Konrad 2005.

Study characteristics
Methods	Cross‐over trial with 2 interventions: LD‐MPH and HD‐MPH placebo
Participants	Number of participants screened: not stated Number of participants included: 44 (37 boys (84%), 7 girls (16%)) Number of participants followed up: 44 Number of withdrawals: not stated Diagnosis of ADHD: DSM‐IV (combined type 100%) Age: mean 10.3 years (SD 1.9, range 8‐12) IQ: mean 98.1 MPH‐naive: not stated Ethnicity: not stated Country: Germany Setting: inpatient ward Comorbidity: not stated Comedication: no Other sociodemographics: none Inclusion criteria ADHD diagnosis using multiple measures and observation in playroom, etc Children were included only if they also met criteria for ADHD diagnosis on teachers’ rating scale Exclusion criteria General IQ < 80 (WISC‐III) Any pervasive developmental disorders, receptive language disorders, visual impairments Any kind of additional medication (including SSRIs or anticonvulsants)
Interventions	Participants were randomly assigned to 1 of 6 possible drug condition orders of LD‐MPH 0.25 mg/kg or HD‐MPH 0.5 mg/kg and placebo Mean MPH dosage: 9.4 mg (SD 2.3) for the 0.25‐mg/kg dose; 18.6 mg (SD 5.3) for the 0.50‐mg/kg dose Administration schedule: not stated Time points: not stated Duration of each medication condition: 2 days Washout before trial initiation: not stated Medication‐free period between interventions: no Titration period: before testing, all children were given 0.30 mg/kg MPH each day for ≥ 1 week to ascertain tolerance Treatment compliance: not stated. Within the 6‐day protocol, the order of drug conditions was randomly assigned, with the restriction that the high dose never occurred right after placebo
Outcomes	ADHD symptoms Primary outcomes German Teachers’ Report on ADHD Symptoms (Fremdbeurteilungsbogen für Hyperkinetische Störungen) of the Parental Questionnaire of ADHD symptoms (Diagnostiksystem für Psychische Störungen im Kindes und Jugendalter nach ICD‐10 und DSM‐IV). Sum scores were calculated separately for both symptom scales (hyperactive‐impulsive symptoms and inattentive symptoms)
Notes	Sample calculation: not stated Ethics approval: yes; informed parental consent was obtained for all participants, and the trial was approved by the Medical Ethical Committee of the University Key conclusions of trial authors Trend tests revealed linear effects of MPH dose on Actigraph data in the test session (P = 0.02) and at school (P = 0.001), as well as on sustained attention (P value < 0.001); inhibitory control showed a quadratic dose‐response curve (P value < 0.001) Multi‐variate regression analyses revealed that changes in both hyperactive‐impulsive symptoms (28%) and inattentive symptoms (23%) could be explained by objective changes in motor activity. Thus, for clinical practice, it should be taken into account that behaviour ratings of ADHD symptoms seemed to be predominantly influenced by changes in motor activity. Inclusion of MPH responders only/exclusion of MPH non‐responders/children who have previously experienced AEs while taking MPH before randomisation: yes; before testing, all children were given 0.30 mg/kg MPH each day for ≥ 1 week to ascertain tolerance Any withdrawals due to AEs: not stated Funding source: provided through a grant from the German Research Foundation (DFG grant: KFO112–TP5) Email correspondence with trial author: July 2015. Email sent to trial author to ask for additional information, but we have received no reply
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Within the 6‐day protocol, the order of drug conditions was randomly assigned, with the restriction that the high dose never was given immediately after placebo
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Active medication and placebo were prepared by a trial protocol physician who was not involved in the assessment. All capsules were identical opaque gelatin capsules and were administered in a double‐blind manner
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not stated Selection bias (e.g. titration after randomisation → exclusion of MPH non‐responders or placebo responders): no
Selective reporting (reporting bias)	Unclear risk	No protocol identified