Adrian 2001.

Methods	A patient report of a 10‐year‐old boy referred to a tertiary neurodevelopmental assessment clinic for a second opinion on the management of his ADHD, with particular concern being expressed about aggressive outbursts and poor tolerance of methylphenidate
Participants	Diagnosis of ADHD: ICD‐10 (subtype: unknown) Age: 10 years old IQ: average intelligence Sex: male Methylphenidate naïve: not stated Ethnicity: not stated Country: UK Comorbidity: not stated Comedication: not stated Sociodemographics: Uneventful pregnancy
Interventions	Methylphenidate type: not stated Methylphenidate dosage: started 20 mg/day at 7 years and gradually increased to 40 mg/day Duration of treatment: 2‐3 years Treatment compliance: treatment was administered until 9 to 10 years of age when parents discontinued treatment due to obsessive compulsive symptoms
Outcomes	Non‐serious adverse events: Tics (both motor and vocal). Started at 40 mg/daily and subsided spontaneously after a year of treatment Obsessive compulsive symptoms (predominantly about symmetry) started about 6 months after tics and lasted 2.5 years and resolved at age 10 Sudden and severe aggressive and violent outbursts. The explosive outbursts paralleled the development of preoccupation with symmetry Sedation/semi‐catatonia Increased impulsivity The other adverse events were not found at the assessment 10 months after he stopped methylphenidate treatment
Notes	Key conclusions of the study authors: clinically explosive outbursts can be induced by the pharmacological treatment of ADHD and should not be mistaken for a symptom of the disorder Comments from the study authors: explosive episodes were coincident with a period of treatment with methylphenidate Funding/vested interest: not stated Authors' affiliations: Great Ormond Street Hospital London Supplemental information regarding diagnostic criteria and treatment duration obtained through personal email correspondence with the authors in October 2013 (Adrian 2013 [pers comm])