Attention-deficit hyperactivity disorder in children and youth: A quantitative systematic review of the efficacy of different management strategies

Objective: To obtain estimates of the relative efficacy of 3 main treatment strategies for attention-deficit hyperactivity disorder (ADHD) in children and youth (age < 18 years). Methods: Design: quantitative systematic review, of randomized trials. Subj ects. 999 patients with ADHD from 26 randomized trials. Interventions. medi cations alone, behavioural interventions alone, and a combination of these 2 modalities. Main outcome measure: differences in scores between treatment groups on commonly used teacher and parent-completed behaviour rating scal es. Results: medication-only therapy was efficacious in ADHD. Behavioural thera pies used alone appear ed not to be efficacious in ADHD. Combination therap y, was more efficacious than placebo or no treatment for parent but not tea cher ratings, not more efficacious than drug therapy alone, and more effica cious than behavioural treatments alone based on parent hut not teacher rat ings. Conclusion: Though stimulant medications were found to be an effective trea tment strategy for. ADHD in children and youth, improved difficult to asses s the relative benefits of behavioural interventions alone and combined med ication and behavioural therapy because of the paucity of treatment studies other than medication-only treatment studies and heterogeneity of various kinds that exist in relation to ADHD studies and treatments.