292 Methylphenidate
as 6%. In the mid-1990s approximately 1.5 million American school-age chil-
dren were taking stimulant medications just for ADHD, compared to 50 chil-
dren receiving methylphenidate for any purpose in Great Britain in 1991.
Another comparison: A 1999 report said 1.65% of students in one South Af-
rican urban area were receiving methylphenidate, but none of these children
were Afrikaans. Such dramatic differences in prescribing practices suggest
strong cultural influence on what is considered acceptable medical treatment.
During the mid-1980s great debate arose in the United States about the custom
of routinely prescribing methylphenidate to juveniles. The debate was based
on ethical values rather than strictly medical concerns, with some persons
arguing that the drug was being used as an agent of social control instead of
treating disease. After a flurry of lawsuits, the controversy eased.
A review of 23 studies evaluating ADHD drug effectiveness found little
distinction among methylphenidate, dextroamphetamine, andpemoline.
Drawbacks.Children with ADHD may also experience muscle tics, which
methylphenidate and other stimulants can worsen. Such a dual condition is
challenging, but in short-term usage, methylphenidate has been found effec-
tive for lessening ADHD without increasing tics, even though one study found
that almost 10% of ADHD children may develop temporary tics when taking
methylphenidate. A case report notes that a child began stuttering when dos-
age started, with the stutter ceasing when dosage ceased.
Amphetamine class drugs can promote psychosis and other psychiatric dis-
ability, and such unwanted results have been observed with methylphenidate,
including paranoia and hallucinations. In youngsters methylphenidate has
been known to bring on obsessive-compulsive behavior.
Among juveniles the compound has caused skin rash, stomach distress,
mild headaches, and sleep difficulties. In juveniles the compound can at least
temporarily reduce appetite, although in elderly users the drug has been ob-
served to increase appetite. Controversy exists about whether the drug affects
growth. The substance is associated with stroke suffered by two boys.
Methylphenidate is not recommended for persons suffering from seizures.
The drug has been reported to cause anemia and is suspected of worsening
allergies. The substance has been known to impair vision and is not recom-
mended for persons with glaucoma. Methylphenidate tends to increase im-
mune system activity; in theory that might affect vaccinations and also harm
HIV (human immunodeficiency virus)-positive persons. In some humans ab-
normal liver activity has been seen, but whether the drugcausedorrevealed
the problem is uncertain. The drug appears to cause heart damage in rats and
mice, and a human case has been reported.
Despite potential drawbacks, however, with proper precautions the drug is
considered generally safe for medical utilization.
Abuse factors.In primatescocaineand methylphenidate seem to work in
similar ways; indeed, some illicit substance users have been unable to tell
whether they received a dose of cocaine or methylphenidate. Although meth-
ylphenidate is a Schedule II substance, abuse of the drug is uncommon. De-
mand is small enough that the U.S. Drug Enforcement Administration reports
no illicit manufacturing. A large review of scientific literature covering the
years 1966 to 1998 was unable to substantiate news media claims about wide