Baseline performance moderates stimulant effects on cognition in youth with ADHD.

Whitney D. Fosco, Keri S. Rosch, James G. Waxmonsky, William E. Pelham, Larry W. Hawk

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Attention-deficit/hyperactivity disorder is associated with impaired cognitive functioning and increased delay discounting (i.e., a stronger preference for immediate reward). At the group level, stimulant medication improves cognition and delay discounting, yet not all children exhibit problems in these domains, and previous work has not examined whether stimulant-induced improvements are moderated by baseline performance. To address this question in the current study, 82 children with attention-deficit/hyperactivity disorder (9–12 years old) attended a week-long research camp. On the baseline day (Monday), participants completed tasks of inhibitory control, visuospatial working memory, reaction time variability, and delay discounting. Children then completed a 3-day, randomized, double-blind, placebo-controlled trial of ∼1 mg/kg and 2 mg/kg long-acting methylphenidate (mean doses = 39.1 and 74.3 mg, respectively), during which they were readministered the battery of tasks. Cognitive composites (mean of inhibitory control, working memory, and reaction time variability performance) were created for the baseline and medication evaluation phases. As predicted, the extent to which cognition was improved with medication compared with placebo and with 2 mg/kg compared with 1 mg/kg was greatest among children with poorer baseline cognitive function. Children with stronger baseline cognition exhibited less improvement with methylphenidate compared with placebo and did not benefit from the 2 compared with the 1 mg/kg dose. In contrast, medication-related improvement in delay discounting was unrelated to baseline discounting. Given that improving cognitive function is one potential mechanisms by which stimulants exert their therapeutic effects, this study has significant implications for understanding how and for whom stimulant medication works. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Public Health Significance—Among children with attention-deficit/hyperactivity disorder, this study suggests that stimulant medication markedly improves cognitive functioning for children with cognitive difficulties and that high doses of medication result in further improvement beyond standard doses. For children with relatively good cognition, medication still improved performance but to a smaller degree, and there was no additional benefit from the high dose of medication.

Original languageEnglish (US)
Pages (from-to)302-307
Number of pages6
JournalExperimental and clinical psychopharmacology
Issue number4
StatePublished - Aug 2021

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


Dive into the research topics of 'Baseline performance moderates stimulant effects on cognition in youth with ADHD.'. Together they form a unique fingerprint.

Cite this