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The OROS methylphenidate spray (MPD) was developed to be used in place of traditional oral methylphenidate, which has a bitter taste and is associated with a risk of missed doses in children. The OROS spray is delivered by a single-unit metering sprayer and does not require a dose separator to be added to the oral syringe. Patients, caregivers, and healthcare providers can administer the OROS spray in a single-unit dose to take between meals. This study examined whether oral methylphenidate is more effective, tolerable, and preferred by patients than OROS methylphenidate administered using a single-unit dose sprayer. This randomized, 2-arm, 8-week, open-label study compared the efficacy, safety, and tolerability of oral methylphenidate (Ritalin) 30 mg for children (4 to 12 years) with attention-deficit/hyperactivity disorder (ADHD) and a history of noncompliance with oral Ritalin to OROS methylphenidate spray (MPD) 7.5 mg administered using a single-unit metering dose sprayer. Outcomes included ADHD-RS-IV rating scale total score, investigator-assessed ADHD-RS-IV total score, CGI-S rating scale score, and safety. Mean total ADHD-RS-IV score improved from baseline to week 8 in patients who used OROS methylphenidate spray (7.7, n = 7) vs those who used oral methylphenidate tablets (8.6, n = 7; least squares mean difference: -0.9; 95% CI, -2.7 to 0.9; P =.352). The mean CGI-S score at week 8 was 3.6 for those using OROS methylphenidate spray and 3.2 for those using oral methylphenidate tablets (P =.444). OROS methylphenidate spray was better tolerated, as shown by lower mean scores on the nonstimulant adverse event rating scale (4.8 for OROS methylphenidate spray vs 7.9 for oral methylphenidate tablets; P 827ec27edc