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PEDIATRICS Vol. 107 No. 1 January 2001, p. e10
Dextroamphetamine Salts and Amphetamine Salts (Adderall):
Efficacy Rate and Side Effects
,
, and
From the Departments of * Neurology, Neuropsychology, and
Pediatrics, Marshfield Clinic, and the Department of § Clinical
Research, Marshfield Medical Research Foundation, Marshfield,
Wisconsin.
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ABSTRACT |
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Top
Abstract
Methods
Results
Discussion
Conclusion
References
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Objective. The primary objective of this study was to determine the efficacy rate of Adderall in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). A secondary objective was to address the severity of side effects associated with Adderall treatment in children with ADHD using the Barkley Side Effects Questionnaire (BSEQ).
Design. Randomized, double-blind, placebo-controlled crossover trial.
Setting. A large rural tertiary care clinic.
Patients. Participants were prospectively recruited from children 5 to 18 years of age referred for academic and/or attention problems; 154 children who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for ADHD were enrolled.
Interventions. Two doses of Adderall (0.15 mg/kg/dose and 0.3 mg/kg/dose) were compared with placebo in separate 2-week trials. Participants received each dosage regimen twice daily for 7 consecutive days.
Measurements and Main Results. Efficacy rates were determined by comparing Adderall with placebo during the low-dose crossover sequence and also during the high-dose crossover sequence. The criteria that defined a positive response to Adderall relative to placebo (with each patient serving as their own control) included an indication of response by at least 1 of 2 parent measures of children's behavior or at least 2 of 5 teacher measures of children's behavior. The Adderall efficacy rate was determined based on parent criteria alone, teacher criteria alone, and by a more stringent definition of response that required concurrence between parent and teacher criteria. The Adderall response rate in this study ranged from 59% when requiring concurrence between parent and teacher observers, to 82% when based on parent criteria alone. Overall, 137 of 154 participants (89%) showed a positive response by either the parent or teacher response criteria. Parents completed a modified version of the BSEQ during each week of the trial. Appetite, stomachaches, and insomnia were rated as worse by parents while children were receiving either dose of Adderall; headaches were rated as worse when children were receiving the higher dose of Adderall. Parents rated certain side effects, including staring/daydreaming, sadness, euphoria, and anxious/irritable, as worse during placebo regimens.
Conclusions. We found that Adderall is highly efficacious in our population of youth diagnosed with ADHD. In addition, Adderall is well-tolerated with a side effect profile similar to that reported for other psychostimulants. Key words: attention-deficit/hyperactivity disorder, side effects, efficacy rate, Adderall.
Attention-deficit/hyperactivity disorder (ADHD)
is the most commonly diagnosed neurobehavioral disorder of
childhood and is estimated to affect 5% to 11% of school-aged
children.1 Although various specialists may be involved in
the care of children with ADHD during the continuum of diagnosis and
management, the primary care physician frequently performs the initial
evaluation of a child with the disorder. Therefore, pediatricians
should be cognizant of the efficacy rates and side effect profiles of all currently available psychostimulant medications.
Psychostimulants have served as the primary mode of treatment of ADHD
with reported efficacy rates of ~70%.2 For the past 2 decades, methylphenidate (Ritalin, Novartis, East Hanover,
NJ) and dextroamphetamine (Dexedrine, SmithKline Beecham, Philadelphia,
PA; DextroStat, Shire Richwood Inc, Florence, KY) have been used for
the management of ADHD. A product comprised of mixed amphetamine salts
(Adderall, Shire Richwood Inc) has been marketed for the
treatment of ADHD since 1994. Each Adderall tablet
contains equal milligram portions of d-amphetamine
saccharate, d,l-amphetamine aspartate,
d-amphetamine sulfate, and d,l-amphetamine sulfate.3 This combination of salts and isomers results in
a 3:1 ratio of dextro to levoamphetamine.4 In >4000
patients with ADHD enrolled in an open-label trial of Adderall, reported side effects were typical of other
psychostimulant medications and included decreased appetite, insomnia,
and headaches.4 No research has been conducted to address
the differences between mixed salts of amphetamine and
dextroamphetamine spansules.
