What are the benefits of methylphenidate as a treatment for children and adolescents with attention-deficit/hyperactivity disorder?

Abstract

Psychostimulant medications, such as methylphenidate and amphetamine, are commonly prescribed for attention-deficit/hyperactivity disorder (ADHD) and have been a firstline medication for this disorder for over 60 years. However, a recent Cochrane review has raised doubts about the benefit of methylphenidate in the treatment of childhood ADHD (Storebø et al. 2015). Although the authors demonstrated that methylphenidate was associated with improved teacher-rated ADHD symptoms (standardized mean difference [SMD], -0.77 [95% CI -0.90 to -0.64] in 19 parallel group trials and first phase of crossover trials which included a total of 1698 subjects, the authors concluded that the true magnitude and relevance of this effect is uncertain because of the ''very low quality'' of most of the included studies. They assessed that 96.8% of all 185 trials included in the broader review were at high risk of bias trials according to their interpretation of the evidence. This assumption contrasts with previously published systematic reviews and meta-analyses, including the

Attention Deficit Hyperactivity Disorder in Children and Adults: A Population Survey on Public Beliefs

“…With a worldwide-pooled prevalence of 5.3% among children (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007) and 2.5% among adults (Simon, Czobor, Bálint, Mészáros, & Bitter, 2009), attention deficit hyperactivity disorder (ADHD) is a mental illness of high epidemiological, clinical, and cultural importance. In recent years, controversial discussions about diagnostic labels (Asherson et al, 2010; Moncrieff & Timimi, 2010), etiology (Batstra, te Meerman, Conners, & Frances, 2017; Dehue et al, 2017; Hoogman et al, 2017), and pharmacotherapy (Boesen et al, 2017; Gerlach, Banaschewski, Coghill, Rohde, & Romanos, 2017; Häßler, 2019; Kölch, 2019; Romanos, Coghill et al, 2016; Romanos, Reif, & Banaschewski, 2016; Storebø et al, 2015) have dominated a large part of academic debates surrounding this disorder. Thus, the authors of a recent mega-analysis of subcortical structures and intracranial volumes using magnetic resonance imaging (MRI) brain scans, covered widely in the media, concluded thatpatients with ADHD have altered brains; therefore, ADHD is a disorder of the brain.…”

Risk of Bias and Quality of Evidence for Treatment of ADHD With Stimulant Medication

“…The replies did not agree with what was offered in the critiques, and the rejoinders reiterated parts of the critiques. Over the 2‐year course of the debate, neither side gave much ground, resulting in an impasse.…”

“…The 2015 publication of the Cochrane review prompted a series of critiques, replies, and rejoinders . The brevity of the summary by Storebø et al .…”

“…precluded a description of this debate and discussion, so some details will be presented here to provide context. Excerpts from the titles of publications (Table ) convey the tenor of the exchanges (“contentious debate” and “fierce discussion”). Lists of topics outline the content (Table ).…”

Drug treatment of ADHD – tenuous scientific basis

“…In a final move, the Guidelines Group claimed -without specifying whythat long-term randomised controlled trials are practically and ethically impossible. They point instead to non-randomised epidemiological studies that may suggest positive longterm effects of methylphenidate use on endpoints such as substance abuse, trauma and death (11). However, such studies cannot fully account for confounding causal factors.…”