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Ritalin May Aid Cognition After Childhood Cancer.

Ritalin (methyiphenidate) shows promise for treatment of attention problems in child survivors of acute lymphoblastic leukemia or malignant brain tumors, Dr. Stephen J. Thompson and his colleagues reported.

Standard tests for intelligence, anxiety, depression, and attention were performed in survivors of either acute lymphoblastic leukemia or malignant brain tumors, which are the two most common childhood cancers. To be eligible to participate in the randomized, double-blind, placebo-controlled trial, the children had to be 6-18 years old and have an estimated intelligence quotient greater than 50. Among other things, participants also were required to have academic achievement in the 16th percentile or lower in reading, math, or spelling and an attention deficit in the 16th percentile or lower.

Investigators used several measures to test for the criteria, including the Abbreviated Wechsler Intelligence Scale (tests for global IQ); the Child Behavior Checklist (anxiety/depression); and the Abbreviated Wechsler Individual Achievement Test (academic performance).

A total of 32 patients ranging in age from 0.5 to 12.5 years at diagnosis were eligible to participate in the study. The Ritalin group, which included 15 patients, received from 0.6 mg/kg to 20 mg of the drug daily (J. Chin. Oncol. 19[6]:1802-08, 2001).

As a primary outcome measure, Dr. Thompson of St. Jude Children's Research Hospital, Memphis, and his colleagues evaluated whether Ritalin improves performance on the Conners Continuous Performance Test (CPT), a 15-minute test that presents letters one at a time on a computer screen and requires participants to hit the space bar for every letter they see, except "X". Errors of omission on this test are believed to indicate inattentiveness, and the test is often used to diagnose attention-deficit and hyperactivity disorder.

The improvement in errors of omission was significantly greater for the Ritalin group than for those receiving the placebo. Fourteen of 15 patients receiving Ritalin had fewer such errors, compared with 10 of 17 in the placebo group.

But the effect of Ritalin may be somewhat limited; there was no significant difference between the two groups in terms of errors of commission, defined as failure to withhold from hitting the space bar when an "X" appeared.

If CPT performance improved, researchers administered the California Verbal Learning Test and Visual Auditory Learning tests to further assess the potential cognitive benefits of treatment. But no significant difference in verbal learning or reading retention was observed between the two groups.

Survivors of childhood acute lymphoblastic leukemia and malignant brain tumors are at risk of delayed cognitive defects from previous treatment directed at their central nervous systems. The researchers concluded that, based on their preliminary data, Ritalin improves the ability to sustain attentiveness in this population. Ritalin does not, however, improve participants' ability to inhibit impulsive responses on the CPT, nor does it significantly improve response times. "This diverse pattern of methylphenidate effects suggests that although attention problems may be reduced, other cognitive deficits may not be improved by methylphenidate treatment," the authors noted.

More research is needed to show a sustained response to treatment with Ritalin to justify continued use in these patients, and to evaluate the efficacy of such therapy in home and school environments, the investigators reported.
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Publication:Clinical Psychiatry News
Article Type:Product/Service Evaluation
Date:Aug 1, 2001
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