Medications used to manage ADHDsymptoms include stimulants (methylphenidate, amphetamines) and non-stimulants (atomoxetine, guanfacine, clonidine). Managing ADHD is crucial for improving functioning and long-term outcomes.
Side effects may include decreased appetite, sleep disturbances, and cardiovascular effects. Medication selection must be individualized considering factors like symptom severity, comorbidities, and patient preferences.
Disclaimer: This review article is for informational purposes only and should not be taken as medical advice. Treatment decisions should be made in consultation with a qualified healthcare provider.
Key Points
The key points from this review on evidence-based pharmacologicaltreatment options for ADHDin children and adolescents are:
Rationale
ADHD frequently co-occurs with other psychiatric and somatic conditions, and insufficient treatment is associated with adverse long-term academic, occupational, social, and health outcomes (Arnold et al., 2020; Cortese, 2019).
While the short-term efficacy and safety of stimulant and non-stimulant medications have been well-established (Cortese et al., 2018), evidence gaps remain regarding long-term effects, head-to-head comparisons, and their combination with non-pharmacological treatments (Wong et al., 2019).
Optimizing safe and effective pharmacotherapy as part of a multimodal, individualized treatment plan is crucial.
This review aims to summarize the current state of evidence for the pharmacological treatment of pediatric ADHD, identify research gaps, and provide an overview of novel medications under development.
Method
This paper provides a narrative review of evidence-based pharmacological treatments for ADHD in children and adolescents.
It summarizes key information about currently approved stimulant and non-stimulant medications, including mechanisms of action, formulations, efficacy, tolerability, treatment strategies, and current issues in research.
A systematic cross-sectional analysis of the ClinicalTrials.gov registry was also conducted to identify novel medications currently under development.
Results
Insight
This review provides a helpful synthesis of current evidence-based pharmacological treatment options for ADHD in pediatric populations.
The key insights are:
The findings highlight the importance of a patient-centered, evidence-based approach to optimizing pharmacotherapy for ADHD and the need for further research to inform clinical practice, especially comparative effectiveness trials and studies in real-world populations.
Strengths
The review provides a comprehensive overview of current pharmacological treatment options for ADHD, with helpful details on mechanisms, formulations, efficacy, and safety.
Summarizing the evidence for both stimulant and non-stimulant options, as well as discussing factors influencing treatment selection, provides useful guidance for clinicians.
The cross-sectional analysis of medications in development is a relative strength. The review appropriately highlights key evidence gaps and areas for further research.
Limitations
As a narrative review, the article is prone to selection bias in terms of which studies are included and emphasized.
It does not appear to be a fully systematic review and lacks explicit search criteria.
Meta-analytic results are presented for some but not all medication classes.
The cross-sectional analysis of novel medications relies only on a ClinicalTrials.gov search and does not capture drugs in earlier stages of development.
The article is focused specifically on children and adolescents, without fully discussing the adult ADHD population.
Finally, non-pharmacological treatment modalities are mentioned but not discussed in any depth.
Implications
The review emphasizes that while current pharmacotherapies for ADHD are relatively effective and safe, clinical practice must focus on optimizing individual treatment plans through a multimodal approach.
Medication selection remains more of an art than a science, drawing upon a combination of research evidence, clinical expertise, and patient values. More personalized prescribing approaches may be possible in the future with advances in pharmacogenomics and biomarker development.
At the health systems level, quality metrics and incentives should promote measurement-based, multimodal ADHD care. In terms of treatment development, novel delivery systems for existing medications should be pursued in parallel with identifying new molecular entities with distinct mechanisms of action.
Comparative effectiveness research, including head-to-head medication trials, long-term studies, and real-world evidence, is a priority to guide treatment optimization.
Finally, research must examine medication effects in understudied populations and consider a full range of functional outcomes beyond symptom control.
Policy implications include ensuring affordable access to a range of medication options and supporting research to modernize the ADHD pharmacotherapy evidence base.
References
Primary reference
Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents.Pharmacology & Therapeutics,230, 107940.https://doi.org/10.1016/j.pharmthera.2021.107940
Other references
Arnold, L. E., Hodgkins, P., Kahle, J., Madhoo, M., & Kewley, G. (2020). Long-term outcomes of ADHD: Academic achievement and performance.Journal of Attention Disorders 24(1), 73–85.https://doi.org/10.1177/108705471456607
Cortese, S. (2019). The association between ADHD and obesity: Intriguing, progressively more investigated, but still puzzling.Brain Sciences, 9(10), 256.https://doi.org/10.3390/brainsci9100256
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., … & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis.The Lancet Psychiatry, 5(9), 727-738.https://doi.org/10.1016/S2215-0366(18)30269-4
Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., … & Franke, B. (2015). Attention-deficit/hyperactivity disorder.Nature Reviews Disease Primers, 1(1), 1-23.
Wong, I. C., Banaschewski, T., Buitelaar, J., Cortese, S., Döpfner, M., Simonoff, E., & Coghill, D. (2019). Emerging challenges in pharmacotherapy research on attention-deficit hyperactivity disorder—outcome measures beyond symptom control and clinical trials.The Lancet Psychiatry, 6(6), 528-537.https://doi.org/10.2147/JEP.S256586
Keep Learning
Some Socratic questions for a college class to discuss based on this review paper could include:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
