Solanto 2009.

Study characteristics
Methods	Cross‐over trial with 2 interventions: MPH placebo Phases: week‐long exposure to placebo and to each of 3 different dosage regimens of IR‐MPH
Participants	Number of participants screened: not stated Number of participants included: 30 Number of participants followed up: 25 Number of withdrawals: 5 Diagnosis of ADHD: DSM‐IV (combined (60%), inattentive (40%)) Age: mean 8.53 (combined) and 9.20 (inattentive) IQ: not stated MPH‐naive: all but 1 were stimulant‐naive Ethnicity: not stated Country: USA Setting: hospital Comorbidity: ODD (combined 13%, predominantly inattentive 20%); learning disability (combined 40%, predominantly inattentive 20%); anxiety (combined 0%, predominantly inattentive 10%) Comedication: no Other sociodemographics: minority representation (combined 53%, predominantly inattentive 20%) Inclusion criteria Between 7 and 12 years of age Concordant reports: CPRS and CTRS ‐ Combined group T scores ≥ 65 on both DSM‐IV Inattentive and DSM‐IV Hyperactive‐Impulsive Scales Predominantly Inattentive group T scores ≥ 65 on the DSM‐IV Inattentive Scale and < 65 on the DSM‐IV Hyperactive‐Impulsive scale Diagnosis of ADHD, combined or predominantly inattentive according to a structured diagnostic interview of the parent: DISC Expert clinical diagnosis of ADHD based on review of all information collected Exclusion criteria Currently receiving psychotropic medication WISC‐III: < 80 Mood disorder, Tourette's disorder or psychotic disorder Sensory impairment or chronic medical or neurological condition including asthma that required systemic medication Colour blindness
Interventions	Participants were randomly assigned to 1 of 24 possible drug condition orders of LD‐, MD‐ and HD‐MPH and placebo Mean MPH dosage (Combined vs predominantly Inattentive): LD 0.50 ± 0.12 vs 0.44 ± 0.13; MD 0.83 ± 0.20 vs 0.73 ±‐0.21; HD 1.54 ± 0.31 vs 1.40 ± 0.38 Administration schedule: 3 times daily: morning, midday and 3:00 pm Duration of each medication condition: 1 week Washout before trial initiation: not required Medication‐free period between interventions: no Titration period: open‐label lead‐in week, not specified whether before or after randomisation of treatment Treatment compliance: not stated
Outcomes	ADHD symptoms CPRS, parent and teacher: baseline and end of each medication phase CTRS, parent and teacher: baseline and end of each medication phase ADHD‐RS‐IV: observer, weekly Non‐serious AEs Height, weight and vital signs: observer, weekly Side Effects Rating Scale: observer, weekly
Notes	Sample calculation: no Ethics approval: not stated Key conclusion of trial authors "Results support the clinical utility of MPH in the treatment of predominantly inattentive subtype and provide no evidence of differences in response between subtypes" Exclusion of MPH non‐responders/children who have previously experienced AEs while taking MPH before randomisation: unclear if there was an open‐label titration phase before randomisation Any withdrawals due to AEs: yes; 2 Funding source: not declared Email correspondence with trial authors: April 2014. We received supplemental information from trial authors
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Low risk	Double‐blind, cross‐over with week‐long exposure to placebo and each of 3 different dosage regimens of IR‐MPH in randomly assigned order
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double‐blind, cross‐over with week‐long exposure to placebo and each of 3 different dosage regimens of IR‐MPH in randomly assigned order. Trial medications were prepared and coded by the hospital pharmacy using identical gelatin capsules for active medication and placebo
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	Low risk	Across the 4 placebo and drug conditions, data points were missing as follows: CPRS 1%, CTRS 6%, Parent SKAMP 1%, Teacher SKAMP 4%, Side Effects 0%. Missing scores were replaced by the mean of scores for that group in that condition Selection bias: titration conducted but unclear whether before or after randomisation. No participants were excluded after the 1‐week titration period
Selective reporting (reporting bias)	Low risk	Protocol identified; all outcomes reported