6 x 10 day treatment phases
1 for each treatment / 1.Amount of academic performance = comprehension questions answered in 30 mins
2.Accuracy of academic performance = number of questions correct/ total number of questions answered / 83% / No
Ballinger 1984 / N = 9
Age: 9-15 Sex: male only
years (mean 11.71)
Setting: classroom (type not specified)
(USA) / Not specified /
  1. Placebo
  2. Low dose MPH (0.3mg/kg)
  3. High dose MPH (0.6mg/kg)
/ 3 weeks /
  1. Durrell Analysis of Reading Difficulty
  • Correct word recognition rate
  • Correct comprehension rate
  • Number of words per minute
/ NR / No
Balthazor 1991 / N = 19
Age: 5.5-10.11 years, mean age 7.7 years
Sex: male
Setting: STP,
(USA) / DSM-III /
  1. Methylphenidate 0.3mg/kg
  2. Placebo
/ 10-16 days: 4 assessments on 4 separate days, two sessions each on placebo and active drug / 1.Counting task – 1 to 10 five repetitions, time taken
2.Reading comprehension – workbook with multiple choice questions, data averaged over 5 to 8 days per drug condition. % attempted and % correct in timed 10 min blocks. Completed 1 to 2 hours after medication ingestion. / 100% (Four young children were non-readers) / No
Barkley 1991 / N = 40
Age: 6-11 years
Sex: 36 male, 4 female
Setting: school classroom /clinic,
(USA) / Score above 93rd percentile on Child Attention Problems rating scale. /
  1. Placebo
  2. Low dose (L) 5mg methylphenidate bid
  3. Moderate dose (M) 10mg methylphenidate bid
  4. High dose (H) 15mg methylphenidate bid
/ 4 weeks – each drug condition for 1 week before crossing over to next / 1.Restricted Academic Situation (RAS) – maths problems, 15 mins, assessed:
  • Off tasks
  • Fidgets
  • Out of seat
  • Vocalises
  • Plays with objects
  • (Every 30 seconds as seen on videotape)
    AND
  • Number of problems completed
  • % of problems correct
2.School situations questionnaire (teacher rating) / NR / No
Biederman 2007 / N = 52
Age: 6-12 years, mean 9.1 years
Sex: 33M, 19F
Setting: analogue classroom, 4 sites, school laboratory environment , (USA) / DSM-IV TR /
  1. Placebo (1 week)
  2. MAS XR (active control, mixed amphetamine salts extended release, 1 week)
  3. LDX (lisdexamfetamine disemylate, which is converted to dexamphetamine following ingestion)
/ Duration: 9 x 13 hour classroom visits, treatment duration 6 weeks (3 titration, 3 crossover study) + 3 day washout prior to titration period. Sep 30 2004-Dec 23 2004 / 1.SKAMP = primary measure (Swanson, Kotkin, Agler, M-Flynn and Pelham) Deportment rating scale; independent observer.
2.PERMP = secondary measure (Permanent Product Measure of Performance)
  • PERMP – A = attempted
  • PERMP – C = correct
3.Different versions of same level of PERMP used across sessions so participant never completed same test twice.
4.SKAMP attention rating (independent observer) / 96% / No
Brams 2008 / N = 86
Age: 6-12 years, mean 9.5 years
Sex: 53M, 33F
Setting: laboratory classroom (USA) / DSM-IV /
  1. Dexmethylphenidate ER 20mg/day
  2. Placebo
/ Duration: 5 visits, 1 during 3 weeks prior to study, 4 during treatment. 14 days of treatment / 1.SKAMP combined was primary, deportment and attention were secondary. 0.5,1,2,4, 6 & 8 hours post dose. Compared to pre-dose (hour 0).
