Methylphenidate is the most common treatment for attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is the most common pediatric psychiatric disorder (Swanson et al. 1995), with an estimated childhood prevalence of 9% in boys and 3% in girls (Szatmari et al. 1989). Surface symptoms of inattentiveness and impulsivity (Shue and Douglas 1992;Shaywitz and Shaywitz 1988) are often, though not invariably, accompanied by hyperactivity (Gittelman and Mannuzza 1985). ADHD is highly heterogeneous with several distinct subtypes and often comorbid with learning, anxiety, and conduct problems. During childhood, ADHD is associated with greater risk of low academic achievement, grade failure, delinquency (Barkley 1997) and during adulthood, with psychiatric disorders and substance abuse (Wender 1987). Stimulant medication, primarily methylphenidate, is the most common treatment for ADHD. Because methylphenidate may be associated with altered neurotransmitter levels (Mefford and Potter 1989; Voeller 1991), several investigators have attributed ADHD to a neuroFrom the Novartis Pharmaceuticals Canada Inc., (GAS), Dorval, Quebec, Canada; and The Hospital for Sick Children, Divisions of Neurology (MAM, TH, WR, MJT) and Psychology Research (JR), Toronto, Ontario, Canada.Address correspondence to: Dr. Molly A. Malone, Child Development Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.Received August 26, 1998; revised December 30, 1998; accepted February 05, 1999. N EUROPSYCHOPHARMACOLOGY 1999 -VOL . 21 , NO . 2 Methylphenidate and Attention in ADHD Children 219 chemical imbalance in catecholarnine regulation (Malone et al. 1994;McCracken 1991;Pliszka et al. 1996).Methylphenidate effectively reduces hyperactivity, impulsivity, and inattention in 60-90% of children diagnosed with ADHD (Whalen and Henker, 1991). Improved social skills and school performance have also been documented (e.g., Swanson et al. 1995). However, the optimal dosages have not yet been established and clinical anecdotal descriptions report some children as becoming overfocused, cognitively constricted, introverted, and "zombie-like" on higher doses (Swanson et al. 1991; Thurston et al. 1979). These descriptions are not consistently substantiated by empirical studies, however, which show both linear improvements with dose (Douglas et al. 1995;Solanto and Wender 1989) and adverse effects of high dose levels (Dyme et al. 1982;Malone et al. 1988;Sprague and Sleator 1977). A recent study by Tannock and Schachar (1992) has shown opposing effects of a high dose level at different test sessions with children making more perseverative errors in the first session and fewer in the second, while another study by this same group reported that despite clinical observations of overfocusing, measured attention performance was not affected by a high dose (Tannock et al. 1989).Children with ADHD are thought to have a primary attentional deficit in inhibitory (Barkley 1994;Schachar ...