AHRQ: Update on ADHD Diagnosis and Treatment

Evidence was contributed from 103 articles describing 90 unique studies.

The Agency for Healthcare Research and Quality (AHRQ) has published a systematic review on the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents. 

The researchers sought to update two previously published AHRQ systematic evidence reviews by comparing approaches in the diagnosis, treatment, and monitoring of pediatric patients with ADHD (birth to 17 years old). They searched several databases for studies published between January 1, 2011 through November 7, 2016. Data were graded for quality and evidence, and summary estimates of effects were calculated for meta-analysis. 

A total of 103 articles covering 90 distinct studies were identified for analysis. Regarding diagnosis, the Attention and Executive Function Rating Inventory and Childhood Executive Functioning Inventory proved better than the Cambridge Neuropsychological Test Automated Battery for diagnosing ADHD in patients aged 7–17 years (evidence strength: low). Evidence on the use of electroencephalography (EEG) or neuroimaging to determine an ADHD diagnosis in patients aged 7–17 years was deemed insufficient. 

Since the 2011 review, there has been limited new evidence showing methylphenidate is effective for children <6 years old with ADHD, and that psychostimulants can be effective for children aged 6–12 years. 

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Somnolence and mild gastrointestinal problems were most commonly associated with two ADHD treatments, atomoxetine (Strattera; Eli Lilly) and methylphenidate. Atomoxetine, however, had higher rates of gastrointestinal effects vs methylphenidate (evidence strength: low). 

The review also showed cognitive behavioral therapy may improve ADHD symptoms (evidence strength: low). Where child and parent training helped improve ADHD symptoms, it did not have an impact on academic performance (evidence strength: low). Moreover, omega-3/6 supplementation had no effect on ADHD symptoms (evidence strength: moderate). For all treatments reviewed, the authors found little evidence on the risk of serious adverse events, including cardiovascular risk. 

This update showed insufficient evidence regarding new diagnostic approaches and the harms associated with being labeled as having ADHD. Moreover, there was no data regarding optimal monitoring. The authors concluded, “Future studies are needed to evaluate diagnosis, monitoring, and long-term outcomes for children and adolescents with ADHD managed in usual care settings.”

For more information visit ahrq.gov.