Treatments for ADHD in Children and Adolescents: A Systematic Review

Author:

Peterson Bradley S.12,Trampush Joey2,Maglione Margaret3,Bolshakova Maria3,Rozelle Mary3,Miles Jeremy3,Pakdaman Sheila3,Brown Morah3,Yagyu Sachi3,Motala Aneesa3,Hempel Susanne3

Affiliation:

1. aInstitute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, California

2. bDepartment of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California

3. cSouthern California Evidence Review Center, Los Angeles, California

Abstract

CONTEXT Effective treatment of attention-deficit/hyperactivity disorder (ADHD) is essential to improving youth outcomes. OBJECTIVES This systematic review provides an overview of the available treatment options. DATA SOURCES We identified controlled treatment evaluations in 12 databases published from 1980 to June 2023; treatments were not restricted by intervention content. STUDY SELECTION Studies in children and adolescents with clinically diagnosed ADHD, reporting patient health and psychosocial outcomes, were eligible. Publications were screened by trained reviewers, supported by machine learning. DATA EXTRACTION Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Data were pooled using random-effects models. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards. RESULTS In total, 312 studies reported in 540 publications were included. We grouped evidence for medication, psychosocial interventions, parent support, nutrition and supplements, neurofeedback, neurostimulation, physical exercise, complementary medicine, school interventions, and provider approaches. Several treatments improved ADHD symptoms. Medications had the strongest evidence base for improving outcomes, including disruptive behaviors and broadband measures, but were associated with adverse events. LIMITATIONS We found limited evidence of studies comparing alternative treatments directly and indirect analyses identified few systematic differences across stimulants and nonstimulants. Identified combination of medication with youth-directed psychosocial interventions did not systematically produce better results than monotherapy, though few combinations have been evaluated. CONCLUSIONS A growing number of treatments are available that improve ADHD symptoms and other outcomes, in particular for school-aged youth. Medication therapies remain important treatment options but are associated with adverse events.

Publisher

American Academy of Pediatrics (AAP)

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