Methylphenidate selectively improves story retelling in children with attention deficit hyperactivity disorder

Objectives: The goal of this study was to determine stimulant effects on st ory grammar, comprehension, and errors in the narratives of children with a ttention deficit hyperactivity disorder (ADHD) with and without comorbid la nguage impairment. Previous research has demonstrated impairments in the na rrative abilities of children with ADHD, but the effect of the primary trea tment modality (methylphenidate) is unknown. Methods: Fifty children with ADHD (7 to 12 years of age) were stratified fo r language impairment that might influence performance. In an acute, random ized, placebo-controlled crossover trial with two single doses (10 and 20 m g) of methylphenidate, the children listened to an audiotaped story while v iewing a wordless picture book of the study, then retold the story and answ ered comprehension questions. The narratives were transcribed and coded for story grammar, length, and errors. Results: Methylphenidate only increased children's reporting of the story c haracters' internal responses and attempts. It had no effect on story lengt h or responses to comprehension questions. Responses to the factual questio ns were significantly more accurate than the inferential questions, irrespe ctive of medication dose. Comorbid language impairment had no effect on per formance or stimulant response. Conclusion: Story grammar analysis was sensitive to drug effects, which wer e subtle but specific and clinically meaningful. Results provide evidence f or the theoretical linkage between internal responses and attempts.