ADHD: Children, Adults Benefit From Different Medications

Researchers have found that children and adolescents with attention-deficit hyperactivity disorder (ADHD) benefit more from different medications than adults with the disorder.

“Taking into account both efficacy and safety, [recent evidence] supports methylphenidate in children and adolescents, and amphetamines in adults, as preferred first-choice medications for the short-term treatment of ADHD,” the researchers wrote.

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These findings emerged from a systematic review and meta-analysis of 133 double-blind, randomized controlled trials. Of these, 81 were conducted in children, and 51 were conducted in adults.

All studies included in the analysis had compared amphetamines—including lisdexamfetamine—atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil with either each other or placebo.

Results of the study indicated that all drugs included in the analysis were superior to placebo based on clinicians’ ratings for ADHD core symptoms in children and adolescents, with standardized mean differences (SMDs) of -1.02 for amphetamines, -0.78 for methylphenidate, and -0.56 for atomoxetine.

However, based on teachers’ ratings, only methylphenidate and modafinil were more effective vs placebo (SMDs, -0.82 and -0.76, respectively).

Among adults with ADHD, amphetamines (SMD, -0.79), methylpenidate (SMD, -0.49), bupropion (SMD, -0.46), and atomoxetine (SMD, -0.45), but not modafinil (SMD, -0.16), were more effective than placebo, based on clinicians’ ratings.

For tolerability, amphetamines were less well-tolerated than placebo in both children and adolescents (odds ratio, OR, 2.30) and adults (OR, 3.26). Guanfacine was inferior to placebo in children and adolescents only (OR, 2.64); whereas atomoxetine (OR, 2.33), methylphenidate (OR, 2.39), and modafinil (OR, 0.41) were inferior to placebo in adults only.

Data for the 26-week and 52-week timepoints were insufficient.

“Our findings represent the most comprehensive available evidence base to inform patients, families, clinicians, guideline developers, and policymakers on the choice of ADHD medications across age groups,” the researchers concluded.

—Christina Vogt

Reference:

Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis [Published online August 7, 2018]. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(18)30269-4.