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Improved accuracy was accompanied by a slowing in response latency on several tasks relative to placebo (Turner et al, 2003a; Turner et al, 2004).

We concluded that modafinil may exert its effects through reducing cognitive impulsivity (Bechara et al, 2002; Evenden, 1999).

However, in two other studies, methylphenidate significantly increased thought disorder in patients with schizophrenia (Levy et al, 1993) and increased redundant responding on an oral word production test (Szeszko et al, 1999).

We have shown that modafinil, a wake-promoting agent, has significant cognitive enhancing effects in healthy adults and adult patients with ADHD (Turner et al, 2003a; Turner et al, 2004).

A well-defined biochemical mechanism of action of modafinil has not yet been elucidated.

Nevertheless, recent evidence suggests that modafinil might be acting via a mechanism similar to the newly discovered neuropeptides orexin-A and -B (Chemelli et al, 1999; Scammell et al, 2000) to promote histamine release (Ishizuka et al, 2003).

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Moreover, cognitive flexibility, as measured by the Wisconsin Card Sorting Test (WCST), has been related to community outcome in these patients (Green, 1996; Hartman et al, 2003) and to response to psychological intervention (Wykes et al, 2003).This was accompanied by slowed response latency on the spatial planning task. Importantly, significant improvement in attentional set shifting was seen, despite no effect of modafinil on this task being seen in healthy volunteers or ADHD patients.