ADHD diagnosis and treatment in children and adolescents / Bradley S. Peterson, [and twenty three others].

Format:

Book

Author/Creator:

Peterson, Bradley S., author.

Language:

English

Subjects (All):

Mental health.

Physical Description:

1 online resource

Place of Publication:

Rockville, MD : Agency for Healthcare Research and Quality, 2024.

Summary:

Objective: The systematic review assessed evidence on the diagnosis, treatment, and monitoring of attention deficit hyperactivity disorder (ADHD) in children and adolescents to inform a planned update of the American Academy of Pediatrics (AAP) guidelines. Data sources: We searched PubMed®, Embase®, PsycINFO®, ERIC, clinicaltrials.gov, and prior reviews for primary studies published since 1980. The report includes studies published to June 15, 2023. Review methods: The review followed a detailed protocol and was supported by a Technical Expert Panel. Citation screening was facilitated by machine learning; two independent reviewers screened full text citations for eligibility. We abstracted data using software designed for systematic reviews. Risk of bias assessments focused on key sources of bias for diagnostic and intervention studies. We conducted strength of evidence (SoE) and applicability assessments for key outcomes. The protocol for the review has been registered in PROSPERO (CRD42022312656). Results: Searches identified 23,139 citations, and 7,534 were obtained as full text. We included 550 studies reported in 1,097 publications (231 studies addressed diagnosis, 312 studies addressed treatment, and 10 studies addressed monitoring). Diagnostic studies reported on the diagnostic performance of numerous parental ratings, teacher rating scales, teen/child self-reports, clinician tools, neuropsychological tests, EEG approaches, imaging, and biomarkers. Multiple approaches showed promising diagnostic performance (e.g., using parental rating scales), although estimates of performance varied considerably across studies and the SoE was generally low. Few studies reported estimates for children under the age of 7. Treatment studies evaluated combined pharmacological and behavior approaches, medication approved by the Food and Drug Administration, other pharmacologic treatment, psychological/behavioral approaches, cognitive training, neurofeedback, neurostimulation, physical exercise, nutrition and supplements, integrative medicine, parent support, school interventions, and provider or model-of-care interventions. Medication treatment was associated with improved broadband scale scores and ADHD symptoms (high SoE) as well as function (moderate SoE), but also appetite suppression and adverse events (high SoE). Psychosocial interventions also showed improvement in ADHD symptoms based on moderate SoE. Few studies have evaluated combinations of pharmacological and youth-directed psychosocial interventions, and we did not find combinations that were systematically superior to monotherapy (low SoE). Published monitoring approaches for ADHD were limited and the SoE is insufficient. Conclusion: Many diagnostic tools are available to aid the diagnosis of ADHD, but few monitoring strategies have been studied. Medication therapies remain important treatment options, although with a risk of side effects, as the evidence base for psychosocial therapies strengthens and other nondrug treatment approaches emerge.

Contents:

Preface

Acknowledgments

Key Informants

Technical Expert Panel

Peer Reviewers

Executive Summary

Main Points

Background and Purpose

Methods

Results

Strengths and Limitations

Implications and Conclusions

References

1. Introduction

1.1. Background

1.2. Purpose and Scope of the Systematic Review

2. Methods

2.1. Review Approach

2.2. Study Selection

2.3. Data Extraction

2.4. Risk of Bias Assessment

2.5. Data Synthesis and Analysis

2.6. Grading the Body of Evidence

2.7. Peer Review and Public Commentary

3. Results: Description of Included Evidence

4. Results: Diagnosis of ADHD

4.1. KQ1, ADHD Diagnosis Key Points

4.2. KQ1, ADHD Diagnosis Summary of Findings

4.3. Summary ADHD Diagnosis by Tests for All Age Groups

4.4. KQ1a. What is the comparative diagnostic accuracy of approaches that can be used in the primary care practice setting or by specialists to diagnose ADHD among individuals younger than 7 years of age?

4.5. KQ1b. What is the comparative diagnostic accuracy of EEG, imaging, or approaches assessing executive function that can be used in the primary care practice setting or by specialists to diagnose ADHD among individuals aged 7 through 17?

4.6. KQ1c. For both populations, how does the comparative diagnostic accuracy of these approaches vary by clinical setting, including primary care or specialty clinic, or patient subgroup, including age, sex, or other risk factors associated with ADHD?

4.7. KQ1d. What are the adverse effects associated with being labeled correctly or incorrectly as having ADHD?

4.8. Summary of Findings. KQ1a-d

5. Results: Treatment of ADHD

5.1. KQ2, ADHD Treatment Key Points

5.2. KQ2, ADHD Treatment Results

5.3. Effects by Intervention

5.4. KQ2a. How do these outcomes vary by presentation (inattentive, hyperactive/impulsive, and combined) or other co-occurring conditions?

5.6. KQ2b. What is the risk of diversion of pharmacologic treatment?

5.7. Summary of Findings KQ2a and KQ2b

6. Results: Monitoring ADHD

6.1. Key Question (KQ) 3 ADHD Monitoring Key Points

6.2. KQ 3 ADHD Monitoring Summary of Findings

7. Discussion

Findings in Relation to the Decisional Dilemma(s)

Findings in Relation to Existing Research Syntheses and Practice Guidelines

Implications

Applicability

Abbreviations and Acronyms

Appendixes

Appendix A. Methods

Appendix B. List of Excluded and Background Studies

Appendix C. Evidence Tables

Appendix D. Critical Appraisal and Applicability Tables

Appendix E. List of Included Studies

Appendix F. Expert Guidance and Review

Appendix G. PCORI Checklist.

Notes:

Description based on publisher supplied metadata and other sources.