Lay Summary
We performed a meta-review to systematically appraise systematic reviews published on ADHD related topics based on PRISMA guidelines and the Joanna Briggs Institute (JBI) methodology for umbrella review. There is good evidence about the efficacy of pharmacological treatment, particularly stimulants, in all age-groups, at least in the short term, but there are knowledge gaps about the efficacy of non-pharmacological treatments. Hence, this meta-review has made the existing knowledge on pharmacological and non pharmacological treatment of ADHD more available.
Background
Systematic reviews of research studies are important for establishing scientific evidence, and there has been a steady increase in published systematic reviews on pharmacological and non pharmacological treatment of ADHD during the last decade. However, the growing library of systematic reviews may be difficult to navigate for clinicians, researchers , and policy makers. We here aim to systematically summarize current evidence on ADHD treatment available from systematic reviews.
Methods
We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, Web of Science, for studies published from January 2010- February 14, 2021. We included systematic reviews and meta-analyses on any topic of ADHD that had hits in more than one database (including at least PubMed or Medline), involved two or more reviewers at any stage of review, and, with quality appraisal of included studies. Two independent reviewers performed quality assessment and extracted data adopted from Joanna Briggs Institute manual for evidence synthesis. We here present the results of the meta-review pertaining to pharmacological treatment, non-pharmacological treatment, or pharmacological vs nonpharmacological treatment. Data are presented in narrative synthesis and table format. This study is registered with PROSPERO number: CRD42020165638
Results
Systematic reviews have shown efficacy for pharmacological treatment of ADHD, and consistently stronger effects for stimulants than non-stimulants, in all age groups. In children and adolescents, in terms of efficacy, acceptability, and tolerability, evidence exists for methylphenidate (MPH) as the preferred first choice for short-term pharmacological treatment of ADHD. Similarly, for adults, regarding both efficacy and tolerability, amphetamines is the preferred first pharmacological choice for short-term treatment of ADHD. Few reviews reported that behavioral interventions improve childhood and adulthood ADHD symptoms. However, a comparative review of youth with ADHD suggested that while medication improved ADHD core symptoms, psychosocial interventions effectively improve academic and organizational skills.
Conclusion
In this meta-review, we found that pharmacological treatment was by far the most common topic for systematic reviews and meta-analyses of ADHD. The evidence of efficacy of pharmacological treatment is however mostly restricted to core symptoms of ADHD as an outcome and to short term durations of treatment. , while clinicians, patients, and families are more interested in the long-term effects of treatment on real-life outcomes. Similarly, there is lack of studies for non-pharmacological interventions. Hence, future research should address these gaps related to pharmacological and nonpharmacological treatment of ADHD