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Review: methylphenidate and atomoxetine have similar efficacy and acceptability in children and adolescents with ADHD

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Question: Is methylphenidate (MPH) or atomoxetine superior to the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD)?

Outcomes: Symptoms (assessed on the ADHDRS-IV Parent: Inv and Turgay DSM-IV-Based Child and Adolescent Behaviour Disorders Screening and Rating Scale (T-DSM-IV-S)); response (as defined in the individual studies); acceptability (all cause discontinuation).


Design: Systematic review and meta-analysis.

Data sources: PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic reviews were searched for papers published between January 1995 and December 2010. The reference lists of identified papers were also hand searched. Studies could be published in any language.

Study selection and analysis: Randomised, open label and double blind trials comparing MPH versus atomoxetine for children and adolescents with DSM-IV ADHD diagnosed according to DSM-IV criteria were included. Meta-analyses were carried out using random-effects models in RevMan version 5. Standardised mean difference (SMD) was used for continuous outcomes, and RR was used for dichotomous outcomes. Heterogeneity was assessed using Cochran's Q and the I2 statistic. A funnel plot was used to assess publication bias.

Main results

Nine trials, involving 2762 participants aged between 6 and 16 years, were included. Five trials …

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  • Sources of funding Not reported.

  • ▸ Notes are available online only at


  • Competing interests None.

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