2.PERMP – 10 minute pencil and paper maths test
  • Attempted
  • Correct
/ 93% / No
Brown RT 2006 / N = 153
Age: 8-12, mean 9.9 years (S.D. 1.3)
Sex: 80.4% M
Setting: classroom; 10 investigational sites,
(USA) / DSM-IV /
  1. Atomoxetine, mean dose 32mg/kg (S.D. 0.30) with a range of 0.8mg/kg-1.8mg/kg
  2. Placebo
/ 7 weeks / 1.Academic performance rating scale (APRS); 19 items, assesses productivity (completion) and degree of accuracy in both mathematics and language arts. Each item scored 1-100%. Also assessed written, reading and verbal skills. Total score for APRS used in analysis. / 86% / No
Carlson 1992 / N = 24
Age: 6 - 12 years
Sex: Male
Setting: Academic classroom, 8 week STP,
(USA) / DSM-III-R /
  1. Placebo
  2. Methylphenidate 0.3mg/kg (low dose)
  3. Methylphenidate 0.6mg/kg (high dose)
/ 8 weeks / 1.Direct observation of classroom behaviour with daily points totals (adapted from COCAAD)
2. Timed arithmetic task:
  • Number attempted
  • % correct
3.Timed reading task:
  • Number attempted
  • % correct
4.% of assigned seatwork completed across 3 seatwork assignments
5.Children’s self rating questionnaire for classroom behaviour and academic performance, 8 questions rated 1-10. / NR / Yes
Chacko 2005 / N = 36
Age: 5-6 years
Sex: 32M, 4F
Setting: STP
(USA) / DSMIII-R or DSM-IV /
  1. Placebo
  2. Methylphenidate 0.3mg/kg
  3. Methylphenidate 0.6mg/kg
/ 6 weeks / 1.% time following class rules
2. Productivity (% seatwork completed)
3.Accuracy (% seatwork correct) / NR / Yes
Dopfner 2004 / N = 82
Age: 8-14 years, mean = 10.00 years, (SD 1.6)
Sex: 71M, 8F
Setting: analogue classrooms, 7 centres, (Germany) / ICD-10 or DSM-IV /
  1. Once daily extended release methylphenidate
  2. Twice daily immediate release methylphenidate
  3. Placebo
/ 2-5 weeks / 1.SKAMP Attention and Deportment
2. PERMP 15 minute, age appropriate math test 
  • Number attempted
  • % correct
/ 96% / Yes
Douglas 1986 / N = 16
Age: 7.0-11.6 years, mean 9.2, SD 1.65
Sex: 15M, 1F
Setting: laboratory/regular school classroom, (Canada) / DSM-III /
  1. Placebo
  2. Methylphenidate 0.3 mg/kg
/ 5 days / 1.Arithmetic task, 50 questions, level specific (highest level child capable of working), time limit established during screening depending on child
  • number attempted
  • number completed correctly
  • accuracy score based on % correct out of number attempted
  • efficiency: number completed per minute spent
2.Arithmetic self-correction: 6 mins to find own errors:
  • number correct
  • accuracy score (items correctly corrected out of those identified as wrong)
  • time spent
  • effort
3.Spelling task:
  • number correct
  • time spent studying
  • effort
/ NR / No
DuPaul 1993 / N = 56
Age: 6-11 years,
Sex: 46M, 10F
Setting: regular elementary school classroom (USA) / DSM-III /
  1. MPH 5mg
  2. MPH 10mg
  3. MPH 15mg
  4. MPH 20mg
  5. Placebo
/ 6 weeks for subjects, 1 week for controls / 1.On-task behaviour observation:
  • % of observations on-task.
