Effects of methylphenidate on cognitive functions in children and adolescents with attention-deficit/hyperactivity disorder: evidence from a systematic review and a meta-analysis
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of neuropsychological impairments. The relationship between these neuropsychological deficits and the defining symptoms of ADHD seems more complex than originally thought. Methylphenidate (MPH) is an effective treatment for ADHD symptoms, but its impact on cognition is less clearly understood.Methods With a common systematic search strategy and a rigorous coding and data extraction strategy across domains, we searched electronic databases to identify published placebo controlled trials that compared MPH and placebo on executive and nonexecutive memory, reaction time, reaction time variability and response inhibition in children and adolescents (5-18 years) with a formal diagnosis of ADHD.Results Sixty studies were included in the review, of which 36 contained sufficient data for meta-analysis. Methylphenidate was superior to placebo in all five meta-analyses: executive memory, standardized mean difference (SMD) .26, 95% confidence interval (CI): -.39 to -.13; non-executive memory, SMD .60, 95% CI: -.79 to -.41; reaction time, SMD .24, 95% CI: -.33 to -.15; reaction time variability, SMD .62, 95% CI: -.90 to -.34; response inhibition, SMD .41, 95% CI: -.55 to -.27.Conclusions These data support the potentially important effects of MPH on various aspects of cognition known to be associated with ADHD. Consideration should be given to adding cognitive outcomes to the assessment of treatment outcome in ADHD, considering the complexity of the relationship between ADHD symptoms and cognition.
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Stimulant medication for ADHD, e.g., MPH, is usually a first-choice treatment for ADHD, but it also has an effect on ANS functioning, for example increasing HR and blood pressure and giving rise to difficulties in sleeping.
“Stimulant medication for ADHD, e.g., MPH, is usually a first-choice treatment for ADHD (NICE, 2018) but, together with well documented findings of improvement in cognitive performance (Coghill et al., 2014) and reduction of hyperactivity and impulsivity (Faraone and Buitelaar, 2010), it also has an effect on ANS functioning, for example increasing HR and blood pressure (Liang et al., 2018) and”
From Is autonomic nervous system function atypical in Attention Deficit Hyperactivity Disorder (ADHD)? A systematic review of the evidence (2020) · cites this paper as Coghill et al., 2014
Stimulant medication improves cognitive functioning on laboratory tasks in children with ADHD.
“Many studies have shown that stimulants improve cognitive functioning on laboratory tasks (Coghill et al., 2014; Pietrzak et al., 2006; Rapport & Kelly, 1991; Swanson et al., 2011; Vertessen et al., 2021)”
From The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. (2022) · cites this paper as Coghill et al., 2014
Four meta-analyses testing predominantly single dose effects of stimulants on cognitive performance in children and adults with ADHD have most consistently found effects on mean reaction time (MRT), attention, inhibition and working memory (WM).
“Four meta-analyses testing predominantly single dose effects of stimulants on cognitive performance in children and adults with ADHD, have most consistently found effects on mean reaction time (MRT), attention, inhibition and WM (17, 22, 29, 30).”
From Differential effects of a single dose of Lisdexamfetamine and Guanfacine on cognitive function in children with ADHD (2025) · cites this paper as [22]
The lisdexamfetamine effects on RT and CV extend findings that methylphenidate consistently improves RTV and RT in children with ADHD.
“They extend findings of methylphenidate consistently improving RTV and RT in children with ADHD (22, 29–31), with meta-analytic fMRI evidence showing that this may be underpinned neurofunctionally by MPH-induced deactivation of frontal areas of the DMN which is associated with RTV in people with ADHD (75).”
From Differential effects of a single dose of Lisdexamfetamine and Guanfacine on cognitive function in children with ADHD (2025) · cites this paper as [22]
Methylphenidate both in acute and longer-term dosage has been shown to improve inhibitory measures.
“This was also unexpected as methylphenidate both in acute and longer-term dosage has been shown to improve inhibitory measures (17, 22, 29–31).”
From Differential effects of a single dose of Lisdexamfetamine and Guanfacine on cognitive function in children with ADHD (2025) · cites this paper as [22]
The study's findings could extend evidence for acute and chronic methylphenidate administration significantly improving timing and attention functions in children with ADHD including the same tasks.
“These findings could extend evidence for acute and chronic methylphenidate administration significantly improving timing (66, 94) and attention functions in children with ADHD including the same tasks (22, 29–31).”
From Differential effects of a single dose of Lisdexamfetamine and Guanfacine on cognitive function in children with ADHD (2025) · cites this paper as [22]
The effects of stimulant medications impact laboratory measures of executive function less than rated symptoms.
“Interestingly, the effects of stimulant medications impact laboratory measures of executive function less than rated symptoms (Coghill et al., 2014b; Baroni and Castellanos, 2015).”
