ArticleNeuropsychiatric disease and treatment2026
The Effect of Drug Holidays on Metacognitive and Theory of Mind Skills of Children Diagnosed with Attention Deficit Hyperactivity Disorder: Preliminary Findings.
Article in Neuropsychiatric disease and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: This study aimed to evaluate the impact of summer drug holidays on metacognitive and theory of mind (ToM) skills in children with Attention-Deficit/Hyperactivity Disorder (ADHD) treated with methylphenidate (MPH). Methods: A naturalistic, prospective study was conducted at a child psychiatry outpatient clinic. Fifty-six treatment-naïve children or those restarting treatment after >6 months (aged 9-17, 76.8% male) with ADHD were enrolled. Participants were assessed at baseline, after two months of MPH treatment, and after a two-month summer drug holiday. Assessments included the Clinical Global Impressions-Severity (CGI-S) scale, the DSM-IV-Based Screening Scale for Disruptive Behavior Disorders (D-S-DBD), the Faux-Pas Test (FPT), the Test of Perception of Affect via Nonverbal Cues (TPANC), and the Metacognition Questionnaire for Children (MCQ-C). Attrition was high; only 12 children (21.4% of original sample) completed the full protocol. Analyses were conducted for both completers and the full sample using the Last Observation Carried Forward (LOCF) method. Results: MPH treatment significantly improved CGI-S, parent-rated hyperactive/impulsive and oppositional symptoms, and performance on FPT and affect perception tasks (all p<0.05). In the completer sample, the gains in ToM and affect perception were not significantly reversed after the two-month drug holiday. However, this finding is preliminary due to substantial attrition and limited statistical power. MCQ-C did not show significant change at any time point. Sensitivity analyses revealed that children lost to follow-up had higher baseline symptom and metacognitive problem scores, indicating potential selection bias. Conclusion: Methylphenidate treatment was associated with significant improvements in ADHD symptoms, ToM, and affect perception. The results highlight the need for larger, multi-center studies to reliably assess the impact of drug holidays on higher-order cognitive and social skills in ADHD.
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