Methylphenidate is indicated as a part of a comprehensive treatment programme for attention-deficit hyperactivity disorder when remedial measures alone prove insufficient. Treatment must be under the supervision of a specialist in childhood behavioural disorders. Diagnosis should be made according to DSM-IV criteria or the guidelines in ICD-10.

 

 

Not recommended for children under 6 years; for those over 6 years, initially 5 mg 1-2 times daily, increased if necessary at weekly intervals by 5-10 mg daily to max. 60 mg daily in divided doses; discontinue if no response after 1 month, also suspend periodically to assess child's condition (usually finally discontinued during or after puberty). If the effect wears off in evening (with rebound hyperactivity), a dose at bedtime may be appropriate (establish need with trial bedtime dose).

 

 

It would now not be normal clinical practice to discontinue methylphenidate "during or after puberty". The BNF and data information sheets interpret the "evening dose" slightly differently. In the BNF, this is clearly stated to be a bedtime dose. The data sheets, however, describe "a small evening dose" if the effects wear off too early resulting in disturbed behaviour and/or inability to go to sleep. Current recommendations in the literature consistently suggest that the last dose should be given in the late afternoon (around 4pm).