Methylphenidate, Atomoxetine and Dexamfetamine for Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents (Review) (TA98)

Technology Appraisal Guidance No. 98

Source: National Institute for Health and Care Excellence

NOTE: This guidance replaces Technology appraisal guidance no. 13 issued in October 2000.

The Institute reviews each piece of guidance it issues. Following review and re-appraisal, the previous recommendations on the use of methylphenidate for attention deficit hyperactivity disorder in childhood have been updated and extended. This latest guidance provides recommendations on the use of methylphenidate, atomoxetine and dexamfetamine for the treatment of attention deficit hyperactivity disorder in children and adolescents.

1 Guidance

1.1 Where drug treatment is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended, within their licensed indications, as options for the management of ADHD in children and adolescents.

1.2 The decision regarding which product to use should be based on the following:

  • the presence of comorbid conditions (for example, tic disorders, Tourette's syndrome, epilepsy)
  • the different adverse effects of the drugs
  • specific issues regarding compliance identified for the individual child or adolescent, for example problems created by the need to administer a mid-day treatment dose at school
  • the potential for drug diversion (where the medication is forwarded on to others for non-prescription uses) and/or misuse
  • the preferences of the child/adolescent and/or his or her parent or guardian.

1.3 If there is a choice of more than one appropriate drug, the product with the lowest cost (taking into account the cost per dose and number of daily doses) should be prescribed.

1.4 Drug treatment should only be initiated by an appropriately qualified healthcare professional with expertise in ADHD and should be based on a comprehensive assessment and diagnosis. Continued prescribing and monitoring of drug therapy may be performed by general practitioners, under shared care arrangements.

The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at

Copies of the document can also be obtained by contacting 0845 003 7783 or emailing and quoting reference number N1010. 

This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

© Copyright National Institute for Health and Care Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.

Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email:

Methylphenidate, Atomoxetine and Dexamfetamine for Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents (Review).
Issue Date: March 2006
Review Date: March 2009

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