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New Meta-Analysis: Behavior Therapy + Medication May Be the Most Effective ADHD Treatment

A large analysis indicates that behavior therapy combined with stimulants produces better short-term results for children with ADHD than does either treatment alone, or a host of alternative therapies like cognitive training, diet, or vitamin supplementation.




November 26, 2017

Data from a meta-analysis1 of almost 200 randomized, controlled studies appears to show that behavior therapy combined with stimulant medication is the most successful treatment for children and adolescents with ADHD. Other forms of ADHD treatment — including neurofeedback, dietary changes, and cognitive training — were significantly less effective and comparable to placebos, the researchers say.

The meta-analysis, published earlier this year in the journal PLoS One, identified 190 randomized, controlled studies on various ADHD treatment methodologies that took place before April 2016. The total number of participants, all under 18 years of age, was 26,114. Though each study varied, stimulant and non-stimulant medications, behavioral therapy, neurofeedback, psychotherapy, vitamin therapy, and several other pharmacological and non-pharmacological treatments were included. Overall, 26 “intervention classes” were identified and measured by the researchers.

Of these, stimulants, non-stimulants, and behavioral therapy were all more effective than placebos when used on their own. When behavior therapy and stimulants were combined, however, they received the highest efficacy ratings, and were slightly less likely than other treatments to be discontinued or have adverse effects. “Alternative” treatments like vitamin supplementation, cognitive training, and neurofeedback appeared to be no more effective than placebos, the researchers said.

The results may give hope to parents who find that stimulants alone do not fully control their child’s ADHD symptoms. The researchers, however, caution that their conclusions should be interpreted cautiously, as many of the 190 trials produced results that were deemed “low quality” — meaning they lacked adequate follow-up, were hampered by a small sample size, or had other clinical or methodological limitations.

“Although the quality of evidence is not strong, clinical differences may exist between the pharmacological and non-pharmacological treatments commonly used for the management of ADHD,” the researchers concluded. “Behavioral therapy and pharmacological treatment may improve the symptoms of ADHD and global functioning in the short-term.”


1 Catalá-López, Ferrán, et al. “The Pharmacological and Non-Pharmacological Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review with Network Meta-Analyses of Randomised Trials.” PLoS One, vol. 12, no. 7, Dec. 2017, doi:10.1371/journal.pone.0180355.

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