Methylphenidate is a form of medication known as a central nervous system (CNS) stimulant. It is also known as methylphenidylacetate hydrochloride or MPH.
Methylphenidate is sold under various brand names including Concerta, Delmosart, Ritalin and Xaggitin.
Methylphenidate is believed to work by increasing the amount of dopamine, a natural chemical, found in the brain. Increasing the amount of dopamine is believed to improve self-control, attention and concentration.
Methylphenidate is commonly used to treat attention deficit hyperactivity disorder (ADHD), although it is also sometimes used to treat narcolepsy.
Some people believe that methylphenidate can be used with some autistic individuals to reduce problem behaviours, such as hyperactivity, impulsivity and inattention.
There is a limited amount of research evidence (10 group studies and eight case design studies with three or more participants) into the use of methylphenidate as an intervention for autistic people.
This research suggests that methylphenidate may be beneficial for the treatment of hyperactivity, impulsivity and inattention in some autistic children and young people.
There is almost no research evidence to suggest that methylphenidate may be useful for the treatment of autistic adults.
There is evidence of significant side effects of methylphenidate in some individuals. Those side effects may include insomnia, nervousness, headache, decreased appetite, abdominal pain and other gastrointestinal symptoms, and cardiovascular effects such as tachycardia, palpitations and minor increases in blood pressure.
Further, large scale, double blind, randomised controlled trials of the effects of methylphenidate should be carried out on autistic individuals to determine their effectiveness and safety. These studies should investigate issues such as
We believe that methylphenidate should only be used as part of a comprehensive treatment programme for ADHD, under specialist supervision, where remedial measures alone prove insufficient.
Methylphenidate should be discontinued if there is no response after 1 month, and treatment should be suspended periodically to assess the child's condition
Please read our Disclaimer on Autism Interventions
The aim of using a stimulant medication, such as methylphenidate, on autistic individuals is to reduce behaviours such as hyperactivity, impulsivity and inattention.
According to NICE (2000)
“Methylphenidate is a CNS stimulant. It is licensed as part of a comprehensive treatment programme for ADHD, under specialist supervision, where remedial measures alone prove insufficient.”
Methylphenidate is believed to work by increasing the amount of dopamine, a natural chemical, found in the brain. Increasing the amount of dopamine is believed to improve self-control, attention and concentration.
Methylphenidate is commonly used to treat attention deficit hyperactivity disorder (ADHD), although it is also sometimes used to treat narcolepsy.
Some people believe that methylphenidate can be used with some autistic individuals to reduce problem behaviours, such as hyperactivity, impulsivity and inattention.
There have been a number of claims for the benefits of methylphenidate in autistic individuals. For example,
Reichow, Volkmar and Bloch (2013) carried out a systematic review of the use of medications to treat ADHD in autistic children and reported that “methylphenidate was effective in treating hyperactivity in children with PDDs”. They also reported that “methylphenidate was shown to have moderate, albeit not statistically significant, effects in treating irritability and stereotypies in children with PDDs”.
Stimulant medications (such as methylphenidate) are designed to help individuals with problem behaviours such as hyperactivity, impulsivity and inattention which affect the individual's ability to function.
According to the National Institute for Clinical Excellence (2000)
'Methylphenidate ... is not currently licensed for use in children less than 6 years old.'
Methylphenidate or methylphenidate hydrochloride is a central nervous system stimulant medication used to treat conditions such as ADHD and narcolepsy.
Methylphenidate is sold under various brand names including Concerta, Delmosart, Ritalin and Xaggitin.
It can be given as
The exact amount of each dose needs to be carefully monitored and adjusted by a specialist. This is especially true for autistic individuals because, as Posey et al (2007) noted, 'Optimal dose analyses suggested significant interindividual variability in dose response'.
Di Martino (2004) suggested that 'Administering a single MPH test dose may be useful in identifying children with PDD who may benefit from prolonged therapy.' Autistic individuals who respond can then be given further, low doses which can be gradually increased.
