![]() This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: Specific funding from the Alicia Koplowitz Foundation was received for this work. Received: JanuAccepted: JPublished: July 12, 2017Ĭopyright: © 2017 Catalá-López et al. PLoS ONE 12(7):Įditor: Christian Gluud, Copenhagen University Hospital, DENMARK (2017) The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence consequently, results should be interpreted with caution.Ĭitation: Catalá-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Macías Saint-Gerons D, et al. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. ![]() Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. ![]() Stimulants and non-stimulants seemed well tolerated. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. We analysed interventions by class and individually. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). We performed a systematic review with network meta-analyses.
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