Stoner 1994.

Study characteristics
Methods	2 n‐of‐1, double‐blind, placebo‐controlled, cross‐over, randomised controlled trial. Both cases received 4 levels of the following: MPH 5 mg, 10 mg and 15 mg Placebo After the double‐blind trial, the code was broken, and the best dose was administered to the participant. Follow‐up data on the best dose were also measured. Follow‐up data were recorded anecdotally for the first case (Dan) and systematically for the second case (Bill)
Participants	Number of participants screened: 2 boys Number of participants included: 2 Number of participants followed up: 2 Number of withdrawals: none Diagnosis of ADHD: DSM‐III‐R (subtype not stated) Age: Dan 9 years, Bill 13 years IQ: not stated MPH‐naive: 100% Ethnicity: not stated Country: USA Setting: not stated Comorbidity: not stated Comedication: not stated Other sociodemographics: none Inclusion criteria Not stated Exclusion criteria Not stated
Interventions	Participants were randomly assigned to different orders of 3 doses of MPH and placebo Mean MPH dosage: not relevant Administration schedule: once daily at breakfast Duration of each medication condition: Dan received placebo for 3 days, and 5 days of treatment with 5 mg, 10 mg or 15 mg MPH consecutively. Bill received placebo for 3 days, and 3 days of treatment with 5 mg, 10 mg or 15 mg MPH consecutively Washout before trial initiation: treatment‐naive Medication‐free period between interventions: 24 h between doses Titration period: none Treatment compliance: parents were instructed to initial a monitoring form each time they gave a dose to their child after breakfast. No further description of this was provided Regarding the follow‐up trial: Dan 15 mg; Bill 10 mg (5 mg twice daily)
Outcomes	General behaviour Child Attention Problems Scale (CAP, 12‐items; Barkley 1990): teacher‐rated, at the end of each medication trial Non‐serious AEs Stimulants Drug Side Effect Rating Scale: rated by participants, parents and Bill’s teacher at the end of each medication trial
Notes	Sample calculation: not relevant Ethics approval: not stated Comments from trial authors "Although results from both studies are promising, they must be interpreted with great caution because various methodological and design features introduced threats to internal validity. For example, inclusion of a no‐medication day between trial phases would be more in keeping with standard practice of clinical research trials of medication" "Even though methylphenidate has a relative low half‐life (4 to 6 hours), it is thought to be completely eliminated from the body within 24 hours of ingestion; a carry‐over of effect from one trial to another may have occurred" Key conclusion of trial authors "Curriculum‐based measurement data collected during short medication trials can be used to select a dose of MPH that is likely to be beneficial for a student’s ongoing academic growth" Comments from review authors As we do not know whether any of the children were intellectually disabled, we can use the trial results only in sensitivity analyses The article reports some side effects, but we could not obtain more information on this from the trial authors; therefore, these data are not used in the review Exclusion of MPH non‐responders/children who have previously experienced AEs while taking MPH before randomisation: no Any withdrawals due to AEs: no Funding source: National Association of School Psychologists Email correspondence with trial author: January 2014. Wrote to trial author to request additional information regarding ethics approval, intellectual disability, etc., but have not received a response
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	The order of medication levels was determined randomly. In packing the envelopes, 1 of the trial authors arranged the coded envelopes according to the randomly determined order of trials
Allocation concealment (selection bias)	Low risk	Each medication level was prepared and packed in separate envelopes by a pharmacist
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Each dose of MPH and placebo was ground into a powder, mixed with an inert compound, and was sealed in a small coloured drug capsule, so that doses were identical in appearance and taste. Thus, the pharmacist, the data collectors, the participants and their families did not know the order of drug administration
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Each dose of MPH and placebo was ground into a powder, mixed with an inert compound, and was sealed in a small coloured drug capsule, so that doses were identical in appearance and taste. Thus, the pharmacist, the data collectors, the participants and their families did not know the order of drug administration
Incomplete outcome data (attrition bias) All outcomes	Low risk	All data were provided Selection bias (e.g. titration after randomisation → exclusion of MPH non‐responders or placebo responders): no
Selective reporting (reporting bias)	Unclear risk	No protocol was identified, and no answer was received from the trial author