Firestone 1981.

Study characteristics
Methods	3‐month, randomised, double‐blind, placebo‐controlled, parallel trial, wherein participants were randomly assigned to 3 arms: parent training + placebo (control group) parent training + MPH (intervention group) MPH
Participants	Number of participants screened: 91 Number of participants included: not stated (includes boys and girls) Number of participants followed up: intervention 18, control 13 Number of withdrawals: not stated Diagnosis of ADHD: DSM‐III Age: mean 7.32 years (range 5‐9) MPH‐naive: not stated Ethnicity: not stated Country: not stated Setting: outpatient clinic Comorbidity: not stated Comedication: not stated IQ: 116 Other sociodemographics: all children living at home with ≥ 1 parent. No significant differences in age and IQ between treatment groups. No data on remaining parameters Inclusion criteria 5‐9 years of age Fit DSM‐III criteria for ADD‐H, showing overactivity, short attention span, impulsivity, aggressiveness and oppositional behaviour, both at home and in school, since before 4 years of age Hyperactivity Index of CTRS ≥ 15 IQ > 85 Exclusion criteria Brain damage Epilepsy Psychosis
Interventions	Participants were randomly assigned to MPH + parent training (intervention group) or to placebo + parent training (control group). After the titration period MPH was given only on school days Average MPH dosage: 22 mg/d (range 10 mg/d‐30 mg/d) Titration period: first 3‐4 weeks: MPH was titrated (after randomisation), starting with 5 mg twice/d (morning, noon), 7 days a week Treatment compliance: not stated
Outcomes	ADHD symptoms CTRS 2, CPRS subscale Hyperactivity Index: rated by mothers post‐treatment
Notes	Ethics approval: no information Key conclusions of trial authors All groups showed improvement at home and in school; only with MPH administration were gains in measures of attention and impulse control also seen Results also revealed greater improvement in academic achievement and in classroom behaviour in medication groups as compared with placebo groups No evidence showed significant benefit from the addition of parent training to administration of medication Comment from review authors First trial author has retired; we were not able to get data from him (e.g. protocol, randomisation method) Inclusion of MPH responders only/exclusion of MPH non‐responders/children who have previously experienced AEs while taking MPH before randomisation: no Any withdrawals due to AEs: yes, 4 participants responded adversely and were dropped from the trial Funding source: Ministry of Health
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Children were randomly assigned; no description of how
Allocation concealment (selection bias)	Unclear risk	No data
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Parents, teachers, therapists and those testing the children were unaware of medication conditions
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Parents, teachers, therapists and those testing the children were unaware of medication conditions
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No data Selection bias (e.g. titration after randomisation → exclusion of MPH non‐responders or placebo responders): none
Selective reporting (reporting bias)	Unclear risk	No protocol identified