Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making
Gosling CJ, Garcia-Argibay M, De Prisco M, Arrondo G, Ayrolles A, Antoun S, Caparos S, Catalán A, Ellul P, Dobrosavljevic M, Farhat LC, Fico G, Eudave L, Groenman AP, Højlund M, Jurek L, Nourredine M, Oliva V, Parlatini V, Psyllou C, Salazar-de-Pablo G, Tomlinson A, Westwood SJ, Cipriani A, Correll CU, Yon DK, Larsson H, Ostinelli EG, Shin JI, Fusar-Poli P, Ioannidis JPA, Radua J, Solmi M, Delorme R, Cortese S · BMJ · 2025 November 26
DOI 10.1136/bmj-2025-085875
Objective
To investigate the effects and certainty of evidence for drug and non-drug interventions for attention deficit/hyperactivity disorder across the lifespan and develop an online platform to disseminate living evidence synthesis for shared decision making.
Conclusions
This review provides updated evidence to inform patients, practitioners, and guideline developers about managing attention deficit/hyperactivity disorder symptoms, and the online platform facilitates shared decision making in daily practice.
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Insights
Methylphenidate provides the most consistently supported short-term symptom improvement for children and adolescents, while evidence for lasting benefits of any treatment remains limited.
Researchers conducted an umbrella review of systematic reviews containing meta-analyses of randomised controlled trials that compared drug and non-drug treatments with passive controls in people diagnosed with attention deficit/hyperactivity disorder. They searched six databases, selected the most recent and methodologically robust review for each intervention-outcome combination, recalculated findings using a standard approach, assessed review quality, and graded certainty of evidence across age groups, symptom ratings, treatment duration, acceptability, tolerability, functioning, quality of life, related symptoms, sleep, and appetite.
Several medicines improved short-term symptoms in children and adolescents with moderate to high certainty, with methylphenidate showing benefits consistently across clinician, parent, teacher, and self-assessments. In adults, atomoxetine, cognitive behavioural therapy, and methylphenidate showed reasonably certain symptom benefits, while amphetamines benefited adults in higher-quality trials. Medicines generally caused more treatment discontinuation due to side effects than placebo, particularly among adults. Some non-drug approaches showed large apparent benefits, but the supporting evidence was uncertain, and no intervention had highly certain evidence of long-term effectiveness.
