Methylphenidate Discontinuation and Reinitiation during Long-Term Treatment of Children with Tourette's Disorder and Attention-Deficit Hyperactivity Disorder: A Pilot Study

Mark A. Riddle, Kimberly A. Lynch, Lawrence Scahill, Annelou Devries, Donald J. Cohen, James F. Leckman

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Abstract

The purpose of this study was to assess the effect of long-term treatment with methylphenidate (MPH) on tic symptom frequency and severity. Five boys, ages 8 to 14 years, with Tourette's disorder and attention-deficit hyperactivity disorder were studied in an ON, OFF, ON design. Subjects were admitted to a research unit for observation and videotaping. At Visit 1, blinded 5-min tic counts and nonblinded clinicians' tic ratings (Challenge-Yale Global Tic Severity Scale [C-YGTSS]) were obtained at 7 time points throughout the day, while subjects continued to take their clinically prescribed doses of MPH (mean daily dose 0.5 mg/kg, range 0.2 to 1.0). MPH was discontinued following Visit 1. Two weeks later each subject was readmitted for Visit 2, which was identical to Visit 1 except that no MPH was given. MPH was then reinitiated, and each subject was readmitted 4 weeks later for Visit 3. Mean blinded tic counts and C-YGTSS scores were significantly higher at Visits 1 and 3 (on MPH) than Visit 2 (off MPH). Clinically meaningful changes were observed in all five subjects. Tic frequency and severity diminished after discontinuation of MPH for 2 weeks and increased after reinitiation of MPH for 4 weeks, despite the relatively low doses employed. Further study is required to reconcile these findings with other recent short-term treatment studies that have found no consistent effect of stimulant medication on tic severity. For now, caution and close monitoring appear warranted when children with tic disorders receive long-term treatment with stimulant medication.

Original languageEnglish (US)
Pages (from-to)205-214
Number of pages10
JournalJournal of child and adolescent psychopharmacology
Volume5
Issue number3
DOIs
StatePublished - Jan 1 1995

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health
  • Pharmacology (medical)

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