Major ADHD Review Shows What Treatments Work Best

Researchers from France and the UK have released the biggest review of ADHD treatments to date. They looked at over 200 meta-analyses covering drugs, therapy, and other options for children, teens, and adults. The work points to clear winners based on short-term trial data but flags a big hole in long-term proof. To help people sort it out, the team built a public website where anyone can check evidence on treatments.

Background

ADHD affects millions around the world. People with it often struggle to focus, sit still, or control impulses. These issues show up in school, work, and daily life. Treatments range from pills to talk therapy and exercises. But advice has been all over the place. Some push meds as the fix-all. Others swear by diet changes or mindfulness. Parents and adults often hear conflicting tips from doctors, online forums, and ads.

This new review changes that. A team from Université Paris Nanterre, Institut Robert-Debré du Cerveau de l'Enfant, and the University of Southampton pulled together data from hundreds of past studies. They checked how well treatments cut core symptoms like inattention and hyperactivity. The goal was to rank options by proof strength, not hype. All findings come from randomized trials, the gold standard for testing what works.

Past work has shown meds help in the short run. For example, older meta-analyses found stimulants like methylphenidate beat placebo in adults, with solid effect sizes. Non-drug options like cognitive training showed some gains in kids' control skills. But no one had combined everything into one big picture until now. This review covers kids, teens, and adults separately. It also looks at side effects and how patients and doctors rate changes.

The team made an interactive site to share it all. Users pick age group, treatment type, and outcome. It shows effect sizes, confidence levels, and study quality. This lets doctors, parents, and people with ADHD pick based on real data, not guesses.

Key Details

For children and teens, five medications stand out. These include stimulants such as methylphenidate, lisdexamfetamine, and dexamfetamine. Trials with thousands of kids show they reduce symptoms better than placebo. Effect sizes are medium to large, meaning real drops in hyperactivity and better focus. Non-stimulants like atomoxetine also help but rank a bit lower.

In adults, two meds lead: stimulants and atomoxetine. Data from over 14,000 people in 113 trials confirm they cut symptoms on both doctor and patient reports. Stimulants edge out others with higher effect sizes. Cognitive behavioral therapy, or CBT, matches them for adults. CBT teaches skills to manage impulses and organize tasks. It works well when patients report changes themselves.

Non-Drug Options

Other approaches show mixed results. For kids, physical exercise boosts inhibitory control short-term, topping non-drug picks. But gains fade after stopping. Behavioral therapy holds steady longer, with medium effects that last. Cognitive training and neurofeedback help a little at first but weaken over time. Board games and meditation did nothing in small trials.

In adults, CBT shines alongside meds. Clinicians see gains from cognitive remediation, mindfulness, psychoeducation, and brain stimulation like transcranial direct current. But patients rarely report the same. This gap suggests some therapies look good on paper but feel less real in life.

All top evidence is short-term, often 12 weeks or less. Long-term data is thin. One analysis noted behavioral therapy keeps effects in kids, unlike exercise. But most studies stop early. Safety info is better for meds, with known risks like sleep issues or appetite loss. Stimulants carry a small psychosis risk in rare cases.

"Stimulants and atomoxetine have demonstrated short-term benefits, but it is vital to explore sustainable treatment options and their effects on co-occurring conditions and overall well-being." – Professor Andrea Cipriani, University of Oxford

The website highlights weak spots. Acupuncture, mindfulness, and exercise show promise but fail on study quality. Small groups and bias risks drag them down. CBT for kids lacks strong backing too.

What This Means

People with ADHD often take treatments for years. Yet the best proof only covers weeks or months. This leaves doctors guessing on long hauls. The review calls for more studies tracking outcomes over years. It also pushes comparing meds to therapy head-to-head, including side effects and costs.

For now, it guides choices. Kids do best with one of five meds. Adults add CBT to meds for stronger results. The site makes this easy to see. Parents can check if a new app or diet has trial backing. Adults weigh therapy versus pills based on their reports.

This could shift care. Clinics might pair meds with CBT more for adults. Schools push exercise knowing it helps short-term but needs follow-up. Insurers may cover proven options first. But the long-term gap stays. Many live with ADHD lifelong, so trials must catch up.

Experts say patient input shaped the work. Those with ADHD helped pick questions. This fits a push for care that matches real needs, not just lab scores. The review sets a bar for future tests. It shows what holds up under scrutiny and what needs work.