The prevalence of ADHD among school-aged children as well as the
recently recognized persistence of the disorder into adolescence and
adulthood requiring long-term treatment with psychostimulant medications have contributed to the inclusion of Adderall
in the "Top 200" list of most frequently prescribed medications in
the United States.5 Recent comparative trials indicate
that Adderall is at least as efficacious as
Ritalin.6-10 Potential advantages to the use
of Adderall in the treatment of ADHD include the
following: a longer duration of action than Ritalin6; a dose-dependent duration of
action8; a reduction in the need for in-school dosing of a
psychostimulant9-11; and a smoother course of clinical
action.12 At the conclusion of a comparison trial of
Adderall and Ritalin, Pelham and
colleagues6 recommended Adderall by a ratio
of 3:1 for continued medication treatment in children with ADHD.
However, review of the literature reveals that no study involving large
numbers of children in a naturalistic setting has systematically and
prospectively addressed efficacy rates and side effects associated with
this mixture of amphetamine salts, compared with placebo in a
randomized, double-blind manner.
This prospective study was initiated in 1997 to determine the efficacy
rate and side effect profile of Adderall in the treatment of children newly diagnosed with ADHD from a private, rural, outpatient clinic. The double-blind, placebo-controlled, within-subject crossover methodology applied in this trial has proven effective in research settings as well as general clinical practice
applications.13 In a previous placebo-controlled trial of
Ritalin conducted at our institution, we found this study
design to be an effective clinical method to identify medication
responders and to evaluate stimulant side effects.14
Participants
Participants were recruited prospectively from children 5 to 18 years of age referred to the Marshfield Clinic (Marshfield, WI) for
assessment of academic and/or attention problems. All participants were
newly diagnosed and stimulant-naive.
Instruments
The following instruments were completed at the end of each week
to assess the patients' response to medication. The first 3 instruments were also used to assess patient behaviors at baseline.
METHODS
Top
Abstract
Methods
Results
Discussion
Conclusion
References
structured comments provided by parents and teachers. (See
"Response Evaluation" section.)
Eligibility Criteria
The protocol was approved by the institutional review board of the Marshfield Medical Center. Written informed consent was obtained from parents before enrolling a child in the study. Participants 7 years of age and younger were given a modified "Assent Form" to sign, written in age-appropriate language.
At the time of initial appointment, an extensive medical history form was completed by the family. The Child Behavior Checklist (CBCL)18 served as an initial screening measure for comorbid conditions during this portion of the examination. The results of the CBCL are given in Table 1. The physician and the neuropsychologist each interviewed the family independently, framing their interview questions around the 18 behavioral items from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for ADHD. The physician also completed a physical and neurological examination. The neuropsychologist evaluated the patient for comorbid disorders of mood, anxiety, and conduct. Consultation then occurred between the physician and neuropsychologist regarding their findings. Both physician and neuropsychologist reviewed the results from previsit questionnaires sent to the family (CTRS, CPRS, and ACTeRS) to ensure that the results were consistent with eligibility criteria. (See Table 2 for these baseline test data.)
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To be categorized as either ADHD subtype impulsive or combined (impulsive and inattentive), at least 3 of the following 5 criteria had to be met:
To be categorized as ADHD subtype inattentive, the child had to also meet at least 2 of the following 3 criteria:
Children with a history of seizures, mental retardation, or other significant neurologic history were not eligible for the study.
Response Evaluation
At the end of each week of the double-blind, crossover trial, parents were asked to complete the CPRS, the BSEQ, and a structured behavioral narrative. The classroom teacher completed the CTRS, the ACTeRS, and a structured behavioral narrative.
The narratives were structured to elicit behavioral observations in areas thought to be sensitive to medication effects (eg, time on task, following directions, etc). (See Fig 1 for a sample narrative.) Narratives were judged independently by 2 of the clinical investigators who were blinded to the treatment condition. The narratives were scored as positive if the narrative suggested improvement and negative if the narrative did not suggest improvement from prestudy conditions. If the clinical investigators disagreed on the scoring of the narrative, they would confer to reach agreement. A positive narrative response was one criterion for the identification of Adderall responders.
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Although not commonly used in research of this type, the narrative forms have not only become a standard part of the clinical evaluation process, but also are included as a descriptor of response for the following reasons:
The following criteria were used to classify a child as an Adderall responder:
A child was considered an Adderall responder by the strict response criteria if criteria 1 and 2 were met while receiving either a low dose (0.15 mg/kg) or a high dose (0.3 mg/kg) of Adderall twice daily, compared with response during the corresponding placebo regimen. Children meeting criteria 1 were considered responders by parent response criteria, while those meeting criteria 2 were considered responders by teacher response criteria.
