From research to clinical care: optimizing medication strategies for ADHD

The overall aim of this dissertation was to to advance our understanding regarding current problems in pharmacological treatment of children with ADHD resulting in practical recommendations for clinical implementation. This resulted in the development of a Placebo controlled Titration (PCT) protocol that can be used successfully in clinical practice and that shows advantages of better detection of children who do not benefit from MPH treatment compared titration as usual. Our studies also resulted in further insights on factors influencing clinical improvement with MPH, revealing that higher doses did not universally lead to greater improvement. Furthermore, it was clearly shown that non-specific effects contributed to symptom improvement as reported by parents, possibly partly caused by ‘regression to the mean effects’. Practical recommendations for clinical care were derived from the findings, combined with two other Dutch studies we integrated in the overview in chapter 5. Our meta-regression analyses demonstrated the superiority of MPH over placebo in improving ADHD symptoms and neurocognitive functions, although the effect sizes varied across functions and doses, with for some functions (ADHD symptoms and lower-order neurocognitive functions) clear linear effects of dose.