Objective: This trial evaluated the effect of methylphenidate transdermal system (MTS) on the full spectrum of adult symptoms (attention-disorganization, hyperactivity-impulsivity, emotional dysregulation [ED], and oppositional-defiant disorder [ODD]) found in this disorder. Method: This placebo-controlled, double-blind, flexible-dose, crossover trial employed the Wender—Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and Connor’s Adult ADHD Rating Scale (CAARS) and two measures of adult ODD. Treatment responses of all participants and four subgroups (ADHDalone, ADHD + ED, ADHD + ODD, and ADHD + ED + ODD) were assessed. Results: Around 23% of baseline participants were ADHD alone, 31% were ADHD + ED, 10% were ADHD + ODD, and 36% were ADHD + ED + ODD. There was a significant treatment effect for all symptom areas and all four subgroups. MTS was associated with significantly more adverse events, especially dermatologic side effects. Conclusions: MTS was effective in treating adult ADHD. This clinical trial included numerous participants meeting criteria for ED and ODD. All ADHD symptoms responded positively to treatment with MTS.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author .
2.
Barkley, R.A., & Murphy, K.R. ( 1998). Attention-deficit hyperactivity disorder: A clinical workbook (2nd ed.). New York, NY: Guilford.
3.
Biederman, J., Mick, E., Surman, C., Doyle, R., Hammerness, P., Harpold, T., . . . Spencer, T. ( 2006). Randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biological Psychiatry, 59, 829-835.
4.
Conners, C.K., Erhardt, D., & Sparrow, E. ( 1999). Conners’ Adult ADHD Rating Scales (CAARS). North Tonawanda, New York: Multi-Health Systems.
5.
Faraone, S.V., & Giefer, E.E. ( 2007). Long-term effects of methylphenidate transdermal delivery system treatment of ADHD on growth. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1138-1147.
6.
Faraone, S.V., Glatt, S.J., Bukstein, O.G., Lopez, F.A., Arnold, L.E., & Findling, R.L. (2009). Effects of once-daily oral and transdermal methylphenidate on sleep behavior of children with ADHD. Journal of Attention Disorders, 12, 308-315.
7.
Findling, R.L., Bukstein, O.G., Melmed, R.D., López, F.A., Sallee, F.R., Arnold, L.E., & Pratt, R.D. ( 2008). A randomized, double-blind, placebo-controlled, parallel-group study of methylphenidate transdermal system in pediatric patients with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 69, 49-59.
8.
Guy, W. (Ed.). (1976). ECDEU assessment manual for psychopharmacology: Publication ADM 76-338. Washington, DC: U.S. Department of Health, Education, and Welfare.
9.
Heal, D.J., & Pierce, D.M. ( 2006). Methylphenidate and its isomers: Their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system . CNS Drugs, 20, 713-718.
10.
Jasinski, J.R., Gonzalez, M.A., Peoples, K.A., & Rubin, J. ( 2007). Human pharmacology and abuse potential of transdermal methylphenidate in adults. Poster presentation in annual meeting of the American Psychiatric Association, San Diego, CA.
11.
Jensen, P.S., Hinshaw, S.P., Kraemer, H.C., Lenora, N., Newcorn, J.H., Abikoff, H.B., . . . Vitiello, B. ( 2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 147-158.
12.
Kessler, R.C., Adler, L., Barkley, R., Biederman, J., Conners, C.K., Demler, O., . . . Zaslavsky, A.M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication. American Journal of Psychiatry, 163, 716-723.
13.
McGough, J.J., Wigal, S.B., Abikoff, H., Turnbow, J.M., Posner, K., & Moon, E.A., (2006). randomized, double-blind, placebo-controlled, laboratory classroom assessment of methylphenidate transdermal system in children with ADHD. Journal of Attention Disorders, 9, 476-485.
14.
Paller, A.S., Warshaw, E., Wilens, T.E., & Civil, R. ( 2008). Characterization of dermal reactions with the use of methylphenidate transdermal system in pediatric subjects with attention-deficit/hyperactivity disorder. Poster presentation in annual meeting of theAmerican Academy of Child and Adolescent Psychiatry, Chicago, IL.
15.
Pelham, W.E., Burrows-Maclean, L., Gnagy, E.M., Fabiano, G.A., Coles, E.K., Tresco, K.E., . . . Hoffman, M.T. ( 2005). Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD. Experimental and Clinical Psychopharmacology, 13, 111-126.
16.
Pelham, W.E., Gnagy, E.M., Burrows-Maclean, L., Williams, A., Fabiano, G.A., Morrisey, . . . Morse, G.D. ( 2001). Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings. Pediatrics , 107, E105.
17.
Pelham, W.E., Jr., Manos, M.J., Ezzell, C.E., Tresco, K.E., Gnagy, E.M., Hoffman, M.T., . . . Morse, G. ( 2005). A dose-ranging study of a methylphenidate transdermal system in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 522-529.
18.
Pierce, D.M., Wigal, S.B., Dixon, C.M., & McGough, J.J. ( 2007). Pharmacokinetics of methylphenidate transdermal system in children with ADHD. Poster presentation in 13th annual International Congress of the European Society for Child and Adolescent Psychiatry, Florence, Italy.
19.
Reimherr, F.W., Marchant, B.K., Strong, R.E., Hedges, D.W., Adler, L., Spencer, T.J., . . . Soni, P. ( 2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry, 58, 125-131.
20.
Reimherr, F.W., Marchant, B.K., Williams, E.D., Strong, R.E., Halls, C., & Soni, P. (in press). Personality disorders in ADHD Part 3: Personality disorder, social adjustment and their relation to dimensions of adult ADHD. Annals of Clinical Psychiatry.
21.
Reimherr, F.W., Williams, E.D., Strong, R.E., Mestas, R., Soni, P., & Marchant, B.K. (2007). A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder . Journal of Clinical Psychiatry, 68, 93-101.
22.
Wender, P.H. ( 1995). Attention-deficit hyperactivity disorder in adults. New York: Oxford University Press.
23.
Wood, D.R., Reimherr, F.W., Wender, P.H., & Johnson, G.E. ( 1976). Diagnosis and treatment of minimal brain dysfunction in adults. Archives of General Psychiatry, 33, 1453-1460.
