Eighty-eight children ages 6 through 12 were randomized to daily pine bark extract, methylphenidate, or placebo for 10 weeks. Total ADHD-Rating Scales scores decreased 29% with pine bark extract, 45% with methylphenidate, and 5% with placebo. Hyperactivity/impulsivity decreased 34% with pine bark extract and 36% with methylphenidate and increased 1% with placebo. Inattention decreased 25% with pine bark extract, 52% with methylphenidate, 9% with placebo. Adverse events were reported 5 times more frequently with methylphenidate than with pine bark.