Trends in the use of Ritalin in Canada

November 26, 2001

Stimulants such as methylphenidate (Ritalin) are commonly prescribed for attention-deficit disorder (ADD) with or without hyperactivity. This issue of the Canadian Medical Association Journal presents 2 studies and a commentary that discuss the efficacy, short-term effects and trends in the use of methylphenidate in treating ADD.

In the first study, Howard Schachter and colleagues performed a meta-analysis involving 2897 participants in 62 randomized controlled trials to summarize the efficacy and safety of short-acting methylphenidate for ADD. The median age of participants was 8.7 years, and 88.1% were male. Overall, the studies were judged to be of limited quality. A significant benefit of methylphenidate was reported (effect size reported by teacher 0.78, 95% confidence interval [CI] 0.64-0.91; effect size reported by parent 0.54, 95% CI 0.40-0.67). The authors note that children receiving the drug were more likely to have side effects of decreased appetite (30.3%, 95% CI 18.0-42.6), insomnia (17.0%, 95% CI 8.3-25.8) and stomach ache 99.0%, 95% CI 1.2-16.9). They conclude that despite the apparent short-term clinical benefit of the treatment, the safety and efficacy of long-term treatment requires further investigation.

In the second article, Anton Miller and colleagues examined British Columbia's provincial and health care databases for 1990-1996 to study trends in methylphenidate prescription to children and youth.

The authors note that prescription rates for methylphenidate for children and youth in British Columbia increased more rapidly than in the US, but they still did not approach US levels for the same time period. Miller and colleagues also identified a trend for the drug to be prescribed more often for children and youth in the 2 least-privileged socioeconomic quintiles than for those in the 3 highest socioeconomic quintiles (21.6 v. 18.4 per 1000 children and youth). The authors call for further research into how behavioural disturbances are managed in different socioeconomic groups.

In a commentary on the 2 studies, Benedetto Vitiello emphasizes the efficacy of methylphenidate and its often rapid treatment of the core symptoms of attention-deficit hyperactivity disorder (ADHD), which include hyperactivity, impulsiveness and inattentiveness. He also discusses the results of a double-blind controlled crossover trial of 289 children with ADHD published recently and not included in the meta-analysis by Schachter and colleagues, which showed benefits of methylphenidate treatment without intolerable adverse effects after 13 months of follow-up. He acknowledges, however, that it remains to be seen whether a reduction in ADHD symptoms will result in long-term improvements in academic prognosis and occupational achievement.
p. 1475 How efficacious and safe is short-acting methyphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis

-- H.M. Schachter et al

p. 1489 Prescription of methylphenidate to children and youth, 1990-1996

-- A.R. Miller

p. 1505 Methylphenidate in the treatment of children with attention-deficit hyperactivity disorder

-- B. Vitiello Contacts:Cecily Wallace, Children's Hospital of Eastern Ontario, Ottawa; tel. 613 738-3586

Dr. Anton Miller, Centre for Community Health and Health Evaluation Research for Children's and Women's Health, Vancouver; tel. 604 875-3570, email:

Dr. Benedetto Vitiello, Child & Adolescent Treatment & Preventive Interventions Research Branch, National Institute of Mental Health, Bethesda, MD, tel. 301 443-4283, email:

Canadian Medical Association Journal

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