The Role of Methylphenidate and Aripiprazole in the Treatment of Emotion Dysregulation in Children With ADHD.

Purpose: In this study, we examined the effectiveness of methylphenidate on emotion dysregulation among children with attention-deficit/hyperactivity disorder (ADHD), and the strategy of switching to or adding aripiprazole for nonresponders.

Methods: We conducted a 3-step, 10-week, open-label trial including children (6-18 years old) with ADHD and emotion dysregulation, defined according to the Child Behavior Checklist-Dysregulation Profile. In step 1, patients received methylphenidate treatment for 4 weeks. In step 2, nonresponders were started on aripiprazole treatment for 4 weeks. Nonresponders in step 2 entered step 3, receiving a combination of methylphenidate and aripiprazole for 2 weeks. The primary outcome was the change from baseline in emotion dysregulation, assessed using the irritability subscale of the Aberrant Behavior Checklist. Secondary outcomes included the change from baseline in ADHD symptoms, cross-domain-associated symptoms, adaptive functioning, and neurocognitive profiles.

Results: Among the 30 enrolled patients, 22 (73.3%) responded to methylphenidate (group MR), while 8 entered step 2 (aripiprazole treatment for methylphenidate nonresponders; group MN). In step 2, 5 patients responded to aripiprazole, while 2 patients entered step 3 and received methylphenidate plus aripiprazole. Patients who responded to methylphenidate or aripiprazole exhibited significant improvements in emotion dysregulation (Hedges' g: 2.62 and 1.30, respectively) and school adaptation. Emotion dysregulation severity was correlated with oppositional defiant disorder symptoms, but not with core symptoms of ADHD.

Conclusions: The nature of emotion dysregulation in ADHD is heterogeneous regarding the response to methylphenidate. For most patients, methylphenidate significantly improved emotion dysregulation. Aripiprazole could be effective and safe for methylphenidate nonresponders.