Yu 2010.

Methods	A patient report of 4 boys with attention‐deficit/hyperactivity disorder who developed vasculopathy during treatment with psychostimulants. 3 received treatment with methylphenidate
Participants	Diagnosis of ADHD: ICD‐9/ICD‐10 (subtype: not stated) Age: 11, 12, 16 years old (mean: 13) IQ: no mentally retarded Sex: 3 males Ethnicity: white Country: USA Comorbidity: case 2 (suspected bipolar disorder) Comedication: case 1 (Adderall); case 2 (Abilify and Lamictal, later on they were discontinued and Seroquel was added) Sociodemographics: not stated
Interventions	Case 1 First methylphenidate attempt: Extended release methylphenidate dosage: 54 mg/daily (Concerta). Comedication: Adderall. Administration schedule: not stated. Duration of treatment: 2 years. Treatment compliance: not stated Second methylphenidate attempt: Immediate release‐/dex‐ and extended release‐methylphenidate dosage: Concerta 90 mg/daily and Focalin 20 mg/daily. Administration schedule: not stated. Duration of treatment: 9 months. Treatment compliance: not stated Total duration of psychostimulant treatment: 9 years Case 2 Immediate‐ and extended release methylphenidate dosage: long acting Ritalin: 30 mg/daily and Focalin 2.5 mg/daily Administration schedule: not stated Duration of current treatment: 4 years Total duration of psychostimulant treatment: 5 years Treatment compliance: not stated Case 4 Extended release/dex‐ and immediate release/dex methylphenidate dosage: Focalin XR 20 mg/daily, Focalin IR 10 mg/daily Administration schedule: twice daily, XR in the morning, and IR in the afternoon Duration of treatment: 1 year Total duration of psychostimulant treatment: 7 years Treatment compliance: not stated
Outcomes	Non‐serious adverse events: Case 1 Tachycardia at age 11 while taking Concerta, 54 mg/daily Vasculopathy at age 16. Hands and feet were a continuous blue color which increased in frequency in cold weather. Diagnosed with decreased circulation but not Raynaud's syndrome. Occured when the Concerta dose was increased from 54 mg/daily to 90 mg/daily in 3 months with the same Focalin dose (10 mg/daily) Case 2 Vasculopathy. First diagnosed with Raynaud's syndrome with finger pain and colour changes during a neurology consultation at age 10. At age 12 had diffuse erythema of both earlobes, the fingers of both hands, and the toes of the left foot Tics at age 10 ‐ not clear if these were present prior to ADHD treatment Case 4 Vasculopathy. After taking Focalin for a year, he developed persistent curling of the toes of both feet. In addition, he had reddish and purple colour changes in his hands and feet with cold exposure that lasted for 20 min. No associated pain and only rare paresthesia. At age 10 toes 2, 3, and 4 of both feet were held in a flexed position ('curled toes'), and there was skin discoloration and excoriation
Notes	Funding/vested interest: none Authors' affiliations: Drs Ronald and Elizabeth Weller are co‐owners of the Children's Interview for Psychiatric Syndromes (and the parent's version) and have received annual royalties from copyright ownership of this diagnostic interview. Dr Elizabeth Weller was the principal investigator for a grant from GlaxoSmithKline to investigate the tolerability and efficacy of lamotrigine in children and adolescents diagnosed with bipolar disorder Key conclusions of the study authors: these patient reports raise the concern that adverse effects in the peripheral vascular system of children and adolescents may be associated with psychostimulant treatment Comments from the review authors: none of the patients had their psychostimulants decreased or discontinued. Due to the severe nature of their ADHD symptoms, these patient could not stop or reduce their psychostimulant treatment to determine whether their vascular symptoms would improve Supplemental information received through personal email correspondence with the authors in October 2013 (Yu 2013 [pers comm])