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Comparison of Efficacy and Tolerability of Modified Release Methylphenidate, Osmotic-Release Methylphenidate and Atomoxetine in Children with Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition that affects the daily functioning of children, adolescents, and adults. In this study, we aim to determine the efficacy and tolerability of medications that frequently use in the treatment of ADHD. 
Materials and Methods: 204 primary school-age children with documented DSM-5 ADHD diagnosis were included. Clinical characteristics of the sample were obtained from the medical records and structured psychiatric interviews. Improvement and side effects were assessed with the Clinical Global Impression-Improvement Scale (CGI-I) and the adverse effect scale developed by the authors, respectively. 
Results: Mean age of the patients was 8.32±1.15 and 67.1% of the patients were male. 33.3% of the patients were using modified-release methylphenidate, 35.3% were using osmotic-release methylphenidate, and 31.4% were using Atomoxetine. The CGI-I was significantly different between the three groups (p=0.012). There was no significance in terms of treatment compliance. Sleep disturbances, appetite, and sadness were different between the groups. 
Conclusion: Atomoxetine seems to be less effective and has fewer side effects than modified-release methylphenidate and osmotic-release methylphenidate. Modified release methylphenidate and osmotic-release methylphenidate appear to show similar effectiveness. Osmotic release methylphenidate may be associated with more and severe side effects.