Methylphenidate is the first-choice medication for the treatment of ADHD in children and adolescents. Over the past two decades, several randomised controlled trials re-peatedly showed its efficacy on both the core symptoms and the quality of life besides its tolerability in the short term. The most common adverse effects include sleep disturb-ance, nervous- ness, reduced appetite, weight loss, headache, elevated blood pressure and heart rate. These effects are generally mild, transient and easily manageable by clinicians. Despite the reassuring data in terms of short-term safety and tolerability, some questions still re- main open with respect to the treatment effects in the long term. In the meantime it is however appropriate to continue to refer to the current European clinical practice guide- lines. The paper reports treatment indications, information about the mechanism of action, the Italian available formulations and the answers to the most frequent questions for a correct clinical and pharmacological monitoring of young patients.