[Methylphenidate in the treatment of attention-deficit/hyperactivity disorder: are we achieving an adequate clinical
J Gonzalez de Dios1, E Cardó, M Servera
1Departamento de Pediatría, Hospital Universitario San Juan, 03550 San Juan, Espana. gonzalez_jav@gva.es
Insights
Methylphenidate effectively treats attention-deficit/hyperactivity disorder (ADHD) in children aged 6-12 short-term. Atomoxetine is an alternative if methylphenidate is ineffective or causes side effects.
Area of Science:
- Pediatrics
- Pharmacology
- Clinical Practice
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common childhood behavioral disorder.
- Methylphenidate is the primary pharmacological treatment for ADHD.
Purpose of the Study:
- To evaluate the clinical practice of methylphenidate for ADHD.
- Assessing efficacy, effectiveness, efficiency, and safety of methylphenidate.
Main Methods:
- Systematic review of published articles on ADHD therapeutic management with methylphenidate.
- Critical appraisal using Evidence-Based Medicine methodology.
Main Results:
- Methylphenidate demonstrates efficacy in improving ADHD outcomes short-to-medium term in children (6-12 years).
- Evidence supports methylphenidate as a first-line treatment, with atomoxetine as an alternative for non-responders or those with side effects.
- Limitations in existing trials include patient populations, interventions, outcomes, and publication bias.
Conclusions:
- Methylphenidate is effective for ADHD in children aged 6-12 years.
- Further research is needed on very young children, adolescents, long-term effects, and optimal treatment duration.
- Clinical guidelines recommend methylphenidate as a first-line treatment based on cost-benefit analysis.
Introduction:
Attention-deficit/hyperactivity disorder (ADHD) is the most frequent behavioural disorder in infancy and methylphenidate is the most widely used medication. AIM. To analyze if the use of methylphenidate allows a good clinical practice in ADHD in terms of efficacy, effectiveness, efficiency and safety.
Materials And Methods:
Systematic review of the articles about therapeutic management of ADHD with methylphenidate published in secondary and primary publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group.
Results:
The main secondary information is found in the Cochrane Library, but we also detect relevant articles in Pubmed, mainly published in Journal of the American Academy of Child and Adolescent Psychiatry and Pediatrics. There are many randomized clinical trials with methylphenidate (immediate-release and extended-release methylphenidate) and some systematic review and/or meta-analysis, but these trials have some limitations (in relation to patients, interventions and outcomes) and publication bias.
Conclusions:
From the evidence-based analysis (and from the experience) we detect good scientific evidence that methylphenidate improve target outcomes in ADHD in the short and half-term in children (mainly 6-12 years). The treatment algorithm advises to start with methylphenidate (immediate or extended-release methylphenidate, in relation to cost-benefit parameters); when there is not response (between 10-30% of patients) or evidence of relevant secondary effects, we could consider the use of atomoxetine. There are many questions to solve based on better clinical trials: the efficacy and safety of methylphenidate in very young children and adolescents, long-term effects and the duration of the treatment.
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