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Sustained-Release Concerta (Methylphenidate) May Improve ADHD Teens' Driving Performance: Presented at AACAP

By Paula Moyer
Special to DG News

SAN FRANCISCO, CA -- The driving performance of adolescents with attention-deficit/hyperactivity disorder (ADHD) may be affected by the use of immediate release or sustained release methylphenidate (Concerta).

"Motor vehicle accidents are the leading cause of death in adolescents, and the rate for such deaths is four times higher for adolescent drivers with ADHD," said Dr. Daniel J. Cox, a professor of psychiatric medicine at University of Virginia, in Charlottesville, Virginia, United States.

"The key ADHD-related problem that affects their driving is inattention. However, when treated with stimulant therapy, they drive as well as those without this condition."

In research presented here October 27 at the 49^th annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), Dr. Cox's team found that a sustained-release formulation of methylphenidate is associated with continued attentive driving into the evening hours. On the other hand, impairments are more likely to become manifest during night-time driving when the patients take an immediate-release formulation (Ritalin), because the medication's effects start to diminish in the evening hours.

The team of investigators compared the effects of the two formulations on driving performance throughout the day among adolescent drivers who had ADHD. They recruited six male adolescents who had ADHD and who drive routinely and measured driving performance in simulated driving performances four times throughout two different days, at 2 pm, 5 pm, 8 pm, and 11 pm. On one day the participant was on the immediate-release version of methylphenidate and on the other day the participant was on the sustained-release version, taken once daily.

The investigators generated an "Impaired Driving Score" (IDS) based on z-scores for each participant's performance. They found that the IDS worsened throughout the day when participants were taking the immediate-release formulation but remained stable when they were taking the sustained-release formulation (F=9.3, df = 1, p=0.004). Treatment comparisons at specific time intervals revealed significantly better performance for the sustained-release formulation at 8 p.m. (p=0.01).

For young drivers who are taking an immediate-release medication, physicians can counsel the patient and his or her parents that an extra dose in the evening may be appropriate, said Dr. Cox.

However, the logistics of taking an extra pill are challenging psychologically for adolescents," he said. "They don't want to feel different from their peers. Therefore, a sustained-release formulation, which is only taken once daily, may enable them to avoid feeling different, and yet adhere to their medication regimen and drive safely."

The study was funded by McNeill Consumer & Specialty Pharmaceuticals, the manufacturers of Concerta.

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