Evidence Base for the Pharmacological Treatment of ADHD: State of the Art and Future Needs
Samuele Cortese, MD, PhD, Professor of Child and Adolescent Psychiatry, University of Southampton, UK, Consultant in child and adolescent psychiatry, Solent NHS (National Health System), UK
Integrating individual patient data from RCT and from large-scale observational studies has the potential to move the field from a trial-and-error process towards a precision psychiatry approach.
Meta-analytic evidence based on short-term RCTs shows high and moderate effect sizes in terms of efficacy on ADHD core symptoms for stimulates and non-stimulants, respectively, at the group level. Within-individual observational studies show a significant decrease in unintentional physical injuries, motor vehicle accidents, substance use disorder, criminal acts, depression, and seizure, as well as an improvement in academic functioning, during periods when individuals are pharmacologically treated. They also show no increased risk of psychosis. Adverse events during treatment with ADHD medications can usually be managed, but safety is a concern for some patients, especially those with pre-existing cardiovascular conditions.
- Differentiate, compare and rank ADHD medications in terms of efficacy and tolerability in the short term
- Compare the short and long term effects of ADHD medications
- Distinguish the effects of the medications at the group and individual level