Methylphenidate, parent training, and neuropsychological outcomes in preschool ADHD: secondary analysis of a randomized placebo-controlled trial
Abstract
Background. Methylphenidate (MPH) and behavioral parent training (BPT) are the most recommended interventions for preschoolers with attention-deficit/hyperactivity disorder (ADHD), but their effects on cognition in this age group remain understudied. This pre-registered secondary analysis of the MAPPA randomized controlled trial aimed to examine the effects of MPH and BPT on neuropsychological outcomes, each relative to an active control, and to compare the two interventions directly. Methods. Preschoolers with ADHD (N =153) were randomized to three groups: MPH plus sham parent training (n = 51), placebo MPH plus BPT (n = 51), and active control (placebo MPH plus sham parent training; n = 51). Executive functions, social cognition, and verbal abilities were assessed at baseline and after 8 weeks. Linear mixed models tested time x group interactions, adjusting for IQ, sex, age, ADHD severity, and comorbidities, with a random intercept per child, and false discovery rate (FDR) correction was applied within each cognitive domain. Trial registration: ClinicalTrials.gov NCT02807870. Results. Relative to control, MPH increased Flanker reaction times in the congruent (d = −1.00, pFDR = .009) and incongruent (d = −1.11, pFDR = .004) conditions. After correction, BPT did not differ from control, nor MPH from BPT. Within groups, only MPH showed executive improvements, with higher speed-accuracy scores (Hearts & Flowers d = 0.73; Flanker d = 0.60) and accuracy alongside slower responding. Conclusions. To our knowledge, this is the first randomized trial to compare MPH and BPT on a comprehensive neuropsychological battery in preschoolers with ADHD. Compared with an active control, 8 weeks of MPH led preschoolers with ADHD to respond more slowly on the Flanker task without loss of accuracy. Within the MPH group, combined speed-accuracy efficiency and accuracy also improved, suggesting more deliberate processing. BPT showed no detectable effect on objective cognition, and neither intervention affected social cognition or verbal abilities. Keywords: ADHD, preschoolers, methylphenidate, behavioral parent training, executive functions, social cognition, neuropsychology.
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BibTeX
@misc{teixeira2026methylphenidate,
title = {{Methylphenidate, parent training, and neuropsychological outcomes in preschool ADHD: secondary analysis of a randomized placebo-controlled trial}},
author = {Monike do Nascimento Teixeira and Marcelo Camargo Batistuzzo and Guilherme V. Polanczyk and Adriana Argeu and Eliane Correa Miotto},
howpublished = {PsyArXiv},
year = {2026},
month = oct,
doi = {10.31234/osf.io/ym7w4_v1},
url = {https://osf.io/preprints/psyarxiv/ym7w4_v1/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Methylphenidate, parent training, and neuropsychological outcomes in preschool ADHD: secondary analysis of a randomized placebo-controlled trial
AU - Monike do Nascimento Teixeira
AU - Marcelo Camargo Batistuzzo
AU - Guilherme V. Polanczyk
AU - Adriana Argeu
AU - Eliane Correa Miotto
PY - 2026
DA - 2026/10/03
PB - PsyArXiv
DO - 10.31234/osf.io/ym7w4_v1
UR - https://osf.io/preprints/psyarxiv/ym7w4_v1/
AB - Background. Methylphenidate (MPH) and behavioral parent training (BPT) are the most recommended interventions for preschoolers with attention-deficit/hyperactivity disorder (ADHD), but their effects on cognition in this age group remain understudied. This pre-registered secondary analysis of the MAPPA randomized controlled trial aimed to examine the effects of MPH and BPT on neuropsychological outcomes, each relative to an active control, and to compare the two interventions directly. Methods. Preschoolers with ADHD (N =153) were randomized to three groups: MPH plus sham parent training (n = 51), placebo MPH plus BPT (n = 51), and active control (placebo MPH plus sham parent training; n = 51). Executive functions, social cognition, and verbal abilities were assessed at baseline and after 8 weeks. Linear mixed models tested time x group interactions, adjusting for IQ, sex, age, ADHD severity, and comorbidities, with a random intercept per child, and false discovery rate (FDR) correction was applied within each cognitive domain. Trial registration: ClinicalTrials.gov NCT02807870. Results. Relative to control, MPH increased Flanker reaction times in the congruent (d = −1.00, pFDR = .009) and incongruent (d = −1.11, pFDR = .004) conditions. After correction, BPT did not differ from control, nor MPH from BPT. Within groups, only MPH showed executive improvements, with higher speed-accuracy scores (Hearts & Flowers d = 0.73; Flanker d = 0.60) and accuracy alongside slower responding. Conclusions. To our knowledge, this is the first randomized trial to compare MPH and BPT on a comprehensive neuropsychological battery in preschoolers with ADHD. Compared with an active control, 8 weeks of MPH led preschoolers with ADHD to respond more slowly on the Flanker task without loss of accuracy. Within the MPH group, combined speed-accuracy efficiency and accuracy also improved, suggesting more deliberate processing. BPT showed no detectable effect on objective cognition, and neither intervention affected social cognition or verbal abilities. Keywords: ADHD, preschoolers, methylphenidate, behavioral parent training, executive functions, social cognition, neuropsychology.
ER -