2.Academic efficiency score: number of items completed correctly by child divided by number of items assigned to the class, multiplied by 100 (i.e. % of academic work completed correctly relative to classmates) / NR / Yes
Elia 1992 / N = 33
Age: mean 111.2 months, SD 16.51
Sex: Male
Setting: out-patient unit school, special education classroom
(USA) / DSM-III or 2 standard deviations above normal on CTRS /
  1. Placebo
  2. Methylphenidate (max daily dose 90mg)
  3. Dextroamphetamine (max daily dose 45mg)
/ 11 week – 9 on crossover, 2 baseline before study / 1.Reading task:
  • Number attempted
  • % correct
  • Subtest scores for reading (number attempted and % correct)
2. Arithmetic task
  • Number attempted
  • % correct
  • Subtest scores for arithmetic (number attempted and % correct):
  • Addition
  • Subtraction
  • Addition and subtraction
  • Addition with carrying
  • Subtraction with borrowing
  • Addition and subtraction with carrying or borrowing
  • Multiplication
  • Division
/ NR / No
Evans 1991 / N = 9
(9 in analysis, initially recruited 21)
Age: 11.6-15.0 years
Sex: Male
Setting: Lecture classroom, STP,
(USA) / DSM-IIIR / 1.Placebo
2.Low dose MPH (0.3mg/kg or 0.15mg/kg in overweight)
3. 3. High dose MPH (0.6mg/kg or 0.3mg/kg in overweight)
/ 6 weeks / 1.Daily quiz score  % answered correctly
2. Lecture Q/A assignment  % answered correctly
3.Lecture summary assignment  % of main ideas produced
4.Cumulative test  % correct
5.Classroom observations of conflict and attention deficit disorders (COCAAD)  % of intervals with on-task behaviour / 43% / Yes
Evans 2001 / N = 45
Age: mean = 13.8, SD =1.2
Sex: 40M, 5F
Setting: Junior High School class in STP, (USA) / DSM-III-R / 1.Placebo
2.10mg MPH twice and 5mg MPH once
3.20mg MPH twice and 10mg MPH once
4.30mg MPH twice and 15mg MPH once / 8 weeks, 2 unmedicated, 6 medicated crossover / 1.History worksheet: % correct
2. History quiz: % correct
3.Notes :
  • % main ideas recorded
  • % details recorded
4.Written language:
  • Words written
  • Sequence length
  • Idea (rated 1 poor – 5 superior)
5.On-task behaviour: % observations
6.Homework completed: % of days in drug condition / NR / Yes
Fabiano 2007 / Age: 5-12 years mean 9.35, SD 1.98
Sex: 44M, 4F
N = 48
Setting: analogue classroom setting, USA / DSM-IV /
  1. Placebo
  2. MPH 0.15mg/kg
  3. MPH 0.30mg/kg
  4. MPH 0.60mg/kg
/ 9 weeks / Seatwork completion % (number completed / number assigned x 100) / 96% / Yes
Gorman 2006 / N = 77
Age: 6-12 years
Sex: 56M, 19F (2 unspecified)
Setting: regular school classroom
(US) / DSM-IV /
  1. Placebo
  2. Methylphenidate dose increased over 21 days from 0.25mg/kg to 0.4mg/kg plus half-dose afternoon dose
/ 42 days / 1.Restricted academic task - 15 minutes, set at child’s established ability level, arithmetic problems in room with distracting toys present
  • Z score representing number correct, based on no-medication baseline
  • Task incompatible behaviours (proportion of observed behaviours: off-task, fidgeting, vocalises, out of seat)
/ 97% / No
James 2001 / N = 35
Age: mean = 9.1 SD 1.5, range 6.9-12.2 years
Sex: 21M, 14F
Setting: research school
(US) / DSM-IV / 1.Placebo
2.Adderall
3.Immediate-release dextroamphetamine
4.Dextroamphetamine Spansules. / 8 weeks (plus 3 weeks unmedicated observation) / 1.5 minute timed math task (4 hours post medication), difficulty level selected for each child’s ability.
