The New Landscape of ADHD: Treatments, Myths, and Recent Discoveries

ADHD is a disorder that makes it difficult to maintain attention, control impulsivity, and reduce restlessness. It usually begins in childhood, but in many cases continues to affect adult life. There are many types of treatment for ADHD, such as medications, therapies, lifestyle changes, and other interventions. Because there is a lot of scattered and sometimes even contradictory information, researchers conducted a large study gathering all available data. They analyzed hundreds of studies and created a free online platform to show, in a simple way, which treatments work best, for whom, and with what level of scientific certainty. This platform helps doctors, patients, and families make more informed decisions about treatment.

Attention deficit hyperactivity disorder (ADHD) is a condition marked by persistent and disabling difficulties with attention, hyperactivity, impulsivity, or a combination of these factors. It is estimated that approximately 5% of children are affected by the disorder, and that in about 70% of cases, the symptoms continue to cause impairment in adult life.

ADHD often appears alongside other disorders, such as mood problems, anxiety, and substance use disorders. Furthermore, it is frequently accompanied by challenges such as emotional dysregulation and difficulties with executive functions, which are mental skills responsible for planning, organizing, and controlling behavior.

Because of these symptoms and comorbidities, ADHD is associated with a number of negative outcomes in people's lives, such as lower academic performance, impaired relationships, a higher risk of accidents and physical injuries, and a decline in quality of life. The impact is not only individual: the disorder also generates a significant economic cost. In the United States, it is estimated that annual social spending reaches $19.4 billion for children, $13.8 billion for adolescents, and $122.8 billion for adults.

The interventions available for managing ADHD symptoms are varied and include both medications and non-pharmacological approaches. Among the medications, stimulants such as methylphenidate (Ritalin and Concerta) and amphetamines stand out, as well as non-stimulant medications such as atomoxetine (Atentah), bupropion (Wellbutrin), clonidine (Atensina), guanfacine (Intuniv), and viloxazine (Qelbree). Non-pharmacological strategies include behavioral therapies, dietary interventions, and techniques such as neurofeedback.

Current clinical guidelines generally recommend the use of medications as a first choice, especially stimulants, combined with behavioral or cognitive interventions, in order to offer a more complete treatment tailored to the patient's needs.

Despite the existence of several meta-analyses evaluating these interventions, the practical utility of these studies for clinical professionals is still limited. This is because many meta-analyses focus only on very specific interventions or outcomes, not answering the most frequent questions from professionals and patients.

Another problem is that different analyses often reach contradictory conclusions about the same intervention, as in the case of neurofeedback or cognitive training. Furthermore, many of these analyses do not adequately assess the quality of the evidence, which hinders the implementation of management truly based on scientific evidence.

The situation is exacerbated by a lack of accessible dissemination: scientific results are often restricted to academic publications, leaving patients and families without clear and reliable information about therapies, especially non-pharmacological ones and those related to the treatment of comorbidities. People with lived experience of ADHD have requested more comprehensive online resources capable of summarizing evidence in a clear and applicable way for everyday life.

Given these limitations, a comprehensive review was necessary to fully assess the effects of different interventions for ADHD throughout life and also examine the quality of the available evidence.

This review should also be accompanied by an efficient way to disseminate the results. To this end, and following the methodology proposed by the U-REACH framework, a model that integrates review, evaluation, analysis, and communication of evidence, a broad review of interventions aimed at children, adolescents, and adults with ADHD was carried out.

The goal was to evaluate both the effects and the confidence level of the evidence for different treatments, while simultaneously making this information accessible to clinicians, patients, people with ADHD, guideline developers, and other interested parties. To this end, the researchers also developed an open-access online platform that presents the results in an organized and easy-to-navigate manner.

The main objective of this review was to evaluate the effects of ADHD interventions throughout life and to create a continuously updated online platform that would allow people with lived experience of the disorder to follow the evidence in real time and use it to support shared decisions with healthcare professionals.

The study was structured as a comprehensive review combined with the development of a digital decision support tool. Searches were conducted in six databases from their inception until January 2025, and study authors were contacted when additional information was needed.

