Future research needs for attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment
This Future Research Needs (FRN) report is based on a draft Agency for Healthcare Research and Quality Comparative Effectiveness Review, Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment. The Key Questions (KQs) were:
KQ 1: Among children less than 6 years of age with attention deficit hyperactivity disorder or disruptive behavior disorder, what are the effectiveness and adverse event outcomes following treatment?
KQ 2: Among people age 6 years or older with attention deficit hyperactivity disorder, what are the effectiveness and adverse event outcomes following 12 months or more of any combination of followup or treatment, including, but not limited to, 12 months or more of continuous treatment?
KQ 3: How do (a) underlying prevalence of ADHD, and (b) rates of diagnosis (clinical identification) and treatment for ADHD vary by geography, time period, provider type, and sociodemographic characteristics?
Findings in the draft review for KQ 1 supported the use of parent behavior training in preschoolers both for oppositional behaviors and for attention deficit hyperactivity disorder (ADHD) symptoms, with no adverse events reported. For preschoolers, psychostimulant medications are also generally safe and efficacious for improving behavior and can provide benefits in addition to parent training. However, adverse events, especially irritability and moodiness, can lead to discontinuation, and use for several months to a year slightly affects growth rate.
For KQ 2, long-term effectiveness and safety studies of several psychostimulants in children older than 6 years old and adolescents found they are efficacious for control of inattention and overactivity for extended periods of time. Few serious adverse events were noted. Publications
from the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA) study provide the best data for long-term outcomes. By 3 years, no single intervention group showed superior benefit, which is likely because of individuals obtaining a complex range
of interventions in the community.