  • Total responses
  • Correct responses (both summed weekly)
/ 100% / No
Klein 1991 / N = 83
Age: 6-12 years, mean 8.55 (SD 2.02)
Sex: NR
Setting: NR / American Psychological Association (APA) 1968 criteria /
  1. Placebo (42 children)
  2. MPH (41 children)
  3. (Thioridazine*
  4. MPH + thioridazine)*
*(this report is concerned only with the effects of methylphenidate) / Initial 4 weeks, extended 12 weeks / 1.Wide Range Achievement Test:
  • Reading
  • Arithmetic
  • Spelling
  • Gray Oral Reading Test
/ 96% / No
McCracken 2003 / N = 51
Setting: analog classroom, 4 academic sites, USA
Age: 6-12, mean 9.5, SD 1.9
Sex: 44M, 7F
(US) / DSM-IV /
  1. Placebo
  2. SLI381 10mg
  3. SLI381 20mg
  4. SLI381 30mg
  5. Adderall® - active control
/ 6 weeks (+ 1 week washout) / 1.SKAMP
  • Attention
  • Deportment
2. PERMP – 10 minute age appropriate math test
  • Number attempted
  • Number correct
/ 86% / No
McGough 2006 / N = 80
Age: 6-12 years mean 9.1, SD 1.7
Sex: 57M 22F (I LTF unspecified)
Setting: laboratory classroom sessions,
(USA) / DSM-IV-TR /
  1. Placebo Transdermal System (PTS)
  2. Methylphenidate Transdermal System (MTS)
/ 2 weeks study (following 5 weeks dose optimization open label assessment) / 1.SKAMP
  • Deportment (primary measure)
  • Attention
2. PERMP – age-adjusted math test, at same pre and post-dose points as SKAMP measure taken
  • Number attempted
  • Number correct
/ 99% / No
Pelham 1985 / N = 29
Age: 5.5-11.5,
Setting: STP classroom (day) USA / DSM-III /
  1. Placebo
  2. Methylphenidate 0.15mg/kg
  3. Methylphenidate 0.30mg/kg
  4. Methylphenidate 0.60mg/kg
/ 5 weeks / 1.Arithmetic (sheets, worked on daily, at child’s independent level, 1 problem type per day, randomized across days) Timed 5 min period :
  • Number attempted
  • Number correct
2.Reading (comprehension workbook, 5 booklets randomized across days, averaged over books i.e. over days) Timed 5 min period :
  • Number attempted
  • Number correct
3.Spelling (10 words in younger children, 20 in older, learnt over week)  proportion of words correct in test
4.Classroom observations:
On-task behaviour, observed in 1st 15 mins of class  proportion of intervals on-task, averagerecorded over the week. / 100% / No
Pelham 1987 / N = 13
Age: mean 8.8, (SD 1.50), range 6 years and 7 months to 11 years
Sex: male
Setting: STP (USA) / DSM-III /
  1. Placebo
  2. MPH (standard release)
  3. SR-20
/ 5 weeks / 1.On-task behaviour (and rule following)  % of points kept (assessed 5 times each class)
2. 2 minute timed arithmetic drill
  • Number attempted
  • % completed correctly
3. 10 minute timed reading task
  • Number attempted
  • % completed correctly
4.Seatwork
  • Accuracy (% correct)
  • Productivity (% completed)
/ 100% / Yes
Pelham 1989 / N = 24
Age: 5 years. 3
months – 11 years 3 months
Sex: 12 male 12 female
Setting: STP classroom / DSM-III /
  1. Placebo
  2. MPH 0.3mg/kg
/ 5 weeks / 1.Classroom measures:
  • On-task behaviour
2.Arithmetic task
  • Number attempted
  • Percentage correct
3.Reading task
  • Number attempted
  • Percentage correct.