Systematic reviews that included meta-analyses of randomized clinical trials comparing any pharmacological or non-pharmacological intervention with a passive control group in participants diagnosed with ADHD were considered eligible.

The main outcomes included symptom severity, assessed by different types of observers (such as clinicians, parents, teachers, or the patients themselves), and also at different follow-up periods, such as short, medium, and long term.

Furthermore, the acceptability of the interventions was assessed, measured by the number of dropouts for any reason, and the tolerability, measured by the number of dropouts due to side effects. Secondary outcomes included daily functioning, quality of life, symptoms of associated disorders, and significant side effects such as sleep problems and decreased appetite.

Of the 414 articles analyzed in full, 115 met the eligibility criteria and 299 were excluded. The included articles represented 221 distinct combinations involving participant type, intervention type, comparator, and outcome. For each of these combinations, the most recent and methodologically robust meta-analysis was selected, resulting in 221 re-estimated analyses derived from 47 original reports.

The results showed that, in the short term, alpha-2 agonists, amphetamines, atomoxetine (Atentah), methylphenidate (Ritalin and Concerta), and viloxazine (Qelbree) showed medium to large-sized effects in reducing ADHD symptoms in children and adolescents, with moderate to high-quality evidence.

Methylphenidate, in particular, showed consistent benefits across different raters, with effects significantly superior to placebo. It should be used under strict medical prescription due to the risk of adverse reactions. These medications showed lower tolerability compared to placebo, although this effect was not significant for methylphenidate and atomoxetine.

In adults, interventions such as atomoxetine, methylphenidate, cognitive-behavioral therapy, and, in analyses restricted to high-quality studies, amphetamines, showed efficacy with at least moderate confidence, with effects of medium magnitude.

Medications such as methylphenidate, amphetamines, and atomoxetine showed lower tolerability than placebo, with a higher dropout rate due to side effects. Some non-pharmacological interventions, such as acupuncture and cognitive-behavioral therapy in children and adolescents, and mindfulness in adults, showed significant effects on symptoms, but the certainty of the evidence is still low, preventing firm conclusions.

No intervention presented high-certainty evidence in the long term. As part of the project, an online platform was created that interactively presents the effects and the degree of certainty of the evidence for each intervention, organized by age group, follow-up period, and type of outcome. This publicly available resource was developed to facilitate its use in clinical consultations and shared decision-making.

The review, with its comprehensive and up-to-date synthesis of the evidence, provides a solid foundation to help patients, healthcare professionals, and guideline developers choose the best strategies for managing ADHD. The associated digital platform has the potential to make this knowledge accessible and applicable to everyday clinical practice, promoting more informed, collaborative decisions aligned with the needs of each individual.

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Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making

Corentin J Gosling, Miguel Garcia-Argibay, Michele De Prisco, Gonzalo Arrondo, Anaël Ayrolles, Stéphanie Antoun, Serge Caparos, Ana Catalán, Pierre Ellul, Maja Dobrosavljevic, Luis C Farhat, Giovanna Fico, Luis Eudave, Annabeth P Groenman, Mikkel Højlund, Lucie Jurek, Mikail Nourredine, Vincenzo Oliva, Valeria Parlatini, Constantina Psyllou, Gonzalo Salazar-de-Pablo, Anneka Tomlinson, Samuel J Westwood, Andrea Cipriani, Christoph U Correll, Dong Keon Yon, Henrik Larsson, Edoardo G Ostinelli, Jae Il Shin, Paolo Fusar-Poli, John P A Ioannidis, Joaquim Radua, Marco Solmi, Richard Delorme, and Samuele Cortese

BMJ, 2025;391:e085875

DOI: 10.1136/bmj-2025-085875

Abstract:

To assess the effects of and related evidence certainty of interventions for attention deficit/hyperactivity disorder (ADHD) across an individual’s lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making. Umbrella review and platform for shared decision making. Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary. criteria for selecting studies Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)),acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite). Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions. 115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes (https://ebiadhd-database.org/) was developed. This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice.

Trial registration Open Science Framework https://osf.io/ugqy6/.