A thorough review reveals the latest evidence on ADHD diagnosis, treatment, and monitoring

Hundreds of studies on attention-deficit/hyperactivity disorder (ADHD) are published each year, but more research is needed to ensure that their findings improve lives.

Based on input from experts across the field, Southern California Evidence Review Centerpart of Keck School of Medicine, University of Southern California, we synthesized the latest insights to ultimately inform clinical practice. Broadly speaking, we found that both pharmacotherapy and psychosocial treatments are effective in treating ADHD, and that children with ADHD can and do improve.

“There is more research on ADHD than ever before, but we need to summarize it in a reliable and valid way.” Dr. Suzanne HempelHe is a professor of clinical population and public health at the Keck School of Medicine and director of the Southern California Center for Evidence Review, which oversaw the study.

The team includes researchers from the Southern California Center for Evidence-Based Practice, the Division of Child Psychiatry at the Keck School of Medicine, and the Behavioral Health Institute at Children's Hospital Los Angeles, and has published more than 23,000 studies on ADHD. I considered things. Their works are Agency for Healthcare Research and Quality and was funded by Patient-Centered Outcomes Institute.

The results have just been published Two related papers in a diary Pediatrics, answers big questions about what works to effectively diagnose and treat ADHD and points out ongoing gaps in research, including how best to monitor the progression of the condition over time. Clinicians selected by the American Academy of Pediatrics (AAP) will now use their review of the evidence to develop updated clinical guidelines to inform best practices for ADHD care across the United States.

“Parents, teachers, and health care providers need evidence-based information about ADHD,” Hempel said. “We included only the most robust studies in our review, which allows us to state the strongest evidence.”

New findings regarding diagnosis and treatment

Before starting the literature review, the research team made the following observations. Questions and protocols We collaborate with ADHD experts in the field to ensure we ask and answer questions that can directly benefit patients, families, and healthcare providers. Along the way, the researchers also posted their preliminary findings and welcomed feedback during a 45-day public comment period.

The team conducted extensive research that was not limited to diagnostic tools and treatment approaches that were already known to be effective. From over 23,000 publications, the researchers selected 550 studies for final analysis. Studies were selected if they met the team's selection criteria, which prioritized rigorous research designs such as randomized controlled trials.

Many tools are available for diagnosing ADHD, including parent and teacher rating scales, patient self-report, neuropsychological testing, EEG approaches, imaging, biomarkers, and activity monitoring and observation. Researchers found wide variation in results for several approaches, with some studies showing that a particular method was highly effective and others showing it to be less effective. . “Diagnosis of ADHD is improving, but research is still characterized by a lot of variability,” Hempel says.

Many treatments for ADHD have been rigorously tested, building a strong evidence base for psychosocial approaches such as pharmacotherapy (including both stimulant and non-stimulant drugs) and behavior modification. Other non-drug treatments analyzed by the research team included cognitive training, neurofeedback, physical exercise, nutrition and supplements, parental support, and school interventions.

“Medication has the strongest evidence to improve not only ADHD symptoms, but also other problems often associated with ADHD, such as oppositional and destructive behavior.” Dr. Bradley Peterson, Director of Mental Development Research Institute Children's Hospital Los Angeles (CHLA) and lead author of the review.

Long-term monitoring of ADHD

In addition to reviewing the evidence regarding diagnosis and treatment, researchers investigated what is known about ongoing monitoring of ADHD. How can health care providers assess whether a child or adolescent needs to continue treatment for this condition? Experts in the field agree that this is a serious issue. However, few studies have investigated this issue. The evidence team concluded that further research is needed to monitor ADHD over time.

These publications will be used to support AAP updates. Clinical practice guidelines for ADHDprovides up-to-date advice on how best to diagnose, evaluate, and treat conditions.

“The important point is that ADHD is treatable. There's a lot of research showing that children absolutely can get better,” Hempel said.

About this study

In addition to Drs. Peterson and Hempel, other authors of this study include Joey Trampsch, Mora Brown, Margaret Maglione, Maria Bolshakova, and Mary of the Southern California Center for Evidence Review at the Keck School of Medicine at the University of Southern California.・Roselle, Jeremy Miles, Sheila Pakdaman, Aneesa Motala and others. California.

This work, Agency for Healthcare Research and Quality [Contract No. 75Q80120D00009] And that Patient-Centered Outcomes Institute [Publication No. 2023-SR-03].