Lyon 2010.

Methods	A cross‐over trial with 2 interventions: DEX‐methylphenidate No medication/no intervention 10 children with ADHD and TD were given dexmethylphenidate on 1 visit and no medication on another (day 2 and 3), using a random cross‐over design
Participants	Number of participants screened: 51 Number of participants included: 13 Number of participants followed up: 10 Number of withdrawals: 3 Diagnosis of ADHD: DSM‐IV‐TR (subtype: combined (50%), inattentive (50%)) Age: mean 12.7 years old, range 8‐16 years old IQ: mean 104, range 85‐118 Sex: 9 males, 1 female Methylphenidate‐naïve: not stated Ethnicity: white 70%, African American 0%, Asian 0%, Hispanic 30%, others 0% Country: USA Comorbidity: Tourette's 100% Comedication: 70% Sociodemographics: not stated Inclusion criteria Age 10‐17 years DSM‐IV‐TR diagnosis of ADHD combined with either: Tourette Disorder or Chronic motor/vocal Tic Disorder Baseline Yale Global Tic Severity Scale Total Tic Score ≥ 14 for TD or ≥ 10 for CTD Exhibited 1 or more motor or vocal tics (or both) at a rate of ≥ 1 tic per minute averaged across a 10‐minute videotaped observation Intellectual functioning was at least in the low‐average range or above as indicated by a score of greater than 75 on the Wechsler Abbreviated Scale of Intelligence (WASI) No history of behavioural treatment for tics (greater than 3 weeks in duration) or other treatment in which suppression strategies were a primary component of the intervention Current tic medication at the time of the study was allowed but no change of dose Previous treatment with stimulants was allowed if the participant had not received stimulants for ≥ 48 hours prior to testing proceduresADHD symptoms must have been associated with impairment in at least one domain (home, school) Exclusion criteria Participants with pervasive developmental disorder, schizophrenia, major depressive disorder, bipolar disorder, or substance abuse disorder Participants currently receiving stimulant medication who could not temporarily discontinue it for study procedures Participants with any medical condition that would contraindicate use of a stimulant, such as seizure disorder, previous hypersensitivity to methylphenidate, glaucoma, or a significant cardiac history, including fainting or dizziness, seizures, rheumatic fever, chest pain or shortness of breath with exercise, unexplained change in exercise tolerance, palpitations, increased heart rate, hypertension, heart murmur other than benign functional murmur, or current viral illness with chest pains or palpitations Participants with a family history of sudden or unexplained death in someone less than 35 years of age, sudden death during exercise, cardiac arrhythmias, cardiomyopathy, including hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy or right ventricular cardiomyopathy, long QT syndrome, short QT syndrome or Brugada syndrome, Wolf‐Parkinson‐White syndrome or abnormal cardiac rhythms, event requiring resuscitation in family members under the age of 35, including syncope requiring resuscitation, or Marfan syndrome Participants with abnormal electrocardiogram (ECG) at baseline, including prolongation of the QTc interval greater than 450 ms for males and 470 ms for females Participants who meet full criteria for obsessive‐compulsive disorder or another anxiety disorder requiring pharmacological or behavioural treatment
Interventions	Participants were randomly assigned to 1 of 2 possible drug condition orders of (0.15 mg/kg) methylphenidate and placebo Mean methylphenidate dosage: 7.5 mg/day Administration schedule: once a day Duration of each medication condition: 1 day Washout prior to study initiation: not stated Medication‐free period between intervention: not stated Titration period: none Treatment compliance: not stated
Outcomes	Non‐serious adverse events The Safety Monitoring Uniform Report Form (SMURF) (Greenhill et al. 2004) was administered by one of the investigators on day 1, and after TSP procedures on days 2 and 3 Adverse events were generally mild. 7 (70%) participants experienced ≥ 1 minor adverse event during the study. The most common adverse events possibly related to study drug were drowsiness or sedation (20%) and stomach discomfort (20%)
Notes	Sample calculation: not stated Ethics approval: all study procedures were approved by the institutional review boards (IRB) at the University of Wisconsin‐Milwaukee and New York University Langone Medical Center Key conclusions from study authors: preliminary results suggest that dexmethylphenidate does not appear to enhance tic suppressibility in children with ADHD and TD. First, there was a clear tic‐reduction effect, and not exacerbation, with a 1‐time dose of dexmethylphenidate compared to no medication in these children. Second, youths with TD and ADHD appear to be able to suppress their tics with a behavioural reward comparable to youths with TD without ADHD Comments from the study authors: some limitations of the study design need to be taken into account. First, our sample size was small and participants were recruited from a specialised clinic. Thus, findings may not generalise to non‐specialty settings. Second, 70% of participants were receiving medication for TD, anxiety, OCD, or asthma, and our results might have differed if the participants were not receiving concomitant medication. Third, investigators, parents, and participants were not blind to medication status, because medication was administered openly Comments from the review authors: ADHD outcome data are only available for 7 participants ('data from 3 participants were unusable as a result of computer malfunction') Exclusion of methylphenidate non‐responders/children who have previously experienced adverse events on methylphenidate: no