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Caution urged in prescribing common ADHD drug

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Uncertainties remain about the effect of a widely used medicine on attention deficit hyperactivity disorder symptoms, according to a review by a well-respected research organisation.

Methylphenidate, more commonly known by its brand names Ritalin, Concerta, Medikinet and Equasym has been used to treat ADHD for more than 50 years.

A team of researchers from the Cochrane Collaboration evaluated findings from all of the available trials on the widely used drug.

The review included data from 185 trials involving more than 12,000 children or adolescents. The studies were conducted mainly in North America and Europe, and all compared methylphenidate with either a placebo or no intervention.

The researchers found methylphenidate led to modest improvements in ADHD symptoms, general behaviour, and quality of life.

Analysis of adverse effects showed that children were also more likely to experience sleep problems and loss of appetite while taking methylphenidate, according to the review, which was published by the Cochrane Library.

However, the researchers said their confidence in the trial results was very low.

It was apparent that it would have been possible for people involved in the trials to have been aware of which treatment the children were taking. In addition, the reporting of results was not complete in many of the trials, and for some analyses there was variation among trial results.

Based upon this information, the researchers urge clinicians to be cautious in prescribing methylphenidate, and to weigh up the benefits and risks more carefully.

“This evidence is important for health professionals and parents of children with ADHD”

Morris Zwi

Lead study author Professor Ole Jakob Storebø, a clinical psychologist from Denmark, said: “This review highlights the need for long-term, large, better-quality randomized trials so that we can determine the average effect of this drug more reliably.”

Study co-author, Dr Morris Zwi, a consultant child and adolescent psychiatrist from the Islington Child and Adolescent Mental Health Service, added: “This evidence is important for health professionals and parents of children with ADHD.

“Our expectations of this treatment are probably greater than they should be, and whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence,” he said.

“What we still need are large, well-conducted trials in order to clarify the risks versus the benefits for this widely used treatment,” he noted.

However, the researchers urged clinicians not to rush to discontinue using methylphenidate.

Dr Zwi added: “If a child or young person has experienced benefits without experiencing adverse effects, then there may be good clinical grounds to continue using it.”

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Readers' comments (2)

  • I think we must be cautious with any medication, especially those given to growing children. However having seen the benefits of these drugs, especially during school hours I think some side effects may be acceptable. Yes it does often affect the child's appetite for the six or so hours of action, but if it allows concentration and an increase in self esteem because they are not always the one disrupting the class, then it has to be of value. Parents often feel a sense of guilt when they agree to medication, however quite often the benefit not only to the child, but the whole family is quite enormous once these drugs are given.

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  • My son has ADHD and has tried short and long acting methylphenidate. The change in his behaviour has been incredible. It is the difference between him succeeding and failing in school. I no longer feel that he is about to run headfirst across the road without looking. He is safer!. He has struggled with sleep and appetite. We have just timed meals to coincide with the times it is wearing off. He doesn't always want lunch so we give him extra at dinner so he gets enough. We have also tried to find a bedtime routine that lets him settle although he often won't sleep until I am also in bed. No problem - I just go to bed slightly earlier. We make it work and he has benefited immensly from it.

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