An overuse of methylphenidate (MPH) in the treatment of attention deficit disorders (ADHD) has been reported by the International Narcotics Control Board, and the potential for drug abuse has prompted media criticism and cause for concern among some parents and physicians. A questionnaire was mailed to 160 pediatric neurologists and clinic directors in the United States, and 53 (33%) located in 28 different States responded. A diagnosis of ADHD was made in <5 to 100% (mean 33%) of patients treated, and 10 to 96% (mean 51%) of ADHD patients received stimulant medications. The age groups of patients receiving MPH were 3-5 years (8.7%), 6-12 years (70.3%), 13-18 years (20.4%), and adults (0.6%). The drug of choice was MPH (90%). Pemoline and dextroamphetamine were equally favored as 2nd or 3rd choice stimulants. The mean average daily dose of MPH was 20 mg (range 10-40 mg); the mean maximum daily dose was 52 mg (range 25-85 mg). Drug holidays at weekends and school vacations were recommended by 65%. The duration of therapy with stimulants ranged from 1 to 5 years (mean 3.5 years). The adverse effects of MPH were as follows: personality changes in 7%, tics (5%), weight loss (4%), seizures (0.9%), and miscellaneous (2.3%), including insomnia (3), headache (2), increased activity (2), and parental anxiety (1). [1]
COMMENT. An overuse of methylphenidate by physicians treating attention deficit hyperactivity disorders in the United States was not supported by this questionnaire survey of pediatric neurologists. The side effects reported, especially personality changes, are usually dose related.
Contraindications or factors requiring extra caution in the use of stimulants for ADHD are as follows: 1) Tourette’s syndrome or tics, 2) family history of tics, 3) history of seizures and/or EEG dysrhythmia, 4) history of drug abuse/dependence, 5) family history of drug abuse, 6) psychosis or anxiety/depression, 7) poor nutrition or short stature, 8) headaches, sleep disturbance, 9) liver dysfunction (pemoline), 10) treatment with other medications eg. clonidine, MAO inhibitors.