stimulant medications such as methylphenidate have been used extensively for the management of attention deficit hyperkinetic disorder ( adhd ) . the efficacy and safety of methylphenidate have been examined in numerous clinical trials , systematic reviews , and meta - analyses . available evidence suggests that stimulants are more effective than placebo , with effect sizes varying from 0.8 to 1.1 and a positive early response in approximately 70% of cases . the most common side effects associated with methylphenidate are insomnia , headache , irritability , agitation , loss of appetite , nausea , and weight loss . obsessive - compulsive symptoms ( ocs ) as a side effect of methylphenidate have rarely been reported . there are occasional case reports describing these in children and adolescents . in this report , we present a case of an adolescent boy diagnosed with adhd and mixed disorder of scholastic skills , who developed ocs after starting methylphenidate , which resolved completely after stoppage of the medication , and review the literature on the association of ocs with methylphenidate . a 14-year - old boy presented to the hospital with a history of behavioral problems since early childhood . since 3 years of age , he was found to be fidgety , would frequently run about / leave his place in situations where he was expected to be seated , would not be able to engage in play activities calmly with friends , would not be able to wait for his turn , and would frequently interrupt others during their conversation . he would frequently forget his belongings in school and would easily get distracted with the slightest of noise . he would have difficulty in sustaining attention on tasks including studies , play activities , and would leave the same unfinished . in addition , since 6 years of age , he had difficulty in reading , i.e. , would read words incorrectly and slowly ; had difficulties in written expression , i.e. , would make multiple grammatical errors , write mirror images of alphabets , had lack of clarity in his writings , had difficulties with number sense , calculations , and problem - solving . over the years , his symptoms kept on worsening , and he continued to have poor grades in the school . he was diagnosed to have adhd along with mixed disorder of scholastic skills ( after detailed assessment for learning disability ) at 14 years of age . in view of adhd , he was started on methylphenidate and the dose was gradually increased to 15 mg / day . within 10 days of starting methylphenidate , he started to have ocs in the form of need for symmetry or exactness about furniture / paper / books being properly aligned , worry about words not being said in a compulsive symptoms included the need to order / arrange articles , checking locks and appliances repeatedly , and the need to repeat routine activities such as turning appliances on and off , and going in and out of doorway unless he felt he did it the right number of times ( not associated with magical thinking ) . during this period , there was no associated history of fever , sore throat , arthralgia , skin lesions , tics , depressive , manic , and psychotic symptoms . past history and family history did not reveal any evidence of obsessive - compulsive disorder ( ocd ) . in view of the temporal correlation of onset of ocs with methylphenidate , an association of two was suspected and methylphenidate was stopped . over the period of the next 2 weeks , the ocs subsided completely . in view of the disappearance of symptoms with stoppage of methylphenidate , later , he was managed with nonpharmacological measures for his adhd as family refused to administer any medication . ocss are rarely described in patients treated with psychostimulants . a search of pubmed revealed only seven case reports of patients who developed ocs with stimulant medications and only one study reported on the prevalence of ocs with stimulants . as is evident from table 1 , in eight out of the nine cases , stimulants were used for adhd and in one case stimulant was used for the management of treatment - resistant depression in an 82-year - old man . all the children and adolescents were aged 814 years and there was slight preponderance for boys . all cases of ocs were seen with the use of methylphenidate , with the exception of one case description in which ocs was noted with the use of d - amphetamine . the dose range of methylphenidate , at which ocss were noted , varied from 10 to 90 mg / day , and in few cases , ocss were accompanied by tics . in the majority of cases , ocss emerged during the initial phase of treatment with methylphenidate ; however , in few cases , ocss were detected after 10 months to 2 years . in majority of the cases , stoppage of methylphenidate led to amelioration of ocss or significant improvement in ocss in 12-month time . however , in few cases , selective serotonin reuptake inhibitors were used for the management of ocs . the type of ocss varied across the case reports , with some authors reporting typical ocss such as repeated hand washing , wiping the furniture and walls with shirt sleeves , checking rituals , and reassurance seeking . in other case reports , ocss included compulsive stealing and hoarding , thoughts of stabbing and killing people , thoughts of mother doing dirty things ; compulsions in the form of drumming , crowing , smelling people , food , and cloths , ordering and symmetry , locking and unlocking and writing excessively about mechanics of locking and unlocking , and tying and untying shoelaces repeatedly . there is the only one study that evaluated abnormal movements or perserverative / compulsive behaviors with the use of stimulants and reported that 34 ( 76% ) out of 45 hyperactive boys had such symptoms . however , these adverse effects were transient and in only one case , severe ocs led to discontinuation of stimulant . the authors noted that compulsive behavior , resembling typical ocd , was more common with dextroamphetamine when compared with methylphenidate . further , it was observed that compulsive behaviors associated with tics were seen only with methylphenidate . case reports of obsessive - compulsive symptoms seen with stimulants these reports suggest that though rare , ocss can present as adverse effects of methylphenidate . hence , whenever a child who is on stimulants presents with new - onset ocs , the association of ocs with stimulants must be suspected before considering an independent diagnosis of comorbid ocs / ocd . in such situations , stoppage of methylphenidate must be considered as a first step in the management of ocs ; however , if the symptoms of ocs persist , then the addition of anti - obsessional agents such as selective serotonin reuptake inhibitors may be considered .
literature on the association of methylphenidate and obsessive - compulsive symptoms ( ocs ) is sparse . 
 this report discusses a case of a 14-year - old boy , who developed ocs ( in the form of need for symmetry , obsessive doubts ; compulsive symptoms included the need to order / arrange articles and repeated checking behavior ) , within 10 days of starting methylphenidate at the dose of 15 mg / day . 
 stoppage of methylphenidate led to amelioration of ocs over 2 weeks . 
 the case description suggests that whenever a child on stimulants presents with new - onset ocs , association of ocs with stimulants must be suspected before considering an independent diagnosis of comorbid ocs / obsessive - compulsive disorder .