Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis
Luisa S Sugaya1,2, Luis C Farhat1,2, Pietro Califano1
1Department of Psychiatry Faculdade de Medicina FMUSP Universidade de São Paulo São Paulo Brazil.
Insights
Stimulants effectively reduce attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers. This systematic review supports considering stimulant medication for treating ADHD in young children.
Area of Science:
- Pediatric Neurology
- Psychopharmacology
- Evidence-Based Medicine
Background:
- Limited robust evidence exists for treating preschoolers with attention-deficit/hyperactivity disorder (ADHD).
- Systematic reviews are crucial for synthesizing evidence to guide treatment recommendations for this population.
Purpose of the Study:
- To evaluate the efficacy and acceptability of stimulant medications for preschoolers diagnosed with ADHD.
- To provide an evidence-based summary for clinicians regarding stimulant use in young children with ADHD.
Main Methods:
- Systematic review and meta-analysis of double-blinded randomized controlled trials (RCTs).
- Searched major electronic databases and clinical trial registries up to March/July 2022.
- Assessed ADHD symptom severity (efficacy) and all-cause dropout rates (acceptability) using random-effects models.
Main Results:
- Five RCTs involving 489 participants were included.
- Stimulants significantly reduced ADHD symptom severity compared to placebo (SMD = -0.59, p < 0.0001).
- No significant difference in acceptability (all-cause discontinuation) was found between stimulants and placebo.
Conclusions:
- Stimulant medications are efficacious in reducing ADHD symptoms in preschool-aged children.
- Clinicians should consider stimulants as a treatment option for preschoolers with ADHD.
- Moderate confidence in efficacy evidence, but low confidence in acceptability estimates warrants further research.
Background:
Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD.
Methods:
We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597).
Results:
Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; p < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; p = 0.45) but the confidence of estimate was very low.
Conclusions:
Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.
More Related Videos
05:48The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients
Published on: June 12, 2020
13:09Using Brain Activation nir-HEG/Q-EEG and Execution Measures CPTs in a ADHD Assessment Protocol
Published on: April 1, 2018
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
01:29Stimulants
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
01:25Adrenergic Agonists: Indirect-Acting Agents
One mechanism involves depleting stored catecholamines by displacing them from synaptic vesicles. These agents, known as "displacers," are transported into vesicles at the expense of noradrenaline. Examples include amphetamine and tyramine, which lack a catechol moiety, resulting in prolonged action, improved oral...