Researchers Urge Caution in Prescribing Children Methylphenidate for ADHD
The review authors remain uncertain about the effect of methylphenidate on ADHD symptoms, despite large amount of research. Some evidence of increased sleeplessness and loss of appetite leads researchers to encourage more caution in use of methylphenidate.
The Cochrane Review included data from 185 randomised controlled trials involving more than 12,000 children or adolescents. The studies were conducted mainly in the United States, Canada, and Europe; included males and females aged 3 to 18 years; and all compared methylphenidate with either a placebo or no intervention.
When researchers combined data from identified trials, they found that methylphenidate led to modest improvements in ADHD symptoms, general behaviour, and quality of life.
Analysis of adverse effects showed that children were more likely to experience sleep problems and loss of appetite while taking methylphenidate.
However, the researchers’ confidence in all results was very low. It was apparent from assessing the included trials 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 review highlights the need for long-term, large, better-quality randomised trials so that we can determine the average effect of this drug more reliably,” said Ole Jakob Storebø, MD, Psychiatric Research Unit, Region Zealand, Denmark.
“This evidence is important for health professionals and parents of children with ADHD,” said Morris Zwi, MD, Islington CAMHS, London, United Kingdom. “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. What we still need are large, well-conducted trials in order to clarify the risks versus the benefits for this widely used treatment.”
The researchers have also urged that clinicians and families should not rush to discontinue using methylphenidate.
“If a child or young person has experienced benefits without experiencing adverse effects, then there may be good clinical grounds to continue using it,” said Dr. Zwi. “Patients and their parents should discuss any decision to stop treatment with their healthcare professional before doing so.”
An abridged version of the Cochrane Review will appear in the BMJ later this week.
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