Review
Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis

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Highlights

  • Psychological and pharmacological treatment options seem to effectively reduce ADHD symptoms in childhood.

  • There is a dearth of studies on combined treatment options for ADHD.

  • ADHD research should focus on developing and evaluating interventions for youth.

  • Meta-analyses need international standardization regarding conducting and reporting.

Abstract

There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.

Section snippets

Method

Our protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) and assigned registration number CRD42015025062. Derivation from protocol can be found in supplemental material. To take the highest quality approach we followed the Cochrane Handbook guidelines (Version 6.2) for conducting “Overview of Reviews” (Higgins et al., 2021; Pollock et al., 2020) and the PRISMA-Statement (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2009) in reporting our

Results of the search

Our final literature search identified 453 relevant articles. After the screening process, 16 meta-analyses ultimately met our inclusion criteria and were included in qualitative and narrative synthesis (Fig. 1). A list of excluded articles and reasons for their exclusion can be requested from the authors. One of the included 16 meta-analyses provided effect sizes for more than one intervention (Klassen, Miller, Raina, Lee, & Olsen, 1999).

In the following, each intervention's screening and

Summary of results

This umbrella review entailing meta-meta-analysis provides an overview of the latest meta-analytical evidence on the effectiveness of pharmacological and psychological interventions for treating ADHD in children and adolescents. As no previous research has examined the literature in this way, no systematic review summarizing meta-analyses of interventions for children and adolescents with ADHD was available before the present study. To ensure a high scientific standard, we followed the latest

Conclusion

This paper reveals meta-meta-analytical knowledge on the efficacy of pharmacological and psychological interventions and their combination for children with ADHD. Our overview advances the field of ADHD intervention research by identifying evidence gaps, thereby contributing to standardization and providing recommendations for future ADHD treatment studies and meta-analyses. Pharmacological and psychological treatment options seem to be effective in treating ADHD according to parental and

Author contributions

Selina Türk: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing - original draft, Writing - review & editing. Ann-Kathrin Korfmacher: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing - original draft, Writing - review & editing. Heike Gerger: Supervision, Conceptualization, Methodology, Writing - review & editing. Saskia van der Oord:

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Competing Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgment

We would like to thank Dr. Thomas Munder (University of Zurich, UZH) for his suggestion of Heike Gerger as statistical expert.

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