During data collection from parents of a child started on methylphenidate, which statement suggests an adverse effect?

• A. He doesn't seem to sleep well at night.
• B. He has been frequently interrupting others.
• C. He seems to get distracted very easily.
• D. He has to fidget constantly with something.

Answer: (D)

Methylphenidate is a stimulant that increases brain arousal. A parent reporting that the child is fidgeting constantly with something points to medication-induced restlessness or jitteriness, a known adverse effect of stimulant ADHD treatments. This kind of restlessness indicates the drug is producing unwanted activation, which can occur even as the drug helps with attention. While sleep problems can also occur with stimulants, the persistent, new-onset motor restlessness is the clearest sign that the medication is causing an adverse effect. If this happens, clinicians often reassess the dose or timing and monitor for other signs like increased anxiety or potential tics, adjusting management as needed.