EFFECTS OF LATE-AFTERNOON METHYLPHENIDATE ADMINISTRATION ON BEHAVIOR AND SLEEP IN ATTENTION-DEFICIT HYPERACTIVITY DISORDER

Objective. This study evaluated the effects on behavior and sleep of m ethylphenidate (MPH) administered at 4 PM to children with attention-d eficit hyperactivity disorder (ADHD). Methodology. Twelve children adm itted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pe rtaining to the period from dose administration until sleep onset, wer e supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night. ResuIts. MPH resulted in markedly improved behavioral control compared with placebo; there was no differ ence between 15-mg and IO-mg MPH doses. MPH did not alter sleep latenc ies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compar ed with 15 mg of MPH and the placebo. Weight loss was apparent among 8 3% of the patients, but dinner intake did not vary with third-dose con dition. Conclusions. Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians a void a third, late-afternoon administration for fear of inducing insom nia. This study's findings show that children with ADHD derive substan tial symptom reduction from MPH administered in late afternoon, with n o untoward effects on sleep. Therefore, three-times-a-day dosing shoul d be considered for those children exhibiting ADHD symptoms in the eve ning. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep pr oblems and weight loss remains sound treatment practice.