The Better Dose of ADHD Stimulant Medication to Help Cognitive Performance is a Low Dose
For Inattentive ADD the best dose of ADHDmedication is a low dose. The adage that is used to treat ADHD-PI is, "Start low and go slow". It turns out that the Inattentive ADD medication recommendations of low dose stimulants may be the best treatment for ADHD Combined type as well! A very interesting study was just completed and published in the March-April edition of the Journal of Learning Disabilities and the findings point to this conclusion. The researchers of this study gathered kids that had been diagnosed as Inattentive ADD, Combined type ADHD or Hyperactive/Impulsive ADHD. They then rated each participant's executive function and working memory function and impulsive behavior and then labeled the study participants as significantly impaired if they had 'cool' (low) working memory function and 'hot' (high) impulsive behavior scores.
We know from many other studies that kids and adults with Inattentive Attention Deficit (ADHD-PI) have low impulsive behavior scores and low working memory/executive functioning or executive function scores while the Combined type ADHD kids have greater impulsive behavior scores and low executive function and working memory scores. After rating the participants they started them of either low dose or significantly higher dose Ritalin. What they found was that the participants who responded the most beneficial to any dose of stimulants such as Ritalin were those kids with higher impulsive behavior and low working memory scores, the Combined ADHD kids.
What was most interesting from this study however was that while the greater doses of Methylphenidate significantly helped the impulsive behavior aspect of the ADHD, the working memory or neuropsychological functioning of all the participants suffered at the higher doses of Ritalin. This is what the authors of the report, entitled "Executive impairment determines ADHD medication response: implications for academic achievement", concluded; "Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the most improving dose for behavior. "
What this all means in English is that all our ADHD kids, not just the Inattentive ADD kids would perform better, from a cognitive or executive functioning point of view, on lower doses of Methylphenidate. What this means from a practical standpoint is that if we want our combined type kids to shine cognitively, we have to figure out another way to manage their impulsive behavior. The authors conclude that their "Findings offer one possible explanation for why long-term academic MPH (stimulants such as Ritalin) treatment gains in ADHD have not been realized." Studies such as these will help people with Inattentive ADD because it will give the ADHD intervention researchers a stronger motive to find treatments that improve cognitive functioning rather than diminish it.
Those of us with Inattentive ADD kids and those of us with Inattentive ADD have not been served well by medications that have focused on fixing the behavioral issue of Combined type and Hyperactive/Impulsive ADHD. When we find Inattentive ADD treatments that focus on cognitive improvement, the entire ADHD community will benefit from them.
We know from many other studies that kids and adults with Inattentive Attention Deficit (ADHD-PI) have low impulsive behavior scores and low working memory/executive functioning or executive function scores while the Combined type ADHD kids have greater impulsive behavior scores and low executive function and working memory scores. After rating the participants they started them of either low dose or significantly higher dose Ritalin. What they found was that the participants who responded the most beneficial to any dose of stimulants such as Ritalin were those kids with higher impulsive behavior and low working memory scores, the Combined ADHD kids.
What was most interesting from this study however was that while the greater doses of Methylphenidate significantly helped the impulsive behavior aspect of the ADHD, the working memory or neuropsychological functioning of all the participants suffered at the higher doses of Ritalin. This is what the authors of the report, entitled "Executive impairment determines ADHD medication response: implications for academic achievement", concluded; "Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the most improving dose for behavior. "
What this all means in English is that all our ADHD kids, not just the Inattentive ADD kids would perform better, from a cognitive or executive functioning point of view, on lower doses of Methylphenidate. What this means from a practical standpoint is that if we want our combined type kids to shine cognitively, we have to figure out another way to manage their impulsive behavior. The authors conclude that their "Findings offer one possible explanation for why long-term academic MPH (stimulants such as Ritalin) treatment gains in ADHD have not been realized." Studies such as these will help people with Inattentive ADD because it will give the ADHD intervention researchers a stronger motive to find treatments that improve cognitive functioning rather than diminish it.
Those of us with Inattentive ADD kids and those of us with Inattentive ADD have not been served well by medications that have focused on fixing the behavioral issue of Combined type and Hyperactive/Impulsive ADHD. When we find Inattentive ADD treatments that focus on cognitive improvement, the entire ADHD community will benefit from them.
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