An evidence-based medicine approach to combined treatment for ADHD in children and adolescents

Psychiatrists need to update their skills to incorporate advances in psychiatric practice and to do so "at the bedside."To this end, evidence-based medicine (EBM), which is widely used as an educational heuristic in other areas medicine and has begun to make inroad in psychiatry training programs, provides practical methods to access, evaluate, and interpret the medical literature regarding disease causation, prognosis, diagnostic tests, and treatment strategies.With respect to treatment, EBM asserts the primacy of randomized, controlled trials for demonstrating efficacy, and, in some cases, the use of meta-analytic or systematic literature reviews conducted according to pre-specified criteria. Using the common clinical problem of when and how to combine drug and psychosocial interventions at the level of the individual patient, this article illustrates the principles of EBM as they pertain to how best to combine drug and psychosocial treatments for children and adolescents with ADHD.