4.Seatwork (including handwriting, language & spelling, additional reading and additional arithmetic)
  • Productivity (amount completed)
  • Accuracy (amount correct)
/ 100% / No
Pelham 1990 / N = 22
Age: 8.08 to 13.17 years; mean 10.39, SD 1.38
Sex: Male
Setting: STP, (USA) / DSM-III-R / 1.Placebo
2.10mg standard MPH
3. Comparable dose SR-20
4.56.25mg pemoline
5.10mg Dexedrine spansules (DS) / 6.5 weeks (medicated/ placebo) plus 1.5 weeks previous adaptation / 1.10 minute timed reading task
  • Number attempted
  • % correct
2. Seatwork
  • % completed (productivity)
  • % correct (accuracy)
/ NR / Yes
Pelham 1993 / N = 31
Age: 5.42-9.92 years, mean 8.23
Sex: male
Setting: STP, (USA) / DSM-III-R /
  1. Placebo
  2. Low dose MPH (0.3mg/kg except in 4 obese = 0.15mg/kg)
  3. High dose MPH (0.6mg/kg except in 4 obese = 0.3mg/kg)
/ 5 weeks (5 weeks medicated, STP 8 weeks in total) / 1.Observed on-task behaviour (COCADD), repeated (around 38 per class) 15 second observations in the first 50 minutes of class :
  • % observed intervals on-task
2.Seatwork (reading, arithmetic and language arts)
  • % completed (productivity)
  • % correct (accuracy)
/ 100% / Yes
Pelham 1999 (April) / N = 27
Age: mean = 9.6, SD .6, range 5.8 to 12.7 years
Sex: 21M, 4F (2 unspecified)
Setting: 8 week, weekday STP,
(USA) / DSM-IV /
  1. Placebo
  2. Ritalin (MPH) 10mg
  3. Ritalin (MPH) 17.5mg
  4. Adderall 7.5mg
  5. Adderall 12.5mg twice daily
/ 6weeks / 1.Seatwork:
  • Productivity (% complete)
  • Accuracy (% correct)
2. On-task behaviour (during seatwork period
  • % observations on task
/ 93% / Yes
Pelham 1999 (Dec) / N = 21
Age: 6-12 years, mean 10.26 (SD 1.9)
Sex: 19M, 1F
Setting: STP, (USA) / DSM-IV /
  1. Placebo
  2. 0.3mg/kg MPH three times daily
  3. 0.3mg/kg MPH twice daily
  4. 0.3mg/kg MPH morning only
  5. 0.3mg/kg Adderall twice daily
  6. 0.3mg/kg Adderall morning plus 0.15mg/kg late afternoon
  7. 0.3mg/kg Adderall morning only
/ 6 weeks (following 2 weeks baseline and adaptation; total program length 8 weeks) / 1.Seatwork
  • Productivity (% complete)
  • Accuracy (% correct)
2. On-task behaviour - % of observed intervals on-task / NR / Yes
Pelham Jr 2005 / N = 36
Age: 6-13, mean 9.6
Sex: 33M, 3F
Setting: STP at 3 sites,
(US A) / NIMH Diagnostic Interview Schedule for Children /
  1. Placebo (patch)
  2. MTS 6.25cm2 (0.45mg/h)
  3. MTS 12.5cm2 (0.9mg/h)
  4. MTS 25cm2 (1.8mg/h)
/ 8 days / 1.Seatwork:
  • % completion
  • % correct (accuracy)
/ 72% (due to absence) / Yes
Rapport 1985 / N = 12
Age: 6-10 years
Sex: male
Setting: regular school classroom (and laboratory, but lab results not used in this extraction)
(USA) / DSM-III /
  1. Placebo
  2. 5mg MPH
  3. 10mg MPH
  4. 15mg MPH
/ 5 weeks / 1.% intervals (observations) on-task
2.Academic seatwork (arithmetic and language arts) recorded daily:
  • % complete
  • % accurate
/ 83% / No
Rapport 1986 / N = 14
Age: 6-10 years (mean 7.75 years)
Sex: 12 male, 2 female
Setting: Child’s regular classroom / DSM-III /
  1. Placebo
  2. MPH 5mg
  3. MPH 10mg
  4. MPH 15mg
/ 5 weeks /
  1. Behavioural observation – on-task or off-task
  2. Morning assignment (arithmetic &/or phonic)
  • % completed
  • % accurate
/ NR / No
Rapport 1987 / N = 42
Age:6-11 years, mean 8.5 years.
