A novel methodology for monitoring pharmacological-treatment effects for adolescents and adults with attention-deficit disorder with hyperactivity in general practice
Abstract
A Quick Test of Cognitive Speed (AQT) provides a novel method for monitoring dose-effects and establishing dose-optimization for adolescents and adults with ADHD, treated in general practice. The AQT processing speed measures, recorded as total naming time (s), probe reactive and active attention and cognitive overhead. Multicenter studies validated that these measures can differentiate the effects of incremental methylphenidate doses, establish a point of reference for dose optimization, and identify non-responders to medication. Here we report the updated results from controlled dose-monitoring of 70 previously medicated adults with ADHD to illustrate the methodology. Sixty-three patients responded to treatment with methylphenidate based on reductions in naming times. Single-dimension color and form naming, with 40 randomized visual stimuli each, indicated minimal changes in reactive attention with incremental methylphenidate doses. Color-form and shift cost measures, probing active attention, indicated significant improvements first with low-dose and then with high-dose methylphenidate. For close to 50% of the responders, measures of active attention (color-form) and cognitive overhead (shift cost), calculated as [Color-Form s – (Color s + Form s)] were optimized and within the average-normal range after low-dose methylphenidate. Increasing methylphenidate doses beyond the point of dose optimization did not result in further improvements of measures of reactive or active attention or cognitive overhead. With high-dose methylphenidate, the active attention and overhead measures were reduced to within the average-normal range for all but two patients. Treatment effects were compared with methylphenidate and atomoxetine for a small sample and indicated no statistical differences. The results suggest that in general or psychiatric practice color-form combination naming times and shift costs can provide proxy measures for active attention during treatment with methylphenidate or atomoxetine.
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DOI: http://dx.doi.org/10.18103/imr.v5i7.835
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