Bibliographic information
Recommendation
For children 6 years old and above and adolescents who have an attention deficit hyperactivity disorder (ADHD) diagnosis, methylphenidate may be considered, provided that: ADHD symptoms are still causing persistent significant impairment in at least one domain of functioning (education, interpersonal relationships, occupation), after the implementation of environmental modifications in schools, at home or in other relevant settings; a careful assessment of the child/adolescent has been conducted; the child/adolescent and the caregivers, as appropriate, have been informed about ADHD treatment options and supported in decision-making; methylphenidate prescription is made by, or in consultation with, a specialist.
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
Remarks y Methylphenidate treatment should be offered only in the context of a management plan that address psychosocial risks and vulnerabilities and environmental factors that have an impact on symptoms, functioning, well-being and participation of children and adolescents with ADHD. y Methylphenidate treatment should be combined when possible with brief parent behavioural therapies. y Children and adolescents receiving methylphenidate should be maintained under close clinical monitoring for improvement in symptoms and prevention of adverse effects. y A specialist care provider trained on management of ADHD should reassess the child/adolescent’s management plan for ADHD at least once per year. y The rationale for specialist assessment before prescription of methylphenidate is that diagnosis of ADHD requires specialist clinical judgement especially given the risks of misuse of methylphenidate.
Implementation considerations y It is important to consider the health system’s capacity to enforce and implement protocols for ADHD diagnosis; to prescribe and initiate methylphenidate treatment by or in close consultation with a specialist; and to ensure careful clinical monitoring for side-effects, clinical response, adherence, treatment acceptability, and dose adjustment.