Methylphenidate for ADHD in children and adolescents: throwing the baby out with the bathwater
Open accessAbstract
A recent Cochrane review assessed the efficacy of methylphenidate for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Notwithstanding the moderate-to-large effect sizes for ADHD symptom reduction found in the meta-analysis, the authors concluded that the quality of the evidence is low and therefore the true magnitude of these effects remains uncertain. We identified a number of major concerns with the review, in the domains of study inclusion, approaches to quality assessment and interpretation of data relating to serious adverse events as well as of the clinical implications of the reported effects. We also found errors in the extraction of data used to estimate the effect size of the primary outcome. Considering all the shortcomings, the conclusion in the Cochrane review that the status of the evidence is uncertain is misplaced. Professionals, parents and patients should refer to previous reviews and existing guidelines, which include methylphenidate as one of the safe and efficacious treatment strategies for ADHD.
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The efficacy and safety of ADHD medications remains controversial.
“However, even though recommended in clinical guidelines,9, 10, 11, 12, 13, 14 the efficacy and safety of ADHD medications remains controversial.15, 16, 17”
From Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis (2018) · cites this paper as [15]
The Abstract describes a dispute over methylphenidate’s efficacy, and the ‘Serious adverse effects (SAEs) of MPH’ section disputes how its safety evidence was interpreted. This supports the existence of controversy for methylphenidate in children and adolescents, but the paper does not establish the claim for ADHD medications generally. The indexed passages provide no page numbers. (LLM, conf=0.83)
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Cites
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Why the Cochrane Risk of Bias Tool Should not Include Funding Source as a Standard Item
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Flagged first, then by citations
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Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30269-4 · Cited by 1,402 · see citing works
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- Authors
- Banaschewski, T., Buitelaar, J., Chui, C. S. L., Coghill, D., Cortese, S., Simonoff, E., & Wong, I. C. K.
- Affiliations
- Central Institute of Mental Health (DE)
- Radboud University Medical Center (NL)
- University of Hong Kong (HK)
- The University of Melbourne (AU)
- University of Southampton (GB)
- King's College London (GB)
- UCL School of Pharmacy (GB)
- Corresponding author
- Simonoff, Emily
- ORCID
- Venue
- Evidence Based Mental Health
- Publisher
- BMJ
- Published
- 2016-10-06
- Volume
- 19
- Issue
- 4
- Pages
- 97-99
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC10699535
- OpenAlex
- W2528032411
- Cited by
- 35
- References
- 5
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 4 · 2021: 1 · 2019: 4 · 2018: 9 · 2017: 9 · 2016: 3
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Evidence-Based Mental Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- Brandeis University
- National Institute for Health and Care Research (NF-SI-0514-10073)
- University of Oxford
- European Commission
- Servier
- H. Lundbeck A/S
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- methylphenidate, attention deficit hyperactivity disorder, children and adolescents, Cochrane review critique, quality of evidence, serious adverse events, stimulant efficacy
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Humans, Methylphenidate, Parents, Treatment Outcome, Uncertainty
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