{
  "abstract": "Abstract Objectives To assess the effects of and related evidence certainty of interventions for attention deficit/hyperactivity disorder (ADHD) across an individual’s lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making.Design Umbrella review and platform for shared decision making.Data sources Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary.Eligibility criteria for selecting studies Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)), acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite).Data synthesis Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions.Results 115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes ( https://ebiadhd-database.org/) was developed.Conclusions This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice.Trial registration Open Science Framework https://osf.io/ugqy6/.",
  "authors": [
    {
      "affiliations": [
        "Laboratoire DysCo, Université Paris Nanterre, 92000 Nanterre, France",
        "Department of Child and Adolescent Psychiatry, Institut Robert Debré du Cerveau de l’enfant Robert Debré Hospital, APHP, Paris, France",
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"
      ],
      "name": "Corentin J Gosling"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK",
        "School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Miguel Garcia-Argibay"
    },
    {
      "affiliations": [
        "Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Imaging of Mood and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain"
      ],
      "name": "Michele De Prisco"
    },
    {
      "affiliations": [
        "Mind-Brain Group, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain"
      ],
      "name": "Gonzalo Arrondo"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Institut Robert Debré du Cerveau de l’enfant Robert Debré Hospital, APHP, Paris, France",
        "Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France"
      ],
      "name": "Anaël Ayrolles"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Institut Robert Debré du Cerveau de l’enfant Robert Debré Hospital, APHP, Paris, France"
      ],
      "name": "Stéphanie Antoun"
    },
    {
      "affiliations": [
        "Université Paris 8, Laboratoire DysCo, Saint-Denis, France"
      ],
      "name": "Serge Caparos"
    },
    {
      "affiliations": [
        "Psychiatry Department, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Facultad de Medicina y Odontología, University of the Basque Country UPV/EHU, Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barakaldo, Bizkaia, Spain",
        "Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, UK"
      ],
      "name": "Ana Catalán"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Institut Robert Debré du Cerveau de l’enfant Robert Debré Hospital, APHP, Paris, France",
        "Université Paris-Cité, Paris, France",
        "3I Brain- Immune system Brain interactions in physiology, infections or inflammation, INSERM U1141 NeuroDiderot, Paris, France"
      ],
      "name": "Pierre Ellul"
    },
    {
      "affiliations": [
        "School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden"
      ],
      "name": "Maja Dobrosavljevic"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil"
      ],
      "name": "Luis C Farhat"
    },
    {
      "affiliations": [
        "Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain",
        "Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Spain"
      ],
      "name": "Giovanna Fico"
    },
    {
      "affiliations": [
        "School of Education and Psychology, University of Navarra, Pamplona, Spain"
      ],
      "name": "Luis Eudave"
    },
    {
      "affiliations": [
        "Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands",
        "Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands",
        "Accare Child Study Center, Groningen, Netherlands"
      ],
      "name": "Annabeth P Groenman"
    },
    {
      "affiliations": [
        "Unit of Mental Health Research, Southwest Denmark, Department of Regional Health Services, University of Southern Denmark, Odense, Denmark",
        "Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark",
        "Child and Adolescent Mental Health Centre, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark"
      ],
      "name": "Mikkel Højlund"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Pôle de Psychiatrie de l’Enfant et de l’Adolescent, Centre Hospitalier Le Vinatier, Bron, France"
      ],
      "name": "Lucie Jurek"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France"
      ],
      "name": "Mikail Nourredine"
    },
    {
      "affiliations": [
        "Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain",
        "Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Spain",
        "Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain"
      ],
      "name": "Vincenzo Oliva"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK",
        "Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK",
        "Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK",
        "School of Psychology, University of Southampton, Southampton, UK"
      ],
      "name": "Valeria Parlatini"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands",
        "Accare Child Study Center, Groningen, Netherlands"
      ],
      "name": "Constantina Psyllou"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK",
        "Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, London, UK",
        "Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain"
      ],
      "name": "Gonzalo Salazar-de-Pablo"
    },
    {
      "affiliations": [
        "Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK",
        "Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK"
      ],
      "name": "Anneka Tomlinson"
    },
    {
      "affiliations": [
        "Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK"
      ],
      "name": "Samuel J Westwood"
    },
    {
      "affiliations": [
        "Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK",
        "Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK",
        "NIHR Oxford Health Clinical Research Facility, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK"
      ],
      "name": "Andrea Cipriani"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany",
        "Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA",
        "Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA",
        "Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA",
        "German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany",
        "German Center for Child and Adolescent Health (DZKJ), partner site Berlin, Berlin, Germany"
      ],
      "name": "Christoph U Correll"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea"
      ],
      "name": "Dong Keon Yon"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Henrik Larsson"
    },
    {
      "affiliations": [
        "Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK",
        "Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK",
        "NIHR Oxford Health Clinical Research Facility, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK"
      ],
      "name": "Edoardo G Ostinelli"
    },
    {
      "affiliations": [
        "Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, South Korea",
        "Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea"
      ],
      "name": "Jae Il Shin"
    },
    {
      "affiliations": [
        "Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, UK",
        "Department of Brain and Behavioural Sciences, University of Pavia, Italy",
        "Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, UK",
        "Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany"
      ],
      "name": "Paolo Fusar-Poli"
    },
    {
      "affiliations": [
        "Departments of Medicine, of Epidemiology and Population Health, and of Biomedical Data Science, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA"
      ],
      "name": "John P A Ioannidis"
    },
    {
      "affiliations": [
        "Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Imaging of Mood and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain",
        "Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Spain",
        "Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK"
      ],
      "name": "Joaquim Radua"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany",
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Psychiatry Department, University of Ottawa, Ottawa, Ontario, Canada",
        "The Ottawa Hospital, Ottawa, Ontario, Canada"
      ],
      "name": "Marco Solmi"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry, Institut Robert Debré du Cerveau de l’enfant Robert Debré Hospital, APHP, Paris, France",
        "Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France",
        "Université Paris-Cité, Paris, France"
      ],
      "name": "Richard Delorme"
    },
    {
      "affiliations": [
        "Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK",
        "Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK",
        "Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK",
        "Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA",
        "DiMePRe-J Department of Precision and Regenerative Medicine, Jonic Area, University of Bari “Aldo Moro,” Bari, Italy"
      ],
      "name": "Samuele Cortese"
    }
  ],
  "title": "Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making",
  "uid": "a2316991-8420-5f65-8822-435d217fd779"
}