The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG)

Abstract

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.

Diagnosis and management of ADHD: A pediatric perspective on practice and challenges in Switzerland

“…Nevertheless, some participants expressed the need for further training. Another reason for few referrals to specialists could be the shortage of child & adolescent psychiatrists, which was also expressed by our participants and is in line with research from other countries (24,34,36).…”

“…Pediatricians reported that they perceive the subjectivity of the ADHD diagnosis as challenging, which was also repeatedly reported in other studies (16,17,34). However, only few participants reported to refer children with suspected ADHD to a specialist for a further diagnostic workup.…”

Phytotherapy for Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-analysis

“… Sonuga-Barke et al (2013) in order to deal with the issue of the potential for bias due to lack of blinding is psychosocial interventions tarted to compared the so-called the “most proximal” outcome (MPROX—i.e., rated by persons closest to treatment delivery and, therefore, the most vulnerable to lack of blinding) with the measure judged by the group consensus to be most blinded (PBLIND, i.e., probably blinded). In a series of meta-analyses, the same working group (European Network for Hyperkinetic Disorders-EUNETHYDIS; Daley et al, 2014 ; Stevenson et al, 2014 ; Cortese et al, 2016 ; Coghill et al, 2021 ) showed that in non-pharmacological trials, MPROX effects were considerably larger (and more significant) than PBLIND effects though the scale of this MPROX-PBLIND discrepancy varied by treatment type—largest for parent training (where blinding was most challenging to implement) and smaller (though still substantial) for neurofeedback and cognitive training. An overview of systematic reviews of dietary interventions concluded that individual study methods were weak and that different meta-analyses have used very different inclusion and exclusion criteria and that this has resulted in a wide range of estimated effect sizes ( Stevenson et al, 2014 ; Banaschweski et al, 2018 ).…”

Towards pathophysiology-based interventions for children with ADHD and increased screen time utilisation

“…An emerging body of evidence suggests that ADHD is also significantly associated with increased screen time utilisation (STU) (e.g., 2 ), which can add to the burden of ADHD. However, current clinical guidelines 3 do not include any specific recommendation for the screening and management of increased STU in individuals with ADHD.…”