Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate are reported in a study of 91 children receiving MPH (titrated to 0.7 mg/kg twice a day) or placebo for 4 months at the Hospital for Sick Children, Toronto, Canada. Symptoms of ADHD and comorbid oppositional behavior improved while at school, but not on returning home. Side effects were observed by the parents, not by teachers, and necessitated MPH withdrawal in 10%; these included sadness, behavioral deterioration, irritability, withdrawal, lethargy, violent behavior, and mild mania. Anorexia, loss of weight gain (without effect on growth), and stomachache were the most common physiological side effects, and withdrawal, sadness, and crying, the most common affective side effects during MPH treatment. [1]

COMMENT. Methylphenidate administered twice daily benefits behavior and attention of ADHD children in the classroom but not in the home. Three times daily schedule of doses might facilitate completion of home work assignments and lead to improved parent-child relations. (see Ped Neur Briefs Nov 1996; 10:82, for review of MPH dosing schedules and a report by Stein MA, Roizen NJ et al).