Kolko 1999.

Study characteristics
Methods	Randomised, placebo‐controlled, cross‐over trial with 2 possible drug interventions and placebo, as well as 2 possible psychological interventions: MPH at 0.3 mg/kg MPH at 0.6 mg/kg placebo and behaviour modification no behavioural modification
Participants	Number of participants screened: 70 Number of participants included: 22 (all boys) Number of participants followed up: 16 Number of withdrawals: 6 Diagnosis of ADHD: DSM‐III‐R (subtypes not stated) Age: mean 9.6 years (range 6.9‐12.9) IQ: not stated MPH‐naive: not stated Ethnicity: African American (75%) Country: USA Setting: "partial hospitalisation" summer treatment programme Comorbidity: CD (44%), ODD (56%), anxiety disorder (18.8%), major depressive disorder (11.5%), dysthymia (6%), intermittent explosive disorder (6%), developmental articulation disorder (6%), asthma (12.5%) Comedication: not stated Other sociodemographics: 3 lived with 1 or both parents, 6 lived with grandparents, 1 lived with an aunt, 4 lived with non‐relatives, 2 lived with foster mother. 44% of families received welfare Inclusion criteria Not stated Exclusion criteria Not stated
Interventions	Participants were randomly assigned to different possible drug condition orders of 0.3 mg/kg and 0.6 mg/kg MPH and placebo Mean MPH dosage: not stated Administration schedule: 8:00 am and 11:30 am to 12.00 pm Duration of each medication condition: 1 day. Each medication condition was administered once per week for a total of 6 days during the trial Washout before trial initiation: 2 weeks Medication‐free period between interventions: no Titration period: none Treatment compliance: not stated Behavioural intervention: behaviour modification and no behaviour modification were alternated on a weekly basis for a total of 3 weeks per condition
Outcomes	ADHD symptoms Abbreviated IOWA CRS, which includes an Inattentive/Overactive subscale and an Oppositional Defiant subscale Non‐serious AEs Barkley Stimulant Side Effects Rating Scale. Adapted by changing the rating scale to include only 4 points rather than 9 points
Notes	Sample calculation: not stated Ethics approval: not stated Key conclusions of trial authors MPH and behaviour modification had certain unique, main and incremental effects that extend findings supporting their combination and suggest that integrated studies should evaluate multiple dimensions of functioning in novel settings Incorporation of other intervention components in combined treatments may be warranted to enhance clinical efficacy Comments from review authors Barkley Stimulant Side Effects Rating Scale was adapted by changing the rating scale to include only 4 points (rather than 9 points) after pilot‐testing. Therefore, we cannot be sure whether the scale is still valid Limitations: the number of participants studied was small, and only 22 of 70 screened met trial eligibility criteria Exclusion of MPH non‐responders/children who have previously experienced AEs while taking MPH before randomisation: no Any withdrawals due to AEs: yes, 2 Funding source: not declared Email correspondence with trial author: January 2014. We were unable to obtain additional data (Nilausen 2014 [pers comm])
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Each MPH condition was administered once per week for a total of 6 days during the trial, and behaviour modification and no behaviour modification were alternated on a weekly basis, for a total of 3 weeks per condition. Thus, daily MPH conditions were crossed with 2, weekly behavioural intervention conditions
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	Low risk	It is stated: "MPH or placebo was placed in identical opaque capsules"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	High risk	Not stated Selection bias: exclusion of 2 participants with challenging behaviour
Selective reporting (reporting bias)	Unclear risk	No protocol available