For the latest information on specific formulations and recommended dosages please see BNF: Methylphenidate Hydrochloride and BNF for Children: Methylphenidate Hydrochloride.
The cost of using methylphenidate will depend on a number of factors including the supplier, the brand, the dosage, and the length and frequency of treatment.
According to the BNF website accessed on 21 May 2018, the NHS indicative price for three of the commonly used brands was as follows
Within the UK, methylphenidate is available free of charge to patients via the National Health Service. In other countries the costs may be covered by some insurance policies.
The amount of time it takes to use methylphenidate will depend on a number of factors including the overall length of treatment, the frequency of treatments and the time taken to administer a single dose, as well as the needs of the person undertaking it.
Methylphenidate Immediate action tablets or liquid are usually taken 2-3 times a day, preferably 35-40 minutes before meals, with the last dose several hours before bedtime. Intermediate or long acting methylphenidate in tablet or capsule form is usually taken once a day in the morning.
NICE (2000) recommended that
"Methylphenidate should be discontinued if there is no response after 1 month, and treatment should be suspended periodically to assess the child's condition."
In addition, the U.S. National Library of Medicine (2017) issued the following warning about prolonged use of methylphenidate.
“Methylphenidate can be habit-forming. Do not take a larger dose, take it more often, take it for a longer time, or take it in a different way than prescribed by your doctor. If you take too much methylphenidate, you may find that the medication no longer controls your symptoms, you may feel a need to take large amounts of the medication, and you may experience unusual changes in your behavior."
According to NICE (2000)
“Common adverse effects of treatment include insomnia, nervousness, headache, decreased appetite, abdominal pain and other gastrointestinal symptoms, and cardiovascular effects such as tachycardia, palpitations and minor increases in blood pressure.”
According to the BNF website, accessed on 21 May 2018, side effects may include
“Uncommon: Abnormal dreams; confusion; constipation; dyspnoea; epistaxis; haematuria; muscle cramps; suicidal ideation; urinary frequency. Rare: Angina; sweating; visual disturbances. Very rare: Angle-closure glaucoma; blood disorders; cerebral arteritis; dependence; erythema multiforme; exfoliative dermatitis; hepatic dysfunction; leucopenia; myocardial infarction; neuroleptic malignant syndrome; psychosis; seizures; thrombocytopenia; tolerance; Tourette syndrome. Frequency not known: Bradycardia; convulsions; supraventricular tachycardia.”
The Royal College of Psychiatrists recommends that a child being treated with stimulants 'should have their height and weight measured regularly' because of possible effects on appetite.
Please see U.S. National Library of Medicine (2017) for a full list of other potential side effects.
- Autistic Individuals
Researchers have identified some potential hazards for autistic individuals. For example, Cortese et al (2012) reported
"The most common adverse events associated with the use of psychostimulants in children and adolescents with ASD include: appetite reduction, sleep-onset difficulties, irritability and emotional outbursts."
There are some contraindications (something which makes a particular treatment or procedure potentially inadvisable) for methylphenidate. For example, according to the BNF website, accessed on 21 May 2018, methylphenidate may be contraindicated in individuals with the following conditions:
“Anorexia nervosa; arrhythmias; cardiomyopathy; cardiovascular disease; cerebrovascular disorders; heart failure; hyperthyroidism; phaeochromocytoma; psychosis; severe depression; severe hypertension; structural cardiac abnormalities; suicidal ideation; uncontrolled bipolar disorder; vasculitis.”
