Efficacy of Oral Methylphenidate and Risperidone in Treatment of Attention-Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder of childhood. Worldwide approximately 5-12% of children have ever been diagnosed with ADHD. Dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits and abnormalities of the dopamine transporter are the pathophysiology of ADHD. This site is the main target for medications such as psychostimulants e.g. methylphenidate for ADHD. In addition, to other pharmacological strategies, antipsychotic drugs such as Risperidone have been used for ADHD. The use of antipsychotic medication has been rising significantly for treating DBD in ADHD children. Objective: This study aimed to compare the effectiveness of oral Methylphenidate and Risperidone in children with ADHD. Methods: Conducted as a randomized controlled trial (RCT) at the Outpatient Unit of Pediatric Neurology, National Institute of Neurosciences and Hospital in Dhaka, Bangladesh, the study enrolled eighty children aged 3-14 years diagnosed with ADHD based on DSM-V criteria and confirmed by CPRS. Participants were randomly assigned to receive either Risperidone (experimental group, n=40) or Methylphenidate (control group, n=40). The efficacy and side effects of the medications were evaluated at 3-, 6-, and 12-week intervals, with changes in Conner's parent rating subscales and behaviour in school, family, community, and peer groups compared between the groups. Statistical analysis was performed using SPSS version 23. Results: Both medications demonstrated significant improvements in oppositional, cognitive, hyperactivity, and ADHD index sub-scales by the end of treatment. While the Risperidone group showed early response by 6 weeks, a substantial proportion of the Methylphenidate group required 12 weeks to respond. Academic performance, family dynamics, community engagement, and peer interactions improved in both groups, with a notably significant improvement observed in the Risperidone group at 6