Dosing and Preparation of Study Medications
Identically appearing Adderall and placebo capsules were prepared by the research pharmacy at the Marshfield Medical Research Foundation. Each patient dose was calculated on a mg/kg basis rounded up to the nearest 2.5-mg dose. Active dosage forms were compounded by placing a 10-mg Adderall tablet, one half of a tablet (5 mg), or one quarter of a tablet (2.5 mg) in an opaque capsule and packing the capsule with lactose powder. Matching placebos were prepared by filling a capsule corresponding in size to the active dosage form with an appropriate weight of lactose powder to prevent differentiation between drug and placebo regimens. A sufficient quantity of Adderall and placebo capsules were dispensed in containers distinguishable only by the label corresponding to the appropriate week of the study. Patients were instructed to take 1 capsule twice daily (7 AM and 1 PM) from the appropriate container for each 7-day week of the study. Patients were also instructed to swallow the capsules whole and not crush or break the capsule.
Randomization
A computer program written by our biostatistics staff used a random number generator to create the randomization list, blocked by treatment sequence, which was maintained by the investigational pharmacy. On determining eligibility and obtaining informed consent, participants were randomized to receive a sequence of Adderall/placebo or placebo/Adderall. In each sequence, the participant received the low dose (0.15 mg/kg/dose) of Adderall before receiving the high dose (0.3 mg/kg/dose). The study design is illustrated in Fig 2. Participants received capsules in 4 bottles labeled only by week, with each bottle containing Adderall (or the corresponding placebo dose) in 2 daily doses (maximum dose 40 mg/day) for 7 consecutive days beginning on a Saturday. Because Adderall has a relatively short half-life of 4 to 8 hours,12 dosing regimens were alternated over 4 successive weeks without a washout period. Through these procedures, both clinical staff and participants were blinded to the treatment sequence and only knew that each participant's trial would include both drug and placebo weeks. Only at the end of the 4-week trial was the blind broken.
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Statistical Analyses
Simple estimates of efficacy were calculated based on the available data (number of responders/number of patients with response data available). However, because some parent or teacher ratings were missing for either dosage regimen, not all participants could be evaluated on both low and high Adderall doses. Including all valid data and not excluding participants with missing results is in keeping with standard practice for the analysis of randomized clinical trials and helps to avoid possible biases that might otherwise be introduced if, for example, the participants most likely to complete the trial19 were those with the best response. To determine an estimated efficacy rate using incomplete data, an Estimation Manifestation algorithm was used to compute maximum likelihood estimates.20 Confidence limits on the maximum likelihood estimates were determined using the bootstrap method.21
Efficacy rates by gender and age group were compared using
2 tests. The differences in individual side
effect rates were evaluated using the Wilcoxon signed-rank tests,
without adjustment for multiple comparisons. The Wilcoxon rank-sum test
was used to perform crossover analyses22 of differences in
the continuous rating scales for Adderall versus placebo,
and Hodges-Lehmann23 estimates of the treatment effect
were computed with approximate 95% confidence limits. 
statistics
were used as a means of validating the narratives by determining their
association with the better established rating scales. Analyses were
deemed statistically significant at the 5% level of significance
(P < .05). Data management and analyses were performed
using SAS software (SAS, Cary, NC).24
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RESULTS |
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Top
Abstract
Methods
Results
Discussion
Conclusion
References
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Demographics
A total of 154 children met diagnostic criteria for entrance into the study. Participants ranged in age between 5 and 16 years; 113 of the participants (73%) were boys and 41 (27%) were girls. Given the clinic's location in a rural, agricultural setting, nearly all of the patients enrolled in the study were white. The majority of the participants were in a regular classroom; 18 (12%) were enrolled in exceptional educational needs programs such as a learning disabled or an emotionally disabled program. Nuclear family history of ADHD, learning disabilities, or depression was reported in 41 participants (27%). The demographic data are presented in Table 3.
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The majority of children (n = 76; 49%) were diagnosed with the combined type of ADHD; 56 (36%) with the inattentive type; and 22 (14%) with the hyperactive/impulsive type of ADHD. Diagnostic and comorbidity data are presented in Table 4.
