Efficacy and Tolerability of Different Interventions in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Luan, Ruiling; Mu, Zhiling; Yue, Fang; He, Shaoying

doi:10.3389/fpsyt.2017.00229

Cited by 11 publications

(42 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two observations were detected as outliers and so removed from the dataset before performing the SAOB: Bazanova et al's (51) individualized NFB and individualized NFB coupled with EMG-Biofeedback groups. Indeed, these two groups presented very large within-ES (–3.41 and –3.95), even bigger than those reported in the literature on medication treating ADHD (109). These large values broke our working hypothesis, so in order to be able to conclude on the results obtained by the SAOB, an outlier rejection was implemented.…”

Section: Discussionmentioning

confidence: 55%

Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis

et al. 2019

View full text Add to dashboard Cite

Meta-analyses have been extensively used to evaluate the efficacy of neurofeedback (NFB) treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, each meta-analysis published in the past decade has contradicted the methods and results from the previous one, thus making it difficult to determine a consensus of opinion on the effectiveness of NFB. This works brings continuity to the field by extending and discussing the last and much controversial meta-analysis by Cortese et al. ( 1 ). The extension comprises an update of that work including the latest control trials, which have since been published and, most importantly, offers a novel methodology. Specifically, NFB literature is characterized by a high technical and methodological heterogeneity, which partly explains the current lack of consensus on the efficacy of NFB. This work takes advantage of this by performing a Systematic Analysis of Biases (SAOB) in studies included in the previous meta-analysis. Our extended meta-analysis (k = 16 studies) confirmed the previously obtained results of effect sizes in favor of NFB efficacy as being significant when clinical scales of ADHD are rated by parents (non-blind, p -value = 0.0014), but not when they are rated by teachers (probably blind, p -value = 0.27). The effect size is significant according to both raters for the subset of studies meeting the definition of “standard NFB protocols” (parents' p -value = 0.0054; teachers' p -value = 0.043, k = 4). Following this, the SAOB performed on k = 33 trials identified three main factors that have an impact on NFB efficacy: first, a more intensive treatment, but not treatment duration, is associated with higher efficacy; second, teachers report a lower improvement compared to parents; third, using high-quality EEG equipment improves the effectiveness of the NFB treatment. The identification of biases relating to an appropriate technical implementation of NFB certainly supports the efficacy of NFB as an intervention. The data presented also suggest that the probably blind assessment of teachers may not be considered a good proxy for blind assessments, therefore stressing the need for studies with placebo-controlled intervention as well as carefully reported neuromarker changes in relation to clinical response.

show abstract

Section: Discussionmentioning

confidence: 55%

Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…We ultimately included 14 NMAs and 90 MAs, reporting on 15 disorders or groups of disorders. For ADHD, we included three NMAs 5,20,21 and 21 MAs 22‐42 ; for autism, one NMA 43 and 21 MAs 12,44‐63 (including one focusing on comorbid anxiety disorders and autism) 12 ; for depressive disorders, two NMA 7,10 and seven MAs 64‐70 ; for obsessive‐compulsive disorder, one NMA 71 and six MAs 72‐77 ; for anxiety disorders, two NMAs 11,78 and five MAs 12,79‐82 (plus two MAs specific on social anxiety disorder 83,84 ); for enuresis, one NMA 85 and six MAs 86‐91 , for disruptive behavior/dissocial/conduct disorders, five MAs 92‐96 (plus one focusing on youth with comorbid ADHD) 25 ; for eating disorders, one NMA 97 and four MAs 98‐101 ; for schizophrenia spectrum disorders, three NMAs 8,102,103 and two MAs 104,105 ; for bipolar disorder, four MAs 106‐109 ; for tic disorder, two MAs 110,111 ; for Tourette's disorder, two MAs 112,113 ; for encopresis, two MAs 114,115 ; for developmental coordination disorder, one MA 116 ; and for PTSD, one MA 117 .…”

Section: Resultsmentioning

confidence: 99%

Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review

et al. 2021

View full text Add to dashboard Cite

Top‐tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this journal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial interventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta‐analyses (NMAs) and meta‐analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability outcomes. Co‐primary outcomes were disease‐specific symptom reduction and all‐cause discontinuation (“acceptability”). We included 14 NMAs and 90 MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co‐primary outcomes, and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta‐analytic evidence, the most convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention‐deficit/hyperactivity disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy (CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive‐compulsive disorder; CBT in post‐traumatic stress disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results from this umbrella review of interventions for mental disorders in children/adolescents provide evidence‐based information for clinical decision making.

