Effect of methylphenidate on substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: a systematic review

Introduction and objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) affects 2.2% of children and adolescents. The risk of substance use disorders (SUD) is twice as high among people with ADHD, requiring targeted approaches. This study aimed to evaluate the effect of methylphenidate on the development of substance use disorders among children and adolescents with ADHD, including alcohol, tobacco, and other drugs. Methods: A systematic search was conducted on January 26^th, 2023. Characteristics of the study and participants were extracted and the risk of bias evaluated. Results: From the 2,854 articles identified and 14 registry entries, seven reports were included in the review, accounting for 860 participants, with 526 from intervention (61.2%) and 334 from control groups (38.8%). Treatment with methylphenidate was consistently protective against drug use. Discussion: Methylphenidate treatment may be effective in reducing SUD risk, especially in young drug users. Preventive measures are needed, including health promotion and interventions tackling health determinants, particularly in vulnerable groups. Further high-quality studies are required to strengthen our findings.