Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there is a trade off between benefits and harms of the intervention.
Population: Children and adolescents (aged 2–20 years) with ADHD
Intervention: Methylphenidate
Comparison: No treatment ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Any serious adverse events (timing of outcome measure unclear) | Occurs more commonly with methylphenidate compared with no treatment (favors comparison) | Very Low |
Seizures (timing of outcome measure unclear) | No statistically significant difference | Very Low |
Psychotic disorder (timing of outcome measure unclear) | Occurs more commonly with methylphenidate compared with no treatment (favors comparison) | Very Low |
Sudden death (timing of outcome measure unclear) | See note ᵇ | Very Low |
Suicide (timing of outcome measure unclear) | See note ᶜ | Very Low |
Arrhythmias (timing of outcome measure unclear) | Occurs more commonly with methylphenidate compared with no treatment (favors comparison) | Very Low |
Hypertension (timing of outcome measure unclear) | No statistically significant difference | Very Low |
Myocardial infarction (timing of outcome measure unclear) | No statistically significant difference | Very Low |
Ischemic stroke (timing of outcome measure unclear) | No statistically significant difference | Very Low |
Heart failure (timing of outcome measure unclear) | Occurs more commonly with no treatment compared with methylphenidate (favors intervention) | Very Low |
Nonserious adverse events (timing of outcome measure unclear): insomnia and sleep problems | Occurs more commonly with methylphenidate compared with no treatment (favors comparison) | Very Low |
Nonserious adverse events (timing of outcome measure unclear): decreased appetite | Occurs more commonly with methylphenidate compared with no treatment (favors comparison) | GRADE assessment not performed for this outcome |
Nonserious adverse events (timing of outcome measure unclear): overall | See note ᵈ | Very Low |
Withdrawal from treatment (timing of outcome measure unclear): all-cause | Occurs more commonly with no treatment compared with methylphenidate (favors intervention) | Very Low |
Withdrawal from treatment (timing of outcome measure unclear): due to serious adverse events | See note ᵉ | Very Low |
Withdrawal from treatment (timing of outcome measure unclear): due to nonserious adverse events | See note ᶠ | Very Low |
Withdrawal from treatment (timing of outcome measure unclear): due to adverse events of unknown severity | See note ᵍ | Very Low |
Note ᵃ The control group in one study received atomoxetine. See the Cochrane Clinical Answer (CCA) for more details. ᵇ No comparative studies reported on sudden death. Three noncomparative studies (6301 participants) found that 0.20% (95% CI 0% to 15.9%) of people receiving methylphenidate died suddenly. ᶜ No comparative studies reported on suicide. Two noncomparative studies studies (5596 participants) found that 0.10% (95% CI 0% to 0.30%) of people receiving methylphenidate died by suicide. ᵈ No comparative studies reported on overall nonserious adverse events. Forty-nine noncomparative studies (13978 participants) found that 51.2% (95% CI 41.2% to 61.1%) of people receiving methylphenidate had at least one nonserious adverse event. ᵉ No comparative studies reported on withdrawal from treatment due to serious adverse events. Seven noncomparative studies (1173 participants) found that 1.20% (95% CI 0.60% to 2.30%) of people receiving methylphenidate withdrew from treatment due to serious adverse events. ᶠ No comparative studies reported on withdrawal from treatment due to nonserious adverse events. Thirty-seven noncomparative studies (7142 participants) found that 6.20% (95% CI 4.80% to 7.90%) of people receiving methylphenidate withdrew from treatment due to nonserious adverse events. ᵍ No comparative studies reported on withdrawal from treatment due to adverse events of unknown severity. Twenty-two noncomparative studies (3708 participants) found that 7.3% (95% CI 5.3% to 10.0%) of people receiving methylphenidate withdrew from treatment due to adverse events of unknown severity.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of group‐based parent training programs on emotional and behavioral adjustment in their children?
- Can amphetamines improve symptoms in children and adolescents with attention deficit hyperactivity disorder (ADHD)?
- What adverse events are associated with methylphenidate in children and adolescents with attention deficit hyperactivity disorder (ADHD)?
- What are the benefits and harms of social skills training for children and adolescents aged 5 to 18 years with ADHD?
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