Angina (chest pain caused by reduced blood flow to the heart muscles); angle-closure glaucoma (damage to the optic nerve caused by pressure of the fluid inside the eye); anorexia nervosa (eating disorder); arrhythmias (irregular heartbeats); bipolar disorder ( condition that affects your moods, which can swing from one extreme to another); bradycardia (slow heart beat); cardiomyopathy (diseases of the heart muscle) ; cardiovascular disease(disease affecting the heart or blood vessels); cerebral arteritis (inflammation of the blood vessel wall affecting the brain); cerebrovascular disorders (diseases that affect the blood vessels of the brain and blood circulation); dyspnoea (difficult or laboured breathing); epistaxis (nosebleed); erythema multiforme (skin condition); exfoliative dermatitis (redness and peeling of the skin); haematuria (presence of blood in the urine); hepatic dysfunction (liver failure); hyperthyroidism (excessive production of thyroid hormone); leucopenia (reduction in the number of white cells in the blood); myocardial infarction (heart attack); neuroleptic malignant syndrome (life-threatening reaction to antipsychotics); phaeochromocytoma (rare tumour of adrenal gland tissue); psychosis (mental health problem in which a person's perception of reality becomes distorted); hypertension (high blood pressure); structural cardiac abnormalities (defect or abnormality of the heart that does not affect the blood vessels in the heart); suicidal ideation (suicidal thoughts); supraventricular tachycardia (abnormally fast heart beat); thrombocytopenia (low blood platelet count); Tourette syndrome (condition characterised by a combination of involuntary noises and movements called tics); vasculitis (inflammation of the blood vessel wall).
Methylphenidate is a powerful drug with many potential side effects and contraindications. For this reason it should only be obtained on prescription from either a paediatrician or psychiatrist, or from a GP on the advice / recommendation of a psychiatrist.
According to NICE (2000),
“On the basis of evidence from experts, the Committee concluded that [methylphenidate] 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.”
Methylphenidate was patented in1954 in the United States by the Ciba-Geigy Pharmaceutical Company, now known as Novartis.
It is marketed under various brand names including Concerta, Delmosart, Ritalin and Xaggitin.
We have identified 18 articles on the use of methylphenidate as a treatment for autistic people in peer-reviewed journals published in English.
Four of the articles (Jahromi et al, 2009; Posey et al, 2007; Research Units on Pediatric Psychopharmacology Autism Network, 2005; Scahill et al) reported on the same clinical trial.
These studies we identified included more than 600 autistic individuals aged from three years old to 18 years old, although the bulk of studies looked at primary school children and adolescents. Individuals with specific diagnoses included people with autistic disorder, Asperger syndrome or pervasive developmental disorder - not otherwise specified. Most of the participants in these studies were also diagnosed with attention deficit hyperactivity disorder (ADHD).
The length of intervention varied between a single, one-off dose to multiple doses delivered over three years. However, in most cases, the intervention lasted between four to six weeks. The dosage of methylphenidate varied from 0.21 mg per kg body with per day to 1.5 mg per kg body weight per day. Younger children received smaller doses than adolescents and adults. In most cases, the medication was started at a low dose and gradually increased to a higher maximum dose.
10 of the studies used a group design, usually comparing a specific dose of methylphenidate with a placebo and/or with a different dosage of methylphenidate. Nine of these group studies used a crossover design in which the participants received first one treatment and then another. One of the studies used a parallel group design in which different groups of participants received different dosages of methylphenidate. Eight of the studies used a single case design in which the participants only received methylphenidate or another stimulant but nothing else.
There are a number of limitations to all of the research studies published to date. For example
For a comprehensive list of potential flaws in research studies, please see Why some research studies are flawed.
There is a limited amount of research evidence (10 group studies and eight case design studies with three or more participants) into the use of methylphenidate as an intervention for autistic people.
This research suggests that methylphenidate may be beneficial for the treatment of hyperactivity, impulsivity and inattention in some autistic children and young people.
There is almost no research evidence to suggest that methylphenidate may be useful for the treatment of autistic adults.
There is evidence of significant side effects of methylphenidate in some individuals. Those side effects may include insomnia, nervousness, headache, decreased appetite, abdominal pain and other gastrointestinal symptoms, and cardiovascular effects such as tachycardia, palpitations and minor increases in blood pressure.
Further, large scale, double blind, randomised controlled trials of the effects of methylphenidate should be carried out on autistic individuals to determine their effectiveness and safety. These studies should
This section provides details of scientific studies into the effectiveness of this intervention for autistic people which have been published in English-language, peer-reviewed journals.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.