Abstract / Description of output
Research has shown that 20–30% of prisoners meet the diag-
nostic criteria for attention-deficit hyperactivity disorder (ADHD).
Methylphenidate reduces ADHD symptoms, but effects in pris-
oners are uncertain because of comorbid mental health and
substance use disorders.
To estimate the efficacy of an osmotic-release oral system
methylphenidate (OROS-methylphenidate) in reducing ADHD
symptoms in young adult prisoners with ADHD.
We conducted an 8-week parallel-arm, double-blind, rando-
mised placebo-controlled trial of OROS-methylphenidate versus
placebo in male prisoners (aged 16–25 years) meeting the DSM-5
criteria for ADHD. Primary outcome was ADHD symptoms at 8
weeks, using the investigator-rated Connors Adult ADHD Rating
Scale (CAARS-O). Thirteen secondary outcomes were measured,
including emotional dysregulation, mind wandering, violent atti-
tudes, mental health symptoms, and prison officer and educa-
tional staff ratings of behaviour and aggression.
In the OROS-methylphenidate arm, mean CAARS-O score at 8
weeks was estimated to be reduced by 0.57 points relative to the
placebo arm (95% CI −2.41 to 3.56), and non-significant. The
responder rate, defined as a 20% reduction in CAARS-O score,
was 48.3% for the OROS-methylphenidate arm and 47.9% for the
placebo arm. No statistically significant trial arm differences
were detected for any of the secondary outcomes. Mean final
titrated dose was 53.8 mg in the OROS-methylphenidate arm.
ADHD symptoms did not respond to OROS-methylphenidate in
young adult prisoners. The findings do not support routine
treatment with OROS-methylphenidate in this population.
Further research is needed to evaluate effects of higher average
dosing and adherence to treatment, multi-modal treatments and
preventative interventions in the community.
Keywords / Materials (for Non-textual outputs)
- randomised controlled trial
- attention-deficit hyperactivity disorders
- forensic mental health services