Efficacy and side effects of twice daily (bid) and three times daily (tid) methylphenidate (MPH) dosing schedules (mean dose, 8 mg, 0.3 mg/kg) in 25 boys with attention deficit hyperactivity disorder (ADHD) were compared in a 5-week, placebo-controlled, crossover evaluation at the Departments of Psychiatry and Pediatrics, University of Chicago. Three times daily dosing provided greater improvement than the bid schedule on Hyperactivity/Impulsivity Conners Parent and Teacher Rating scales. Compared to placebo, appetite and total sleep time were adversely affected by tid dosing but not bid schedules. The incidence of side effects with tid compared to bid dosing was not significantly different. No effect on weight was noted in this short time period. 
COMMENT. This short term study shows that more frequent, smaller dose, three times daily MPH treatment is often preferable to twice daily dosing schedules. The incidence of insomnia, usually regarded as a disadvantage of afternoon doses, is not increased, and teacher and parent ratings of MPH efficacy are benefited. Doses of MPH for ADHD should be selected for each individual child according to the time of occurrence of symptoms and not with regard to the pattern of possible side effects. An evening free from parent-child conflict and a home-work assignment satisfactorily completed may lead to improved self esteem and better classroom performance. Closer monitoring of MPH dosing schedules, using both parent and teacher abbreviated reports, should result in optimal treatment efficacy.
The benefits of a group treatment developmental approach, involving patients and their families, as a supplement to medication, are reported from the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA.