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

Lincolnshire Partnership NHS Trust, Child and Family Services, Moore House, 10/11 Lindum Terrace, Lincoln, LN2 5RS, e-mail: Annelizthompson{at}aol.com

Saeed A. Nazir, Consultant Child and Adolescent Psychiatrist

Lincolnshire Partnership NHS Trust, Grantham Health Clinic, Grantham

Mohammed J. Abbas, Senior House Officer in Psychiatry

Lincolnshire Partnership NHS Trust, Moore House, Lincoln

Julie Clarke, Associate Specialist in Community Paediatrics

United Lincolnshire Hospitals Trust, Grantham and District General Hospital, Grantham

Declaration of interest

None.

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.

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