Appraisal of Clinical Practice Guidelines for the Management of Attention Deficit Hyperactivity Disorder (ADHD) Using the AGREE II Instrument: A Systematic Review

PLoS One. 2019 Jul 5;14(7):e0219239. doi: 10.1371/journal.pone.0219239. eCollection 2019.


Background and objective: High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD.

Methods: A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.

Results: Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs.

Conclusions: Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended. The protocol for this study was published in PROSPERO (International prospective register of systematic reviews). Link: and is additionally available from Link:

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Databases, Factual
  • Evidence-Based Practice
  • Humans
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / trends*

Grant support

This work was supported by Saudi ADHD Society. URL: This is part of a comprehensive project for adaptation of National CPG for ADHD sponsored by the Saudi ADHD Society. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.