From Top-Down Dysregulation—From ADHD to Emotional Instability (2016) · cites this paper as Coghill et al., 2014b
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Flagged first, then by citations
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Top-Down Dysregulation—From ADHD to Emotional Instability
Petrovic, P., & Castellanos, F. X. (2016) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2016.00070 · Cited by 179 · see citing works
“…formed the basis for the notion that the neurobiology of ADHD entails at least two pathways, one related to motivation, emotion and reward, and the other focused on dysregulation of action and thought resulting from poor inhibitory control (Sonuga-Barke, 2002; Thorell, 2007; Coghill et al., 2014a).”
BackgroundRuiz-Goikoetxea, M., Cortese, S., Aznarez-Sanado, M., Magallón, S., Alvarez Zallo, N., Luis, E. O., de Castro-Manglano, P., Soutullo, C., & Arrondo, G. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.11.007 · Cited by 175 · see citing works
Linking ADHD to the Neural Circuitry of Attention
Mueller, A., Hong, D. S., Shepard, S., & Moore, T. (2017) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2017.03.009 · Cited by 158 · see citing works
Bellato, A., Arora, I., Hollis, C., & Groom, M. J. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.11.001 · Cited by 172 · see citing works
Response Inhibition and Interference Control in Obsessive–Compulsive Spectrum Disorders
van Velzen, L. S., Vriend, C., de Wit, S. J., & van den Heuvel, O. A. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00419 · Cited by 159 · see citing works
Yu, R., Nevado-Holgado, A. J., Molero, Y., D’Onofrio, B. M., Larsson, H., Howard, L. M., & Fazel, S. (2019) · PLOS Medicine · doi:10.1371/journal.pmed.1002995 · Cited by 152 · see citing works
Sonuga‐Barke, E. J. S., Becker, S. P., Bölte, S., Castellanos, F. X., Franke, B., Newcorn, J. H., Nigg, J. T., Rohde, L. A., & Simonoff, E. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13696 · Cited by 157 · see citing works
Computer-based Cognitive Training for ADHD
Sonuga-Barke, E., Brandeis, D., Holtmann, M., & Cortese, S. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.009 · Cited by 92 · see citing works
Mehren, A., Reichert, M., Coghill, D., Müller, H. H. O., Braun, N., & Philipsen, A. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-019-0115-2 · Cited by 86 · see citing works
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Janssen, T. W. P., Bink, M., Geladé, K., van Mourik, R., Maras, A., & Oosterlaan, J. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0144 · Cited by 58 · see citing works
Rosch, K. S., Fosco, W. D., Pelham, W. E., Waxmonsky, J. G., Bubnik, M. G., & Hawk, L. W. (2016) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-015-0031-x · Cited by 43 · see citing works
Isfandnia, F., El Masri, S., Radua, J., & Rubia, K. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105703 · Cited by 36 · see citing works
Pelham, W. E., Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., Gnagy, E. M., Greiner, A. R., Coles, E. K., Connor, C. M., et al. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000725 · Cited by 19 · see citing works
“Many studies have shown that stimulants improve cognitive functioning on laboratory tasks (Coghill et al., 2014; Pietrzak et al., 2006; Rapport & Kelly, 1991; Swanson et al., 2011; Vertessen et al., 2021) and academic seatwork productivity in analog classrooms (Fabiano et al., 2007;…”
BackgroundMarx, I., Weirich, S., Berger, C., Herpertz, S. C., Cohrs, S., Wandschneider, R., Höppner, J., & Häßler, F. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00122 · Cited by 18 · see citing works
Vanzin, L., Crippa, A., Mauri, V., Valli, A., Mauri, M., Molteni, M., & Nobile, M. (2020) · Behaviour Change · doi:10.1017/bec.2020.3 · Cited by 13 · see citing works
El Masri, S., Kowalczyk, O. S., Chiu, T. H., Criaud, M., Lukito, S., Mazibuko, N., Salazar de Pablo, G., Perez Rodriguez, V., Makos, O., Lam, S.-L., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1676472
- Authors
- Coghill, D. R., Seth, S., Pedroso, S., Usala, T., Currie, J., & Gagliano, A.
- Affiliations
- University of Dundee (GB)
- National Health Service (GB)
- University of Messina (IT)
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 76
- Issue
- 8
- Pages
- 603-615
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2009766215
- Cited by
- 271
- References
- 100
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 15 · 2023: 18 · 2022: 19 · 2021: 29 · 2020: 21 · 2019: 24 · 2018: 28 · 2017: 23 · 2016: 21 · 2015: 25 · 2014: 18
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion)
- UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, cognitive function, executive function, memory, reaction time, response inhibition, children and adolescents, stimulant medication, neuropsychological deficits, treatment outcome assessment
- MeSH terms
- Age Factors, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Cognition Disorders, Methylphenidate, Neuropsychological Tests
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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