A Descriptive Review of Nordic Clinical Practice Guidelines for Pediatric ADHD: Evaluating the Evidence Base for Methylphenidate.

Background: Pediatric medication use in Attention Deficit Hyperactivity Disorder (ADHD) is rising sharply across the Nordic countries, with Iceland and Finland currently showing the highest prevalence rates. The reasons behind the cross -country differences remain unclear. Objective: To describe the level of agreement in the graded evidence base for methylphenidate - the first-line ADHD medication for children - as is available in the Nordic Clinical Practice Guidelines (CPGs) on pediatric ADHD. Method: Relevant Nordic CPGs covering ADHD medication treatment for children over 6 years-of-age were identified using strict search criteria and by visiting the Nordic CPG databases (in Nov 2025). Only the most current version of CPGs was included in the analysis and relevant links from the CPG were visited and reviewed with relevant sections adopted. All english translations were produced with the aid of large linguistic models. Results: The Icelandic CPG lacked the grading of available evidence for methylphenidate altogether. For benefits, the chosen outcomes varied and the Finnish and Norwegian CPGs graded the quality of evidence as of high quality, the Danish as moderate and the Swedish from moderate to very low. For potential harms associated with methylphenidate use, also the Norwegian CPGs lacked the grading of evidence. The Finnish CPG concluded on high to moderate quality of evidence, the Swedish on moderate to very low and the Danish only on very low quality of evidence. Conclusions: There is a low level of agreement between Nordic guidelines regarding the quality of evidence for methylphenidate in pediatric ADHD. This could contribute to the observed cross-country differences in prescribing practices. A centralized CPG development process and stronger collaboration among Nordic CPG working groups seem warranted.