CLINICAL QUESTION
What treatments for attention-deficit/hyperactivity disorder (ADHD) offer the best effectiveness and tolerability for children, adolescents, and adults?
BOTTOM LINE
The massive analysis allows for drilling down into the relative benefits of medications and nondrug treatment of symptoms of ADHD in children and adults. An online tool found in the reference shows the relative efficacy and tolerability of more than 30 interventions by age group. (Level of Evidence = 1a)
SYNOPSIS
Two investigators searched six databases, including the Cochrane Library, to identify 115 systematic reviews that used meta-analyses of randomized controlled trials of medications or other options for the treatment of ADHD. This deluge of data produced 221 combinations of participants, interventions, comparators, and outcomes, which allowed several conclusions to be drawn. For symptom control in children and adolescents, alpha-2 adrenergic receptor agonists (eg, guanfacine), amphetamines, atomoxetine, methylphenidate, and viloxazine (Qelbree) have a medium to large effect (moderate- to high-certainty evidence). In children, atomoxetine and methylphenidate produce adverse effects at a rate similar to placebo. In adults, atomoxetine, cognitive behavior therapy, methylphenidate, and amphetamines have a medium effect on symptoms (moderate-certainty evidence), but the medications produce adverse effects. According to low-certainty evidence, acupuncture and cognitive behavior therapy in children and adolescents, and mindfulness in adults reduce symptoms. Despite being used to treat ADHD since the 1960s, there is no high-quality research that acupuncture, cognitive behavior therapy, or mindfulness produce long-term benefit.
Study Design: Meta-analysis (other)
Funding Source: Government
Setting: Various (meta-analysis)