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Efficacy
Of the 154 children enrolled in this study, 115 had complete data for all dosing regimens throughout the 4-week duration of the trial. Both parent and teacher response data were available for another 28 patients for at least 1 of the 2-week comparison periods (low or high dose). Therefore, the total number of children with response data available for both observers on at least 1 dose was 143 of the 154 children enrolled.
The simple estimates of Adderall efficacy rates for all participants evaluated during at least 1 (high or low) dosing regimen were as follows: 54% (78/143) based on the response by the strict criteria (parent and teacher concur); 81% (121/149) based on parent response criteria; and 73% (106/146) based on teacher response criteria. A detailed breakdown of patient response is illustrated in Fig 3. Overall, 137 of 154 participants (89%) displayed a positive response to Adderall by either parent or teacher criteria.
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The maximum likelihood estimates of efficacy were similar to simple estimates of efficacy based on participants for whom complete data were available. The maximum likelihood estimates (efficacy rates adjusted for missing data) were 59% based on the strict response criteria; 82% based on parent response criteria; and 77% based on teacher response criteria.
No significant difference in Adderall efficacy rates was found among genders or ADHD diagnostic subtypes. A statistically significant difference in the efficacy rate of Adderall was found among the 3 age groups (P = .036). Children 5 to 7 years of age had an efficacy rate based on the strict criteria of 60% versus 71% for children 8 to 9 years of age and 48% for children 10 years of age and older. These results are presented in Table 5.
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Utility of the Narratives
Of collateral interest was the utility of the structured narrative
in measuring response. statistics were used to measure the
agreement with respect to response of the parent and teacher narratives
with the corresponding continuous rating scales. In all cases, the
narratives were significantly associated with the continuous measures,
with ranging from .48 to .66.
The effect of the narratives on the observed response rates was determined by recalculating response without the narratives. This left only a single measure of response for the parent observer (the CPRS Hyperactivity Index), which reduced the parent response such that 54 rather than 78 participants were responders by the strict response criteria. Elimination of the narrative had less impact on the teacher response, however, which involved 4 other measures; the overall response by either parent or teacher would have declined by only 5 responders, reducing the overall response from 137/154 (89%) to 132/154 (86%).
Adderall Effects on Rating Scales
The general effects of Adderall on the continuous rating scales used to measure response were evaluated in both the low- and high-dose periods. All 5 scales showed highly significant (P < .001) improvement on both low- and high-dose Adderall. Table 6 presents estimates of the overall treatment effect with 95% confidence limits. The estimates all show improvement on Adderall (median decreases in the Conners' scales and median increases in the ACTeRS scales). The estimated treatment effects on high dose were larger for all scales and were significantly larger for all but the CPRS Hyperactivity Index.
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Side Effect Profile
Appetite, stomachaches, and insomnia were rated as worse by parents while children were receiving either the high or low dose of Adderall, compared with placebo. Decreased appetite and insomnia were much more of a problem on the high dose than on the low dose. When children were receiving either dose of Adderall, staring/daydreaming was rated as improved by parents. Sadness/unhappiness as well as euphoria were rated as improved while children were receiving the low dose of Adderall, and while children were receiving the high dose of Adderall, anxiety and irritability were rated as improved. These results are illustrated in Figs 4 and 5.
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Occurrence of these side effects was found to be similar by gender and diagnostic group. When side effects were evaluated by age group, insomnia was reported significantly more often in the 10 years of age and older group than in the younger age groups while on the high dose of Adderall (P = .011). One participant dropped out of the study because of changes in the preexisting tic disorder.
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DISCUSSION |
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Top
Abstract
Methods
Results
Discussion
Conclusion
References
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The Adderall response rate in this study ranged from 59% when requiring concurrence between parent and teacher observers, to 82% when based on parent criteria alone. This is consistent with the commonly reported response rate of approximately 70% for any one stimulant medication used in the treatment of ADHD.2,25 This efficacy rate is also consistent with the rate observed in our investigation of Ritalin14 that used the same response criteria and study design. The placebo-controlled, within-subject, crossover methodology used in this trial accounts for any placebo response by defining a positive response to Adderall as improvement greater than that observed during the corresponding placebo regimen. The estimates of stimulant efficacy commonly reported in the literature apply to group effects, whereas the placebo-controlled, crossover design used herein informs the clinician about response in the individual patient.