Sex: M=37, and F=5
Setting: regular classroom / DSM-III /
  1. Placebo
  2. MPH 5mg fixed doseMPH10mg fixed dose
  3. MPH 15mg fixed dose
  4. MPH 20mg fixed dose
/ 6 weeks / 1.Behavioural observation – on task or off task
2.Seatwork
  • Percentage completed
  • Percentage accurate.
  • AES (academic efficiency score)
/ NR / No
Rapport 1994 / N = 104
Age: 6-11 years,
Sex: 86M, 15F (3 unspecified, drop outs)
Setting: regular classroom
(USA) / DSM-III /
  1. Placebo
  2. 2. 5mg MPH
  3. 10mg MPH
  4. 15mg MPH
  5. 20mg MPH
/ 6 weeks / 1.% observations “on-task”
2. Assigned seatwork – consistent with child’s ability level (1.5-2 hours post-dose)
  • % complete
  • % accurate/correct
3.Academic efficiency score (AES) – representing % academic assignments completed correctly / 96% / No
Richardson 1988 / N = 58
Age: 7-13
Sex: NR
Setting: regular classroom with some laboratory measures? Not explicitly described / DSM-III /
  1. Placebo
  2. 0.3mg/kg MPH
  3. 0.5mg/kg MPH
  4. 0.7mg/kg MPH
/ 28 weeks / 1.Tests of reading achievement: Gates-MacGinitie Reading Mastery Tests
2.Peabody Individual Achievement Test (subsets including Reading Recognition, Comrehension and Math)
3.Achievement rate: estimated grade equivalent reading score (RGL) (averaging from above tests) / 72% / No
Silva 2005 / N = 54 (53 completed)
Age: 6-12 years, mean 9.4 years
Sex: 34M, 20F
Setting: Laboratory classroom
(USA) / DSM-IV /
  1. Placebo
  2. ER-MPH 20mg
  3. ER-MPH 40mg
  4. OROS-MPH 18mg
  5. OROS-MPH 36mg
/ 6 weeks / 1.SKAMP:
  • attention rating (primary measure)
  • deportment rating (secondary measure)
2.Pencil and paper math test (Swanson et al. 1998) administered during classroom period
  • objective measure of academic productivity
  • 400 problems, children instructed to work through as many as possible in 10 minutes.
  • Math-Attempted score
  • Math-Correct score
Efficacy measured as change from pre-dose values. / 98% / No
Silva 2006 / N = 54
Age: 6-12 years, mean 9.4, SD 1.6
Sex: 38M, 16F
Setting: laboratory classroom
(USA) / DSM-IV / 1.Placebo
2.d-MPH-ER 20mg per day / 12 days / 1.SKAMP (1 hour post-dose)
  • Combined score
  • Deportment
  • Attention
2. PERMP – 400 maths problem at difficulty level assessed for child on practice day, 10 mins, timed:
  • Number attempted
  • Number correct
/ 98% / No
Swanson 1998 / N = 33
Age: 7-14 years, mean 10.58, SD 1.81
Sex: 26M, 7F
Setting: laboratory classroom
(USA) / DSM-IV /
  1. Placebo
  2. Active control (MPH, average dose 12.5mg)
  3. Adderall® 5mg
  4. Adderall® 10mg
  5. Adderall® 15mg
  6. Adderall® 20mg
/ 6-7 weeks / 1.SKAMP
  • Attention
  • Deportment
2.Math Assignment  PERMP – 10 minute test, NB 1st 2 pages set at child’s ability level, last 2 pages set to challenge those who had completed 1st 2 pages within time period
  • Number attempted
  • Number correct
/ 91% / No
Swanson 2004 / N=184[†]
Age: 6-12 years, mean 9.6
Sex: 135M, 48F
Setting: Laboratory classroom
(USA) / DSM-IV /
  1. Placebo
  2. Concerta (MPH extended release)
  3. Metadate (MPH extended release)
/ 3 weeks /
  1. SKAMP
  • 6 Deportment items (interacting with other children, interacting with adults, remaining quiet, staying seated, complying with the teacher’s directions, and following the classroom rules)
