The Novel Use of Objective Laboratory School Tasks to Measure Stress Responses in Children with ADHD

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Sharon B. Wigal, PhD; Carmen Truong, BS; Annamarie Stehli, MPH

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Postgraduate Medicine:

Volume 124 No. 5


Clinical Focus

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DOI: 10.3810/pgm.2012.09.2593
Objective: To pilot the novel use of 2 existing laboratory school measures—the Permanent Product Measure of Performance (PERMP) and the Grammar Task—as provoking stimuli of stress, and to observe the effects of medication and stress on children with attention-deficit/hyperactivity disorder (ADHD). Methods: Children received individually determined optimal doses of an oral methylphenidate stimulant medication on 1 of 2 consecutive modified laboratory school days, which is a setting that is known for being a reliable measure of the exact timing of treatment effects. Blood pressure and heart rate measurements collected after administration of the PERMP, an ability-adjusted math test, were presumed to be stress related when compared with baseline data. In addition, children ranked their stress levels on a stress rating scale and completed the Grammar Task as a measure of academic performance. Results: Seven subjects enrolled in and completed the study. The results suggest that children with ADHD demonstrate a decreased stress response when medicated, as measured by blood pressure, heart rate, and academic performance. Conclusion: Completion of a more difficult PERMP was associated with an increased stress response. This study supports an expanded use of both the PERMP and Grammar Task. Future controlled studies should include larger samples and other indicants of stress responses, particularly peripherally circulating catecholamine levels.

Keywords: ADHD; PERMP; academic measurement; laboratory school; methylphenidate; stimulant medication; prodrug