Differentiating Between Methylphenidate Use and Misuse: Clinical Insights From University Students and Academic Staff in Türkiye

Abstract

Background: Methylphenidate (MPH) is widely prescribed for attention deficit hyperactivity disorder (ADHD), but non-med-ical use is increasing, particularly in academic settings, for cognitive enhancement. This study aims to distin-guish individuals using MPH for ADHD treatment from those misusing it by analyzing clinical and behavioral characteristics. Material/Methods: This retrospective study was conducted at a university-affiliated psychiatric outpatient clinic in Türkiye. Data were collected from structured psychiatric evaluations by a single psychiatrist between January and December 2024. A total of 135 individuals who requested MPH were included. Misuse was defined as use without an ADHD diagnosis, exceeding the prescribed dose, or use through non-oral routes. Participants were categorized into 4 groups based on diagnosis and misuse patterns. Data on demographics, psychiatric history, MPH use, and follow-up attendance were analyzed using descriptive and comparative methods. Results: Of the 135 participants, 3% were ADHD-diagnosed misusers, 33.3% were ADHD-diagnosed non-misusers, 11.9% were non-ADHD misusers, and 51.8% were non-ADHD non-misusers. Non-ADHD misusers were older (mean age 25 vs 22 years, P<0.001), had later MPH initiation (23 vs 15 years, P<0.001), more often held a PhD (Doctor of Philosophy) or an equivalent higher degree (23.3% vs 2.0%, P<0.001), had lower follow-up attendance (32.6% vs 93.9%, P<0.001), and preferred short-acting MPH (73.3% vs 20.4%, P<0.001). ADHD-diagnosed individuals were more likely to have a family psychiatric history (69.4% vs 21.0%, P<0.001). Conclusions: Misuse patterns differ significantly from medically indicated use. Strengthening diagnostic accuracy and im-plementing effective monitoring protocols in academic settings are essential for preventing misuse and sup-porting ADHD treatment.