A massive ADHD study reveals what actually works

The research team, led by scientists from the Université Paris Nanterre (France), Institut Robert-Debré du Cerveau de l'Enfant (France), and the University of Southampton (UK), examined more than 200 meta-analyses. Their work assessed a wide range of treatments, patient populations, and clinical outcomes and was published in The BMJ.

The study was supported by public, peer-reviewed research funding from Agence Nationale de la Recherche (France), France 2030 program (France), and the National Institute for Health and Care Research (UK).

New Interactive Tool Aims to Support Shared Decisions

To help people with attention deficit hyperactivity disorder (ADHD) and their healthcare providers better understand treatment options, the researchers developed an interactive public website. The platform clearly explains how well each intervention is supported by evidence, based directly on the findings of the review (ebiadhd-database.org).

"We know that people with ADHD and their families are often overwhelmed by conflicting messages about which treatments work," says Professor Samuele Cortese, an NIHR Research Professor at the University of Southampton and senior lead author of the study.

"We believe this study and the accompanying website provide the most authoritative, evidence-based, and accessible guidance currently available.

"The Evidence-Based Interventions for ADHD website provides freely available, evidence-based, and continuously updated information in an easy-to-understand way. To the best of our knowledge, this is the first platform in the world to do so based on such a rigorous synthesis of the available evidence."

What the Evidence Shows and What It Does Not

The analysis found strong support for five medications used in children and adolescents. In adults, two medications along with cognitive behavioural therapy (CBT) demonstrated effectiveness with relatively solid evidence. However, all of these findings were limited to short-term outcomes, even though many people receive treatment over much longer periods.

Other interventions, including acupuncture, mindfulness, and exercise, showed signs of potential benefit. Still, the studies supporting these approaches were generally low in quality, often involving small participant groups and a higher risk of bias. Similar limitations affected research on cognitive behavioral therapy in children and adolescents, as well as studies examining the long-term effects of mindfulness in adults. Mindfulness stood out as the only intervention to show large benefits at extended follow-up, although the evidence base remained limited.

Why Accurate Information Matters for Patients

Dr. Corentin Gosling, Associate Professor at Paris Nanterre University and the study's first lead author, emphasizes the real-world consequences of unclear or misleading information.

"Long waiting lists for mental health services are a major issue. Having incorrect information about treatments can make people's journeys even more difficult, by wasting time and money on non-evidence-based approaches, for example.

"By contrast, taking the time to review all treatment options within a shared decision-making process using the web app we developed (ebiadhd-database.org) can empower people with ADHD, leading to better treatment adherence, improved outcomes, and an overall better patient experience."

Implications for Clinical Guidelines and Practice

Overall, the findings align closely with existing international clinical guidelines. In addition to confirming current recommendations, the review offers easy access to high-quality evidence and evaluates treatments that are often not included in official guidelines.

The researchers hope this new initiative will influence clinical practice and policy in a way similar to their earlier project (ebiact-database.com), which focused on evidence-based treatments for autism.

"Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making" was published in The BMJ and is available online.