Ineffectiveness of imipramine in children who fail to respond to methylphenidate.
Imipramine is no backup plan for kids who fail methylphenidate—stick with behavioral fixes.
01Research in Context
What this study did
Doctors gave imipramine pills to hyperactive kids who did not get better on methylphenidate.
They also gave some kids placebo pills that looked the same.
Then they watched who stayed hyper and who paid attention better.
What they found
The imipramine group looked just like the placebo group.
No drop in hyperactivity. No boost in attention.
Switching to imipramine simply did not help.
How this fits with other research
Matson et al. (2009), Cudré-Mauroux (2010), and Taylor (2002) all say the same thing: psychotropic drugs rarely beat placebo for behavior problems.
These reviews cover people with intellectual disability, but the message matches: pills are weak; behavior plans are stronger.
Alsop et al. (1992) looks like a contradiction because they got good results with ADHD kids. But they added high-dose token economies and kept the methylphenidate. The lesson: raise your behavioral ‘dosage’ before you swap drugs.
Why it matters
If a child is not responding to stimulants, do not reach for imipramine. Run a fresh functional assessment, boost reinforcement, and adjust the behavior plan first. You will save time and side-effects.
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02At a glance
03Original abstract
Ten hyperactive children who had failed to respond to methylphenidate were treated with imipramine in a placebo-controlled, crossover design. No significant drug effects were obtained either on parent and teacher ratings of the child's behavior or on the child's performance in a laboratory measure of sustained attention. Findings suggest that imipramine has limited clinical usefulness in the treatment of hyperactive children who fail to respond to methylphenidate.
Journal of autism and developmental disorders, 1980 · doi:10.1007/BF02408464