The stimulant methylphenidate has been used for decades to treat attention deficit and hyperactivity disorder (ADHD). However, a Cochrane Review last month looked at 185 pediatric clinical trials of methylphenidate (Ritalin, Concerta and other brands) and found that the evidence for benefit has generally been of poor quality.

Collectively, the trials involved more than 12,000 children or adolescents with an ADHD diagnosis. Most compared methylphenidate to placebo, with treatment durations ranging from 1 to 425 days (average, 75). Of the 185 trials, 72 (40 percent) were industry-funded.

While the collective data indicate that the drug reduced hyperactivity and impulsivity and increased children’s ability to concentrate, most trials were small and judged to be low quality. For example, methylphenidate’s side effects may have compromised blinding in many studies. While short-term data indicated no life-threatening harms, the drug was associated with an increased risk of side effects such as sleeping problems and decreased appetite.

So should we now be questioning Ritalin? Notes checked in with Elizabeth Harstad, MD, MPH, of the Developmental Medicine Center at Boston Children’s Hospital, who is involved in an ongoing analysis of practice patterns for ADHD management. …Read More