The strict response criteria used in this investigation to define
response to Adderall required that a child's behavioral improvement be documented in 2 environmentsthe classroom setting as
well as the home. Studies in which higher efficacy rates were reported
typically documented behavioral improvement in only one of these
settings. In our study, the estimated efficacy rate for Adderall was 82% based on parent criteria alone and 77%
based on teacher criteria alone. These higher efficacy rates based on behavioral improvement in only one domain are consistent with other
literature reports. Our use of the stringent criteria requiring behavior improvements in both school and home environments was based on
the fact that ADHD is a pervasive disorder affecting multiple domains
of functioning, and Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition criteria require that symptoms be
present in at least 2 of 3 contexts. The recent practice guidelines of
the American Academy of Pediatrics strongly suggest that data from 2 environments be included in making treatment decisions.27
Ideally, efficacy of a stimulant or any other medication or
intervention for the treatment of ADHD should be based on response in
more than one domain. However, literature reports reveal that depending on the behavioral dimension being rated, the degree of concurrence between parents and teacher may be modest, ranging between .30 and
.50.26 Therefore, the efficacy of any stimulant medication
based on concurrence of parent and teacher response data is likely to
be lower than the commonly reported response rate of 65% to 75% that is based on parent, teacher, and/or research raters.26 In
the current trial, Adderall efficacy rates based on parent or teacher response criteria were similar to the commonly reported response rates for other stimulant medications.
No significant differences in Adderall efficacy rates were found among genders or ADHD diagnostic subtypes. However, analysis was limited by the small sample size in each category. Future investigations may clarify the existence of any differences in efficacy rates of stimulants by gender or diagnosis. In addition, the limited variation in ethnicity (nearly all participants were white, with a small number of American Indian participants), may limit generalizability of the findings.
Statistically significant differences in Adderall efficacy were found among age groups. In the group of children 8 to 9 years of age, 71% responded to Adderall, whereas children 5 to 7 years of age had an efficacy rate of 60%, and 48% of children 10 of age and older responded. Although these findings are statistically significant, the clinical significance of this differential efficacy rate by age is difficult to interpret without replication of these findings.
A possible limitation of the crossover design used in this study was the potential for carryover or halo effects to attenuate the observed treatment response. Given the short half-life of Adderall, such carryover would not be expected to result from the drug itself but might result from observer bias. For example, if a child took Adderall in week 1 and responded well, an observer might react so positively that favorable ratings would persist into week 2, reducing the observed response to Adderall. It is considered that these effects would be minimized, however, by the fact that evaluations were obtained at the end of the week. Statistical tests of the rating scales showed no evidence of carryover, although such tests have limited statistical power.28
The side effect profile of Adderall seems to be similar to that of other psychostimulants.14,17,29 Appetite suppression, stomachache, and sleep disturbances occurred during both Adderall dosage regimens. Headaches were reported more frequently when children were receiving the higher dose of Adderall, indicating that this side effect may be dose-dependent.
Three of the behaviors considered to be side effects according to the modified BSEQ actually improved while children were receiving Adderall. Parents reported that anxiety, irritability, and staring/daydreaming occurred less frequently when children were receiving the higher dose of Adderall. Similar findings were reported in our evaluation of Ritalin side effects,14 and 2 of these behaviors (daydreaming and anxiety) were also noted by Barkley et al17 to improve with Ritalin treatment. Overall, these findings indicate that anxiety, irritability, and staring or daydreaming may not be side effects of stimulant medications, but rather symptoms or behaviors of ADHD. Compared with the younger children, higher doses were required for patients >10 years of age for improvement in symptoms of anxiety or irritability. Although we found that the higher dose resulted in improvement of these symptoms, insomnia was then reported more frequently in this age group, compared with the younger children. We plan to reevaluate the side effect profile of Adderall and to look more extensively at subgroup comparisons as our patient population on Adderall and follow-up experience increase.
The adverse effects of stimulant medications tend to be relatively
mild and Adderall does not differ in this respect.
