Meta-analysis of Pharmacological, Non-Pharmacological Treatments for ADHD

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Behavioral therapy alone, behavioral therapy in combination with stimulants, stimulants alone, and non-stimulants alone were all more efficacious than placebo.
Behavioral therapy alone, behavioral therapy in combination with stimulants, stimulants alone, and non-stimulants alone were all more efficacious than placebo.

In a systematic review and meta-analysis published in PLoS One, behavioral therapy combined with stimulants was shown to be more efficacious and tolerable than other treatments for attention deficit/hyperactivity disorder (ADHD).

A total of 190 randomized trials (N=26,114) that evaluated pharmacological, psychological, and complementary and alternative treatments for ADHD were evaluated. Efficacy and acceptability were analyzed by therapy class and individually using random-effects Bayesian network meta-analyses.

Behavioral therapy alone (odds ratio [OR] 2.97; very low-quality evidence), behavioral therapy in combination with stimulants (OR 13.62), stimulants alone (OR 6.21), and non-stimulants alone (OR 3.95) were all more efficacious than placebo.

Behavioral therapy alone (OR 0.58), behavioral therapy in combination with stimulants (OR 0.37), and stimulants alone (OR 0.67) appeared to have the best acceptability with reduced chance of discontinuation compared with placebo.

Compared with placebo, methylphenidate (OR 5.26), amphetamine (OR 7.45), atomoxetine (OR 3.63), guanfacine (OR 3.29), and clonidine (OR 3.96) appeared more efficacious. Methylphenidate (OR 0.59) and amphetamine (OR 0.78) had better acceptability profiles than placebo and atomoxetine (OR 0.85).

Evidence in the study was primarily of low or very low quality.

Based on limited evidence, the researchers concluded that cognitive training, neurofeedback, antipsychotics, and complementary and alternative medicine were not more efficacious or acceptable than placebo.

In conclusion, the study investigators wrote that "although the quality of evidence is not strong, clinical differences may exist between the pharmacological and non-pharmacological treatments commonly used for the management of ADHD. Behavioral therapy and pharmacological treatment may improve the symptoms of ADHD and global functioning in the short-term."

Reference

Catalá-López F, Hutton B, Núñez-Beltrán A, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: a systematic review with network meta-analyses of randomised trials. PLoS One. 2017;12(7):e0180355.

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