Study: Medication most effective for treating ADHD in children
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Key takeaways:
- A review of evidence showed that medication had the best and strongest evidence base for improving ADHD outcomes in children.
- The results will help inform updated clinical practice guidelines from the AAP.
A systematic review of hundreds of studies showed that medication has the best chance to improve ADHD outcomes in children and that other treatments have varied effects, according to results published in Pediatrics.
ADHD is among the most common pediatric neurodevelopmental disorders, and evidence indicates that prescriptions for ADHD medications jumped during the COVID-19 pandemic.
The results of the new review will help inform new AAP clinical practice guidelines for ADHD.
“The AAP is in the process of updating clinical practice guidelines for ADHD and needs a summary of the latest evidence,” Susanne Hempel, PhD, director of the Southern California Evidence Review Center at the University of Southern California in Los Angeles, told Healio.
In a press release, Hempel said: “We have more research than ever on ADHD, but we need to summarize it in a reliable and valid way.”
Hempel and colleagues screened more than 23,000 citations looking for studies with “a strong test design,” she said. They included 312 in the final analysis, using them to assess treatments for ADHD, including combined pharmacological and behavior approaches, medications approved by the FDA, youth-directed psychosocial approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, school interventions and provider or model-of-care interventions.
“The review shows the broad range of tests that have been proposed to identify ADHD,” Hempel said.
The review identified medications — including both stimulants and nonstimulants — as having the strongest evidence base for improving ADHD outcomes for children, but were also associated with adverse events.
“The body of evidence shows that numerous intervention classes significantly improve ADHD symptom severity,” Hempel and colleagues wrote. “This includes large but variable effects for amphetamines, moderate-sized effects for methylphenidate, [norepinephrine reuptake inhibitors], and alpha-agonists, and small effects for youth-directed psychosocial treatment, parent support, neurofeedback, and nutrition or supplements. Cognitive training and school interventions did not significantly improve ADHD symptoms.”
“One surprising result was that despite the importance of the question of how to best monitor the need for and the success of ADHD treatment over time, which has been highlighted by all ADHD experts as a very important question, very few studies have been published that evaluate practical strategies of how to best monitor ADHD over time,” Hempel said.
According to Hempel, despite the large body of research on ADHD, little is known about treating and diagnosing it in certain subgroups — most notably young girls with ADHD, with most research addressing boys or interventions not targeting girls — and children aged under 6 years, with most studies targeting school-aged children.
“We need more information on which data should best be combined to facilitate diagnosis of ADHD, such as parental ratings, teacher input, behavioral observations,” Hempel said. “For treatment studies, we should explore combinations of interventions, such as pharmacotherapy and psychosocial approaches to identify the most effective combinations. And we do need more research on monitoring ADHD over time.”
References:
Peterson B, et al. Pediatrics. 2024;doi:10.1542/peds.2024-065787.
Peterson B, et al. Pediatrics. 2024;doi:10.1542/peds.2024-065854.
Sweeping review reveals latest evidence on the diagnosis, treatment, and monitoring of ADHD. https://keck.usc.edu/news/sweeping-review-reveals-latest-evidence-on-the-diagnosis-treatment-and-monitoring-of-adhd/. Published Mar. 25, 2024. Accessed Mar. 26, 2024.
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