Adam P Goode1,2, Remy R Coeytaux3,4, Gary R Maslow5,6, Naomi Davis5, Sherika Hill5, Behrouz Namdari5, Nancy M Allen LaPointe7,8, Deanna Befus4, Kathryn R Lallinger2,9, Samantha E Bowen10, Andrzej Kosinski2, Amanda J McBroom2,9, Gillian D Sanders2,9, Alex R Kemper11. 1. Duke Orthopaedic Surgery. 2. Duke Clinical Research Institute, and. 3. Department of Family and Community Medicine and. 4. Center of Integrative Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina. 5. Departments of Psychiatry and Behavioral Sciences. 6. Pediatrics, and. 7. Medicine. 8. Premier, Inc, Charlotte, North Carolina. 9. Duke Evidence-Based Practice Center, Durham, North Carolina; and. 10. Duke Center for Autism and Brain Development, School of Medicine, Duke University, Durham, North Carolina. 11. Division of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio alex.kemper@nationwidechildrens.org.
Abstract
CONTEXT: Nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) encompass a range of care approaches from structured behavioral interventions to complementary medicines. OBJECTIVES: To assess the comparative effectiveness of nonpharmacologic treatments for ADHD among individuals 17 years of age and younger. DATA SOURCES: PubMed, Embase, PsycINFO, and Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2009 through November 7, 2016. STUDY SELECTION: We included studies that compared any ADHD nonpharmacologic treatment strategy with placebo, pharmacologic, or another nonpharmacologic treatment. DATA EXTRACTION: Study design, patient characteristics, intervention approaches, follow-up times, and outcomes were abstracted. For comparisons with at least 3 similar studies, random-effects meta-analysis was used to generate pooled estimates. RESULTS: We identified 54 studies of nonpharmacologic treatments, including neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. No new guidance was identified regarding the comparative effectiveness of nonpharmacologic treatments. Pooled results for omega fatty acids found no significant effects for parent rating of ADHD total symptoms (n = 411; standardized mean difference -0.32; 95% confidence interval -0.80 to 0.15; I2 = 52.4%; P = .10) or teacher-rated total ADHD symptoms (n = 287; standardized mean difference -0.08; 95% confidence interval -0.47 to 0.32; I2 = 0.0%; P = .56). LIMITATIONS: Studies often did not reflect the primary care setting and had short follow-up periods, small sample sizes, variations in outcomes, and inconsistent reporting of comparative statistical analyses. CONCLUSIONS: Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments.
CONTEXT: Nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) encompass a range of care approaches from structured behavioral interventions to complementary medicines. OBJECTIVES: To assess the comparative effectiveness of nonpharmacologic treatments for ADHD among individuals 17 years of age and younger. DATA SOURCES: PubMed, Embase, PsycINFO, and Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2009 through November 7, 2016. STUDY SELECTION: We included studies that compared any ADHD nonpharmacologic treatment strategy with placebo, pharmacologic, or another nonpharmacologic treatment. DATA EXTRACTION: Study design, patient characteristics, intervention approaches, follow-up times, and outcomes were abstracted. For comparisons with at least 3 similar studies, random-effects meta-analysis was used to generate pooled estimates. RESULTS: We identified 54 studies of nonpharmacologic treatments, including neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. No new guidance was identified regarding the comparative effectiveness of nonpharmacologic treatments. Pooled results for omega fatty acids found no significant effects for parent rating of ADHD total symptoms (n = 411; standardized mean difference -0.32; 95% confidence interval -0.80 to 0.15; I2 = 52.4%; P = .10) or teacher-rated total ADHD symptoms (n = 287; standardized mean difference -0.08; 95% confidence interval -0.47 to 0.32; I2 = 0.0%; P = .56). LIMITATIONS: Studies often did not reflect the primary care setting and had short follow-up periods, small sample sizes, variations in outcomes, and inconsistent reporting of comparative statistical analyses. CONCLUSIONS: Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments.
Authors: Rie Sakai-Bizmark; Hiraku Kumamaru; Emily H Marr; Lauren E M Bedel; Laurie A Mena; Anita Baghaee; Michael Nguyen; Dennys Estevez; Frank Wu; Ruey-Kang R Chang Journal: Pediatr Cardiol Date: 2022-10-23 Impact factor: 1.838
Authors: Joseph Firth; Scott B Teasdale; Kelly Allott; Dan Siskind; Wolfgang Marx; Jack Cotter; Nicola Veronese; Felipe Schuch; Lee Smith; Marco Solmi; André F Carvalho; Davy Vancampfort; Michael Berk; Brendon Stubbs; Jerome Sarris Journal: World Psychiatry Date: 2019-10 Impact factor: 49.548