Guidance 1.1 Methylphenidate is recommended for use as part of a comprehensive treatment programme for children with a diagnosis of severe Attention Deficit/ Hyperactivity Disorder (ADHD). Severe ADHD is broadly similar to a diagnosis of Hyperkinetic Disorder (HKD), although in some cases treatment may be appropriate for children and adolescents who do not fit the diagnostic criteria for HKD but are experiencing severe problems due to inattention or hyperactivity/impulsiveness.
1.2 Methylphenidate is not currently licensed for children under the age of six or for children with marked anxiety, agitation or tension; symptoms or family history of tics or Tourette's syndrome; hyperthyroidism; severe angina or cardiac arrhythmia; glaucoma; or thyrotoxicosis. Caution is required in the prescribing of methylphenidate for children and young people with epilepsy, psychotic disorders, or a history of drug or alcohol dependence.
1.3 Diagnosis should be based on a timely, comprehensive assessment conducted by a child/adolescent psychiatrist or a paediatrician with expertise in ADHD. It should also involve children, parents and carers and the childs school, and take into account cultural factors in the childs environment. Multidisciplinary assessment, which may include educational or clinical psychologists and social workers, is advisable for children who present with indications of significant comorbidity.
1.4 Treatment with methylphenidate should only be initiated by child and adolescent psychiatrists or paediatricians with expertise in ADHD, but continued prescribing and monitoring may be performed by general practitioners, under shared care arrangements with specialists.
1.5 Careful titration is required to determine the optimal dose level and timing. The drug should be discontinued if improvement of symptoms is not observed after appropriate dose adjustment.
1.6 A comprehensive treatment programme should involve advice and support to parents and teachers, and could, but does not need to, include specific psychological treatment (such as behavioural therapy). While this wider service is desirable, any shortfall in its provision should not be used as a reason for delaying the appropriate use of medication.
1.7 Children on methylphenidate therapy should receive regular monitoring. When improvement has occurred and the childs condition is stable, treatment can be discontinued at intervals, under careful specialist supervision, in order to assess both the child's progress and the need for continuation of therapy. 1.8 This guidance relates only to children and adolescents with ADHD.