show abstract

“…To the best of our knowledge, our network meta-analysis represents the most comprehensive comparative synthesis to date on the efficacy and tolerability of medications for children, adolescents, and adults with ADHD. We have addressed the limitations of previous network meta-analyses, which focused selectively on children and adolescents 19 , 20 , 21 , 22 , 23 , 24 or adults, 25 , 26 , 27 , 28 or included only published material, 21 , 22 , 23 , 24 , 26 non-blinded trials, 19 , 21 , 22 , 23 , 24 or non-core ADHD outcomes. 19 , 22 , 25 , 28 …”

Section: Discussionmentioning

confidence: 99%

“… 18 Thus, compared with standard pairwise meta-analyses, network meta-analyses have been found to increase the precision of the estimates. 18 Previous network meta-analyses in ADHD have focused on either children and adolescents 19 , 20 , 21 , 22 , 23 , 24 or adults only, 25 , 26 , 27 , 28 have typically compared only a few drugs, 24 , 25 , 27 , 29 or have addressed exclusively the safety of treatments. 26…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis

Cortese

Adamo

Giovane

et al. 2018

The Lancet Psychiatry

921

721

View full text Add to dashboard Cite

SummaryBackgroundThe benefits and safety of medications for attention-deficit hyperactivity disorder (ADHD) remain controversial, and guidelines are inconsistent on which medications are preferred across different age groups. We aimed to estimate the comparative efficacy and tolerability of oral medications for ADHD in children, adolescents, and adults.MethodsWe did a literature search for published and unpublished double-blind randomised controlled trials comparing amphetamines (including lisdexamfetamine), atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil with each other or placebo. We systematically contacted study authors and drug manufacturers for additional information. Primary outcomes were efficacy (change in severity of ADHD core symptoms based on teachers' and clinicians' ratings) and tolerability (proportion of patients who dropped out of studies because of side-effects) at timepoints closest to 12 weeks, 26 weeks, and 52 weeks. We estimated summary odds ratios (ORs) and standardised mean differences (SMDs) using pairwise and network meta-analysis with random effects. We assessed the risk of bias of individual studies with the Cochrane risk of bias tool and confidence of estimates with the Grading of Recommendations Assessment, Development, and Evaluation approach for network meta-analyses. This study is registered with PROSPERO, number CRD42014008976.Findings133 double-blind randomised controlled trials (81 in children and adolescents, 51 in adults, and one in both) were included. The analysis of efficacy closest to 12 weeks was based on 10 068 children and adolescents and 8131 adults; the analysis of tolerability was based on 11 018 children and adolescents and 5362 adults. The confidence of estimates varied from high or moderate (for some comparisons) to low or very low (for most indirect comparisons). For ADHD core symptoms rated by clinicians in children and adolescents closest to 12 weeks, all included drugs were superior to placebo (eg, SMD −1·02, 95% CI −1·19 to −0·85 for amphetamines, −0·78, −0·93 to −0·62 for methylphenidate, −0·56, −0·66 to −0·45 for atomoxetine). By contrast, for available comparisons based on teachers' ratings, only methylphenidate (SMD −0·82, 95% CI −1·16 to −0·48) and modafinil (−0·76, −1·15 to −0·37) were more efficacious than placebo. In adults (clinicians' ratings), amphetamines (SMD −0·79, 95% CI −0·99 to −0·58), methylphenidate (−0·49, −0·64 to −0·35), bupropion (−0·46, −0·85 to −0·07), and atomoxetine (−0·45, −0·58 to −0·32), but not modafinil (0·16, −0·28 to 0·59), were better than placebo. With respect to tolerability, amphetamines were inferior to placebo in both children and adolescents (odds ratio [OR] 2·30, 95% CI 1·36–3·89) and adults (3·26, 1·54–6·92); guanfacine was inferior to placebo in children and adolescents only (2·64, 1·20–5·81); and atomoxetine (2·33, 1·28–4·25), methylphenidate (2·39, 1·40–4·08), and modafinil (4·01, 1·42–11·33) were less well tolerated than placebo in adults only. In head-to-head comparisons, only diff...

show abstract

Efficacy and Tolerability of Different Interventions in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Cited by 11 publications

References 84 publications

Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis

Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis

Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review

Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis

Contact Info

Product

Resources

About