The effects of methylphenidate (MPH) administered at 4 PM on behavior and sleep in 12 child psychiatric inpatients with ADHD were evaluated in a double-blind, crossover study at the Division of Child and Adolescent Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY. Early morning and noon doses of MPH were continued through the study period. MPH in 10 and 15 mg doses administered at 4 PM for 12 consecutive days improved evening behavior without altering sleep latencies. The average time to sleep onset in treated and control groups was 49 minutes. Sleep adequacy was improved after 10 mg MPH doses compared to 15 mg MPH and placebo nights. The child seemed tired after waking more often after 15 mg MPH and placebo than on nights after 10 mg MPH. Ten of 12 patients lost an average of 1.2 kg weight, but dinner intake was not altered by the 4 PM dose of MPH. 
COMMENT. The authors recommend three daily doses of MPH in patients who show a beneficial response to two doses at school but who are hyperactive and disruptive at home in the evening. However, they caution that the study was performed at an inpatient setting, the analysis did not exclude possible adverse sleep effects in some individual patients, and the third dose did result in significant weight loss. The effects in outpatients may be different and insomnia and anorexia may require dosage modification. If well tolerated, a third dose of MPH may benefit homework compliance, bedtime habits, and family relations.