Comparative Effectiveness of Pharmacological and Non-pharmacological Therapies for ADHD: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2008-2023).

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition that affects attention, impulse control, and the ability to remain still. These challenges can make it harder for individuals with ADHD to succeed at school, work, and in social situations. Stimulant medications, such as methylphenidate and amphetamines, are commonly used as first-line treatments and are effective at reducing symptoms. However, their use can be limited by side effects, such as insomnia, appetite loss, cardiovascular risks, potential for misuse, and variability in individual response. Since current treatments have drawbacks, many people are exploring nonstimulant options, such as behavioral therapy, dietary changes, and neurofeedback. These approaches may be safer and easier to maintain, but research on their effectiveness remains uncertain. This systematic review and meta-analysis aim to compare the effectiveness of pharmacological and nonpharmacological therapies for ADHD.

Method: We systematically searched PubMed, PsycINFO, Cochrane Library, ClinicalTrials.gov, and IEEE Xplore for randomized controlled trials (2008-2023) evaluating pharmacological (e.g., stimulant medications), non-pharmacological (e.g., behavioral therapy, cognitive training), or combined interventions in children and adolescents with ADHD. The search yielded 318 records. After screening titles and abstracts, 249 were excluded. Sixty-nine full-text articles were assessed, and 18 RCTs met the inclusion criteria for analysis. Primary outcomes were reductions in ADHD symptoms measured by standardized rating scales; secondary outcomes included academic performance, social functioning, and clinical global impression.

Results: Eighteen RCTs were pooled. ADHD symptoms were consistently reduced with stimulant medications (methylphenidate and amphetamines), although effects on academic performance were modest. Non-stimulants, such as viloxazine and guanfacine, showed significant improvements on ADHD-RS scores, but these improvements were only clinically modest. In contrast, some nutritional supplements, particularly iron and omega-3 fatty acids, showed more pronounced benefits in symptom reduction and social functioning. Behavioral and cognitive interventions were not very effective in achieving consistent outcomes. Combined approaches were somewhat more effective in achieving all identified outcomes, particularly social and functional outcomes.

Discussion: Stimulants, such as amphetamines and methylphenidate, consistently showed efficacy in reducing core ADHD symptoms, whereas non-pharmacological interventions showed mixed results.

Conclusion: A comprehensive, individualized treatment plan that may combine pharmacological and non-pharmacological approaches often yields the best outcomes in managing ADHD.

Clinical trial registration number: This review was conducted in accordance with the PRISMA recommendation. The review was entered into the Prospective International Registry of Systematic Reviews (PROSPERO 2024 CRD42024590678).