ADHD Treatments Across the Lifespan
A recent umbrella review of ADHD therapies was published in the BMJ, evaluating both pharmacological and non-pharmacological interventions (221 meta-analyses of RCTs) in children and adults. A continuously updated online platform, “Evidence Based Interventions for ADHD”, was created to disseminate the findings and to act as a tool for shared decision making with patients.
Note that most RCTs available for review involved short-term studies, and no long-term evidence (for any intervention) was found to be at a high certainty level.
Key Findings
Children and Adolescents
The following pharmacotherapies (in the short term) produced statistically significant improvements of medium to large effects and had moderate to high evidence:
- Alpha-2 agonists
- Amphetamines
- Atomoxetine
- Methylphenidate
Refer to the online platform for more details.
The tolerability of amphetamines was lower than placebo in children and adolescents (moderate evidence), while in the same population, atomoxetine and methylphenidate did not differ significantly from placebo for tolerability (high evidence).
Both cognitive behaviour therapy and acupuncture were rated as having large effects for children and adolescents, but the evidence was of low certainty.
Adults
The following treatments had medium to large effects and moderate to high evidence:
- Amphetamines
- Atomoxetine
- Methylphenidate
- Cognitive Behavioural Therapy
In the adult population, all 3 above-listed medications had worse tolerability than placebo (high evidence).
Mindfulness was reported to have a large effect in adults (based on self-reports), but the evidence was of low certainty.
Electronic Cigarettes and Smoking Cessation
A recently published Cochrane review examined the effectiveness, tolerability and safety of using electronic cigarettes (or “vapes”) for long-term smoking cessation using data from 104 studies (n=30,366).
Key Findings
- Compared to nicotine replacement therapy (NRT), the use of nicotine e-cigarettes resulted in higher quit rates (high-certainty evidence), which may produce an extra 3 quitters per 100.
- Compared to non-nicotine e-cigarettes, the use of nicotine e-cigarettes likely produces higher quit rates (moderate-certainty evidence), which may result in an extra 2 quitters per 100.
- Adverse events with e-cigarette use probably occur at a similar rate as using either NRT or non-nicotine e-cigarettes (moderate-certainty evidence). The adverse events most frequently reported included throat irritation, cough, headache and nausea, though they usually lessen with continued use.
- Due to risk of bias in the studies, the evidence that nicotine e-cigarettes may result in higher quit rates than no support or only behavioural support, was rated as low-certainty.