Change in vital parameters at first methylphenidate administration as a predictor of clinical response at six-months follow-up

ADHD is a neurodevelopmental disorder characterized by inappropriate levels of attention, hyperactivity and impulsivity affecting with social, personal and educational functioning. Structural, functional, and neurobiological abnormalities underlie ADHD symptoms and should be considered in therapeutic interventions. International guidelines recommend cognitive behavioral therapy, parent training, and pharmacological treatment, primarily methylphenidate. While methylphenidate enhances treatment efficacy, about 30% of patients show poor response, and no reliable biomarkers for treatment prediction exist. Evidence suggests that methylphenidate increases blood pressure, correlating with attentional improvements and neurobiological changes in ADHD. Blood pressure could thus serve as a low-cost, accessible predictor of methylphenidate response. The aim of this study was to explore whether a change in basic vital parameters like heart rate and blood pressure after a single methylphenidate administration can predict methylphenidate response in children and adolescents with ADHD after 6 months of drug treatment. In this context, data on vital parameters and severity of symptoms made during the first single-dose methylphenidate administration and at 6-month methylphenidate monotherapy were retrieved from patients' medical records. Our results showed that greater blood pressure increases during methylphenidate single dose administration were associated with a greater reduction in ADHD-symptoms after six-months methylphenidate treatment. Our results could help in manage the risk-benefit ratio in pharmacological treatment of ADHD, thus improving tailored-to-patients drug indications.