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Many adults with current impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) do not report an age at onset before 7 years of age and cannot, therefore, be assigned the full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of ADHD. We hypothesized that treatment with oral-release osmotic system (OROS) methylphenidate (MPH) will be safe and efficacious for the treatment of adults with late-onset ADHD.
Method
This was a 6-week, open-label, prospective treatment study of OROS MPH monotherapy in 36 adult patients with late-onset ADHD (onset later than the required 7 years of age) using standardized instruments for diagnosis and a robust oral daily dose of up to 1.3 mg/kg/day. Symptom severity was assessed with the Adult ADHD Investigator Symptom Report Scale (AISRS) and the Clinical Global Impression (CGI) scale.
Results
Subjects reported robust current symptoms of ADHD at pre-treatment baseline (11.1±2.8 DSM-IV symptoms), but had an atypical mean age at onset of 14.2±8.6 years. Treatment with OROS MPH at an average daily dose of 78.2±29.4 mg was associated with a statistically and clinically significant reduction in ADHD symptoms relative to baseline as assessed through the AISRS (−16.4±10.5; P<.001). Using a categorical definition of response (CGI-I much or very much improved), a majority (n=26; 72%) of subjects were rated as improved at endpoint.
Conclusion
These results extend previous findings in adults with full ADHD to adults meeting criteria for late-onset ADHD and support the need for further controlled clinical trials in this population.
Hans Jacob Christoffel von Grimmelshausen (ca. 1621-1676) is the most significant (and still readable) author of seventeenth-century German novels. His Abenteuerlicher Simplicius Simplicissimusremains the one German novel of its time that has attained the stature of "world literature": its unique mix of violent action and solitary reflection, its superlative humor, its realistic portrayalof a peasant turned soldier turned hermit has made it the longest-running bestseller in German literature. Read by students and scholars in comparative literature, history, and German, and by those interested in the development of the picaresque novel in Europe, the work and its "Continuations" have increasingly occupied scholars around the world, who have in recent years shown it to be a work ofsubtle structure and characterization, bearing the imprint of the most advanced political thinking of the time, and showing the influences of some of the most significant works of world literature, including Cervantes' Don Quixote and Barclay's Argenis. This volume of essays by leading Grimmelshausen scholars from Germany, the United States, and England provides analyses of significant topics in his life and works, including questions of genre, structure, satire, allegory, narratology, political thought, religion, morality, humor, realism, and mortality. Contributors: Christoph E. Schweitzer, Italo Michele Battafarano, Klaus Haberkamm, Rosmarie Zeller, Andreas Solbach, Dieter Breuer, Lynne Tatlock, Peter Hess, Shannon Keenan Greene, and Alan Menhennet.
KarlF. Otto is Professor of German at the University of Pennsylvania and has written extensively on German Baroque literature.