  • 7 attention items (getting started, sticking with tasks, attending to an activity, making activity transitions, completing assigned tasks, performing work accurately, and being neat and careful while writing or drawing)
  1. PERMP
  2. PERMP – A = attempted
  3. PERMP – C = correct
/ 85% / No
Tannock 1989 / N = 12
Age: 6-11 years, mean 8.4 (SD 1.4)
Sex: 10M, 2F
Setting: laboratory classroom, (Canada) / DSM-III /
  1. Placebo
  2. Low dose MPH (0.3mg/kg)
  3. High dose MPH (1.0mg/kg)
/ 6 days / 1.Arithmetic task – 5 minutes, increasing difficulty
  • Total correct
  • Total errors
2. Letter-Search Tasks - (finding target letter/sequence in a series of letter-strings), increasing difficulty, timed
  • Total correct
  • Total errors
3. On-task, still and quiet behaviours – proportion of intervals (128 intervals of 10 seconds per medication condition) / NR / Yes
Vyse 1989 / N = 26
Age: 6-12 years, mean 8.5 years, SD 1.4
Sex: 24M, 2F
Setting: Children’s Learning Clinic/regular school classroom
(USA) / DSM-III /
  1. Placebo
  2. 5mg MPH
  3. 10mg MPH
  4. 15mg MPH
  5. 20mg MPH
/ 5 weeks /
  1. On-task behaviour (% intervals on-task)
  2. Regularly assigned academic work (arithmetic problems or language arts, 1.5-2 hours post-dose)
  • % complete
  • % correct
  • AES (% completed correctly)
/ NR / No
Wietecha et al. 2009 / N = 178 (267 in acute phase, 178 in maintenance phase)
Age: 13-16 years, mean 14.45
Sex: 111 male, 67 female
Setting: laboratory classroom
(USA) / DSM-IV-TR / Acute phase:
Number of groups = 2
  1. Fast titration – 0.5mg/kg/day for 3 days, 1.2mg/kg/day for remainder,
  2. Slow titration 0.5mg/kg/day for 7-9 days, then 1.0mg/kg/day for 7-9 days, then 1.2mg/kg/day for remainder
Maintenance phase
Number of groups = 2
  1. Low-dose 0.8mg/kg/day
  2. High-dose 1.4mg/kg/day (not exceeding 100mg/day regardless of pt weight).
/ 48 weeks (8 acute titration, 40 maintenance) / 1.Woodcock Johnson III tests of achievement
2. Grade point average (in English, Math, Science & Social Studies) / 56/178
31% / No
Wigal 2009 / N = 129
Age: 6-12 years, mean age 10.1 (SD 1.5) years.
Sex: 98 males, 31 female
Setting: laboratory school, multicenter
(USA) / DSM-IV-TR /
  1. Placebo
  2. Lisdexamfetamine dimesylate
/ 2 weeks (of randomized treatment following preceding dose optimization phase) / 1. SKAMP-D = primary measure (Swanson, Kotkin, Agler, M-Flynn and Pelham) Deportment rating scale;.
  • SKAMP deportment rating (SKAMP-D)
  • SKAMP attention rating (SKAMP-A)
  • SKAMP-quality of work
2.PERMP = secondary measure (Permanent Product Measure of Performance)
  • PERMP – A = attempted
  • PERMP – C = correct
Both these scales have been validated elsewhere. / 88% / No
Worrall 1993 / N = 63
Age: 5 years 8 month  10 years
Sex: 52 male, 11 female
Setting: not described.
(South Africa) / DSM-III / 1.Placebo (lactose)
2.MPH / 10 days /
  1. Language task
  2. % attempted
  3. % correct
  4. Effort deployed on task (1 = no effort to 7 = excellent effort)
  5. Maths task
  6. % attempted
  7. % correct
  8. Effort deployed on task (1 = no effort to 7 = excellent effort)
/ NR / No

NR: Not reported
STP: Summer Treatment Programme