The adverse effects associated with Adderall in this study
were similar to those reported for other stimulant
medications.14,17,29 The transition from medication to
placebo week was not associated with any negative side effects. The
adverse effects of stimulant medications are well known to physicians
and management of these side effects is not complicateda dose
reduction, dose division, or a change in the time of dosage
administration is often sufficient to alleviate any problems. In some
cases, a switch to a different stimulant medication may be required
because of the intraindividual and interindividual variation in terms
of the frequency and severity of stimulant side effects. During
comparison trials of Adderall and methylphenidate, Pelham
and colleagues6,7 noted that side effects of both
stimulants dissipated with continued treatment. Use of a stimulant side
effect rating scale such as the BSEQ (Fig
6) before initiation of stimulant therapy can provide the physician with a baseline against which parental reports of stimulant side effects can be measured.
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In addition to efficacy and potential side effects, 2 other factors should be considered when prescribing a stimulant medication: compliance and security. First, patients struggle with compliance to the 2 times or 3 times daily dosing schedules typically associated with methylphenidate. Compliance is especially difficult for many adolescent patients. Second, schools typically cannot provide a secure environment for storage of a schedule II medication. This factor is of great concern to parents and school officials given the potential for abuse of stimulant medications by youth not diagnosed with ADHD.30 The longer duration of Adderall may make it the preferred stimulant for many youth diagnosed with ADHD.
Further investigations are necessary to address optimal dosing regimens, compliance, and long-term efficacy of Adderall. The recently released National Institutes of Health Consensus Development Conference Statement on ADHD31 emphasized the paucity of long-term prospective controlled studies that address the safety and efficacy of stimulant medications in children and adolescents. We believe that the methodology described herein can be adapted to determine long-term maintenance of response to psychostimulants for the treatment of ADHD. We have initiated an extensive, longitudinal follow-up investigation designed to determine the maintenance of behavioral response to Adderall among our patients. A new or rechallenge double-blind, placebo-controlled, crossover trial (after a week of washout), will be initiated with participants 18 to 24 months after the initial efficacy trial for this purpose.
Effective treatment of ADHD requires compliance as well as response to the medication. We believe that adaptation of our methodology to include measures of medication compliance will demonstrate that improved long-term outcomes are caused by the stimulant medication itself.
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CONCLUSION |
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Top
Abstract
Methods
Results
Discussion
Conclusion
References
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This study demonstrates that Adderall is highly efficacious in youth newly diagnosed with ADHD. In this trial, >80% of our patients exhibited a positive response to Adderall. The number of side effects that increased while participants were receiving Adderall was small and was limited to stomachache, appetite suppression, sleep disturbances, and headaches. Behaviors including anxiety, irritability, and daydreaming improved while patients were receiving Adderall. For all of these reasons, Adderall is a good option for primary care physicians when considering medical management alternatives for the treatment of youth with ADHD.
Additionally, this study replicated our previous finding that a randomized, placebo-controlled, double-blind trial is a viable methodology for the study of treatment options in children with ADHD in a naturalistic setting. Future research is necessary to better delineate long-term efficacy rates of Adderall and optimal dosing regimens.
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ACKNOWLEDGMENTS |
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Funding for this analysis was underwritten through a grant from Shire Richwood Inc.
The efforts of Pamela S. Mundt and Deborah Tauschek as study coordinators, Carla Finck in management of the study database, and Kejian Liu, PhD, in calculation of the maximum likelihood estimates are gratefully acknowledged.
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FOOTNOTES |
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Preliminary results of this study were presented at the following meetings: American Academy of Neurology; April 6, 1999; Toronto, Canada; Child Neurology Society; October 22-24, 1998; Montreal, Canada; CHADD's Annual International Conference on ADHD; October 15-17, 1999; Washington, DC; and the American Academy of Child and Adolescent Psychiatry; October 21, 1999; Chicago, IL. Abstract of preliminary results was published in Neurology. 1999;52(suppl 2):A154
Received for publication Feb 10, 2000; accepted Sep 7, 2000.
Reprint requests to (P.A.A.) Department of Neurology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449. E-mail: ahmannp{at}mfldclin.edu
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ABBREVIATIONS |
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ADHD, attention-deficit/hyperactivity disorder; ACTeRS, ADD-H Comprehensive Teachers' Rating Scale; CTRS-28, Conners' Teachers' Rating Scale (28 items); CPRS-48, Conners' Parent Rating Scale (48 items); BSEQ, Barkley Side Effects Questionnaire; CBCL, Child Behavior Checklist; SD, standard deviation.
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REFERENCES |
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Strict
criteria require that response criteria by both parent and teacher must
be met at the same dose.
) show means
that are significantly different from zero (P < .05).
