Exploring the Effects of Pharmacological, Psychosocial, and Alternative/Complementary Interventions in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Meta-Regression Approach

Kung-Han Yang; Hsien-Yuan Lane; Yue-Cune Chang; Ruu-Fen Tzang

doi:10.1093/ijnp/pyab034

Exploring the Effects of Pharmacological, Psychosocial, and Alternative/Complementary Interventions in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Meta-Regression Approach

Int J Neuropsychopharmacol. 2021 Oct 23;24(10):776-786. doi: 10.1093/ijnp/pyab034.

Authors

Kung-Han Yang¹, Hsien-Yuan Lane^{2

3

4}, Yue-Cune Chang⁵, Ruu-Fen Tzang^{6

7}

Affiliations

¹ Department of Applied Mathematics, Chinese Culture University, Taipei, Taiwan.
² Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
³ Graduate Institute of Biomedical Sciences, China Medical University Medical College, Taichung, Taiwan.
⁴ Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
⁵ Department of Mathematics, Tamkang University, Taipei, Taiwan.
⁶ Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
⁷ Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.

Abstract

Background: There have been various therapies for attention-deficit/hyperactivity disorder (ADHD), but the previous meta-analysis of ADHD efficacy remains unclear. This study aims to systemically meta-regress the effect sizes (ES) of psychostimulant pharmacotherapy (methylphenidate and lisdexamfetamine), non-stimulant pharmacotherapy (atomoxetine and alpha-2 agonists), psychosocial therapy (parental behavioral therapy [PBT]), combination therapy (psychostimulant plus PBT), and alternative/complementary interventions to determine the right treatment for ADHD.

Methods: We searched various ADHD interventions from the MEDLINE and PubMed databases (National Center for Biotechnology Information) between January 1, 1980, and July 30, 2018. Following the meta-analysis of random effects, the meta-regression analyses were used to explore factors potentially influencing treatment efficacy. The confounding variables included type of treatment, type of study, age, type of symptom scale used, and year of publication.

Results: A total of 107 trials (n = 9883 participants) were included. After adjustment, compared with the psychostimulant therapy (28 trial, 2134 participants), non-stimulant pharmacotherapy (28 trials, 4991 participants) and alternative/complement intervention (25 trials, 1195 participants) were less effective by the ES of -0.384 (P = .004) and -0.419 (P = .028), respectively. However, compared with psychostimulant, PBT (19 trials, 1122 participants; ES = -0.308, P = .095) and the combination of psychostimulant and PBT (7 trials, 441participants; ES = -0.196, P = .209) did not differ significantly.

Conclusions: Psychostimulant therapy surpassed non-stimulant pharmacotherapy and alternative/complement intervention. Psychostimulant therapy, PBT, and the combination of psychostimulant therapy and PBT appear to be similar in efficacy according to this meta-regression.

Keywords: ADHD; behavior therapy; meta-regression; pharmacotherapy; treatment efficacy.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity / therapy*
Central Nervous System Stimulants / therapeutic use
Child
Child, Preschool
Complementary Therapies
Female
Humans
Male
Treatment Outcome

Substances

Central Nervous System Stimulants