ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems.
Bibliografisk noteFunding Information:
SC reports honoraria and reimbursement for talks on ADHD from the Association of Child and Adolescent Mental Health, British Association of Psychopharmacology, and the Canadian ADHD Resource Alliance and Healthcare Convention. PA reports honoraria for consultancy to Shire/Takeda, Eli Lilly, and Novartis; educational and research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma, and QbTech; and speaking at sponsored events for Shire, Lilly, Flynn Pharma, and Novartis. ES-B reports personal fees from Shire and Neurotech Solutions. TB reports personal fees for being on the advisory board from ADHS digital, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche, and Takeda. He received conference support or speaker’s fee by Medice and Takeda. He received royalities from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press, outside the submitted work. DB is an unpaid scientific advisor for an EU-funded Neurofeedback trial. JB reports personal fees for lectures from Janssen, Takeda/Shire, and Medice; and personal fees for being on the advisory board from Roche, Medice, Servier, and Angelini, outside the submitted work. DC reports grants and personal fees from Shire and Takeda, and personal fees from Medice, Servier, and Oxford University Press, outside the submitted work. DD reports grants, personal fees, and non-financial support from Shire/Takeda, personal fees and non-financial support from Eli Lilly and Medice, non-financial support from Qb Tech, book royalties from Hachette, and training and supervision fees from the New Forest Parent Training Programme, outside the submitted work. RWD has received compensation for serving as consultant or speaker, or he or the institution he works for have received research support or royalties from the following organizations or companies: EU (FP7 Programme), US National Institute of Mental Health, German Federal Ministry of Health/Regulatory Agency, German Federal Ministry of Education and Research, German Research Foundation, Volkswagen Foundation, Boehringer Ingelheim, Ferring, Janssen-Cilag, Lilly, Lundbeck, Otsuka, Servier, Shire, Sunovion/Takeda, and Theravance. He was an employee of Eli Lilly in clinical CNS research until August 2008, and owns Eli Lilly stock (small part of the respective annual salary). The drug marketed by Eli Lilly is not mentioned in this guidance. MDo reports grants and personal fees from Eli Lilly, Medice, Shire, Janssen Cilag, Takeda, and Vifor; grants from the German Research Foundation, German Ministry of Health, and Innovation Fund; personal fees from the National Association of Statutory Health Insurance Physicians in Germany, Beltz Publisher, Elsevier, Guilford, Hogrefe, Springer, Wiley, Kohlhammer, and Schattauer. MF reports fees for lectures from Medice and ROVI. CH was an expert member of the National Institute for Health and Care Excellence Guideline (NG87): Attention deficit hyperactivity disorder: diagnosis and management, published in 2018. MH reports personal fees from Medice, Shire, Takeda, Neuroconn, and Hogrefe, outside the submitted work. EK is CSO and Board Member of NLS Pharmaceutics, investigating drugs that are not mentioned in the current guidance. PS reports speaker’s fees paid to his department; and is the CEO and shareholder of HealthTracker Ltd, which is unrelated to the submitted work. CS reports non-personal research funds from Lundbeck and Shire paid to his institution; is a consultant and advisory board member of Editorial Médica Panamericana, Medice, NeuroTech Solutions Ltd, and Shire; received speaker’s bureau from Medice and Shire, and royalties from Editorial Médica Panamericana, Mayo Ediciones, and Springer SBM Spain. H-CS reports speaker’s fees from Medice and book royalties from Cambridge University Press, Elsevier, Hogrefe, Huber, Klett, and Kohlhammer. IW reports grants from Research Grant Council Hong Kong; personal fees from Medice; and grants and personal fees from Janssen, outside the submitted work. AZ reports personal fees for being on advisory boards from Angelini, Edu Pharma, and Shire-Takeda; research grants from Angelini, Janssen, Lundbeck, Otsuka, and Servier; and royalties from Giunti OS and Oxford University Press, outside the submitted work. All other authors declare no competing interests.