Table.
GRADE evaluation of interventions for ADHD in children and adolescents
| Important outcomes | Symptom severity, school performance, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of pharmacological treatments for ADHD in children? | |||||||||
| 6 (1381) | Symptom severity | Atomoxetine v placebo | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 1 (153) | School performance | Atomoxetine v placebo | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (326) | Symptom severity | Atomoxetine v methylphenidate | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for suboptimal dosing of comparator |
| 12 (336) | Symptom severity | Dexamfetamine sulphate v placebo | 4 | −2 | −1 | 0 | 0 | Very low | Quality points deducted for incomplete reporting of results and for methodological problems in one SR. Consistency point deducted for assessing outcomes using different assessment scales and for different treatment durations |
| at least 13 RCTs (at least 1177 people) | Symptom severity | Methylphenidate v placebo | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for incomplete reporting of results and for methodological issues |
| 1 (53) | School performance | Methylphenidate v placebo | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 4 (224) | Symptom severity | Methylphenidate v dexamfetamine sulphate | 4 | −1 | −2 | 0 | 0 | Very low | Quality point deducted for incomplete and poor reporting of results. Consistency point deducted for heterogeneity between RCTs and for conflicting results |
| 13 (at least 753 people) | Symptom severity | Methylphenidate v psychological/behavioural treatment | 4 | −3 | 0 | −2 | 0 | Very low | Quality points deducted for incomplete, poor reporting of results, and for methodological flaws. Directness points deducted for no direct measurements of response and for excluding participant responses |
| 7 (279) | Symptom severity | Clonidine v placebo | 4 | −3 | 0 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and methodological weaknesses. Directness point deducted for inclusion of non-placebo trials |
| 1 (136) | Symptom severity | Clonidine v methylphenidate | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for inclusion of other interventions |
| 2 (203) | Symptom severity | Clonidine plus methylphenidate/dexamfetamine v methylphenidate/dexamfetamine | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results. Directness point deducted for inclusion of other interventions |
| 1 (136) | Symptom severity | Clonidine v clonidine plus methylphenidate | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for inclusion of other interventions |
| 1 (248) | Symptom severity | Modafinil v placebo | 4 | −1 | −1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 2 RCTs in 3 publications (140) | Symptom severity | Bupropion v placebo | 4 | −2 | −1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for conflicting results |
| 1 (40) | Symptom severity | Omega-3 v placebo | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for inclusion of children with suspected but not confirmed ADHD |
| 2 (105) | Symptom severity | Homeopathy v placebo | 4 | −2 | −1 | −1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for conflicting results. Directness point deducted for variation in treatments used |
| What are the effects of psychological treatments for ADHD in children? | |||||||||
| 3 (366) | Symptom severity | Psychological/behavioural treatment v standard care | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and for methodological weaknesses. Directness points deducted for uncertainty about clinical relevance of outcomes measured in 2 RCTs and for different disease severities |
| 1 (24) | Symptom severity | Parent plus teacher training v parent training alone | 4 | −3 | −1 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results and for uncertainty about blinding and randomisation. Consistency point deducted for lack of consistent beneficial effects |
| What are the effects of combination treatments for ADHD in children? | |||||||||
| 3 (35) | Symptom severity | Methylphenidate plus psychological/behavioural treatment v control | 4 | −2 | −1 | −1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for lack of consistent beneficial effects. Directness point deducted for uncertainty about clinical relevance of outcomes assessed |
| 1 RCT in 3 publications (103) | Symptom severity | Methylphenidate plus psychological/behavioural treatment v methylphenidate alone | 4 | −3 | −1 | −1 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results and uncertainty about method of randomisation. Consistency point deducted for lack of consistent beneficial effects. Directness point deducted for not reporting doses used |
| 1 RCT in 3 publications (103) | School performance | Methylphenidate plus psychological/behavioural treatment v methylphenidate alone | 4 | −3 | −1 | −1 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results and uncertainty about method of randomisation. Directness point deducted for not reporting doses used |
| At least 11 RCTs (at least 428 children) | Symptom severity | Methylphenidate plus psychological/behavioural treatment v psychological/behavioural treatments alone | 4 | −2 | 0 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and for no direct comparison between groups. Consistency point deducted for lack of consistent beneficial effects |
| At least 11 RCTs (at least 428 children) | School performance | Methylphenidate plus psychological/behavioural treatment v psychological/behavioural treatments alone | 4 | −2 | −1 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and for no direct comparison between groups. Consistency point deducted for lack of consistent beneficial effects |
| 1 (35) | Symptom severity | Dexamfetamine sulphate plus psychological treatments v psychological treatments alone | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
Type of evidence: 4 = RCT; 2 = ObservationalConsistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk or odds ratio