Evidence on methylphenidate in children and adolescents with ADHD is in fact of ‘very low quality’

Abstract

Banaschewski and colleagues from the European Attention Deficit Hyperactivity Disorder (ADHD) guideline group make a number of critical comments regarding our systematic review on methylphenidate for children and adolescents with ADHD. In this article, we present our views, showing that our trial selection was not flawed and was undertaken with scientific justification. Similarly, our data collection and interpretation was systematic and correct. We have followed a sound methodology for assessing risk of bias and our conclusions are not misleading. We acknowledge that different researchers might make risk of bias judgments at higher or lower thresholds, but we have been consistent and transparent in applying our pre-defined and per reviewed protocol. Although we made minor errors, we demonstrate that the effects are negligible and not affecting our conclusions. We are happy to correct such errors and to engage in debate on methodological and ethical issues. In terms of clinical implications, we are advocating that clinicians, patients and their relatives should weight carefully risks and benefits of methylphenidate. Clinical experience seems to suggest that there are people who benefit from this medication. Our systematic review does, however, raise questions regarding the overall quality of the methylphenidate trials.

Stimulant medication to treat attention-deficit/hyperactivity disorder

“…28 In children, the most common co-existing disorders are oppositional defiant disorder (50%), followed by conduct disorder (35%), specific learning disorders, anxiety (33%), and depression (33%). 28 More recently, meta-analysis suggests that in children with ADHD, stimulants reduce the risk of anxiety in comparison with placebo 29 and that there is no correlation between the frequency and severity of tics and stimulant use in ADHD. 30 Stimulants are useful even when ADHD co-exists with autism spectrum disorders, despite the effect size being around 0.5.…”

Risk of Bias and Quality of Evidence for Treatment of ADHD With Stimulant Medication

“…The 2015 publication of the Cochrane review prompted a series of critiques, replies, and rejoinders . The brevity of the summary by Storebø et al .…”

Drug treatment of ADHD – tenuous scientific basis

“…The most important was from the European ADHD Guidelines Group, which criticised the Cochrane researchers for having made errors (9,10). Among other things, they argued that the MTA study should not have been included in the systematic review, as it did not contain a group that received a pure placebo, or no treatment (9).…”

“…In response, the Cochrane group acknowledged some minor errors, but stood by its conclusions (10). In a final move, the Guidelines Group claimed -without specifying whythat long-term randomised controlled trials are practically and ethically impossible.…”