title: Effects of late-afternoon methylphenidate administration on behavior and sleep in attention-deficit hyperactivity disorder.
abstract: OBJECTIVE
  This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD).
  
  
  METHODS
  Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night.
  
  
  RESULTS
  MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition.
  
  
  CONCLUSIONS
  Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice.
authors.affiliation: Division of Child and Adolescent Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Kent
authors.forename: J C
authors.initials: JC
authors.lastname: Blader
authors.forename: H S
authors.initials: HS
authors.lastname: Koplewicz
authors.forename: H
authors.initials: H
authors.lastname: Abikoff
authors.forename: C A
authors.initials: CA
authors.lastname: Foley
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004435:Eating; D005221:Fatigue / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D010919:Placebos; D012890:Sleep / Q000187:drug effects*; D012894:Sleep Stages / Q000187:drug effects; D014851:Wakefulness / Q000187:drug effects; D015431:Weight Loss
chemical_list: D010919:Placebos; D008774:Methylphenidate