Clinical efficacy of methylphenidate in children and adolescents

Abstract

The efficacy of methylphenidate (MTP) is amply documented for children with ADHD. In addition to modifying the central features of the disorder, inattention, impulsive behavior and excessive motor activity, the medication has been shown also to improve social behavior with peers and adults, as well as academic performance. The concerns that these benefits may not extend beyond the period of active intervention, and that treatment efficacy in only partial in some children, has led to the development of other, psychosocial interventions. Behavioral treatment by itself is ineffective, but contributes significantly to clinical change in children who derive incomplete gains from MTP alone. Cognitive training has not been shown to have therapeutic impact either as a single treatment, or as an adjunct to MTP. Clinical indications for MTP extend to children and adolescents with Conduct disorders. Treatment affects antisocial behavior regardless of the concurrent presence of hyperactivity symptomatology. Extended treatment with MTP alone is difficult to implement in older children due to lack of cooperation. MTP has been shown to be safe. Deceleration of growth velocity is the only identified long-term side effect. It occurs after more than one year of treatment at greater than low doses. It appears completely reversible with treatment cessation prior to the adolescent growth spurt. Efficacy in Attention Deficit-Hyperactivity Disorder (ADHD) is especially well demonstrated in preadolescents, with only sparse evidence for efficacy in adolescents.