Skip to Main Content
Skip Nav Destination

What Works Best for ADHD Diagnosis and Treatment?

March 29, 2024

I’m sure that I’m not the only pediatrician who sees a lot of patients who are being evaluated or are receiving treatment for attention deficit-hyperactivity disorder (ADHD)—after all, approximately 10% of US children carry this diagnosis. While we use a validated screening questionnaire, and while I consider myself to be familiar with the different medication options, I always wonder if there are diagnosis or treatment options that might improve the care that we provide to these patients and their families. Or is there one strategy that is clearly superior to the rest?

I was thus interested in 2 companion articles by Dr. Bradley Peterson and colleagues at the University of Southern California that are being early released this week in Pediatrics: “Tools for the Diagnosis of ADHD in Children and Adolescents: A Systematic Review” (10.1542/peds.2024-065854) and “Treatments for ADHD in Children and Adolescents: A Systematic Review” (10.1542/peds.2024-065787).

While I will summarize the results broadly, there is much too much information to convey in a single blog, and I would encourage you to read both of these articles to extract the information that you need for your own practice.

In the first article about diagnosis, the authors reviewed the existing literature and included 291 articles in their review. They included the following categories of diagnostic tools:

  • Parent Ratings, such as the Child Behavior Checklist
  • Teaching Rating, such as the Conners teacher rating scale
  • Youth Self-reports
  • Combined Rating Scales
  • Other Clinical Tools, such as interview guides
  • Neuropsychological Tests—for example, continuous performance tests (CPTs)
  • Biospecimens—use of blood or urine biomarkers (e.g., erythropoietin receptors, micro RNA levels) to diagnose ADHD
  • EEG (electroencephalogram)
  • Neuroimaging—usually magnetic resonance imaging (MRI)

The authors then compared diagnostic tools with a gold standard of diagnosis by a mental health specialist. The bottom line for diagnostic tools is that there was no winner—none of the tools was rated consistently as “good.” It did seem that use of multiple sources of information did improve the reliability of diagnosis, so the authors suggest that “the judgment of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves” is important in making a correct diagnosis.

The second systematic review about ADHD treatments included data from 540 articles about the following treatment modalities:

  • Medications—stimulants (methylphenidate, amphetamines, modafinil), non-stimulants (norepinephrine reuptake inhibitors, alpha-agonists)
  • Youth-directed psychosocial treatments, either alone or combined with interventions for parents or teachers
  • Parent support
  • School interventions
  • Cognitive training
  • Neurofeedback
  • Nutrition and supplements
  • Complementary, alternative, or integrative medicine—including acupuncture, homeopathy, and hippotherapy
  • Combined medication and behavioral treatments

The authors found the strongest evidence for medications, with the largest effect for amphetamines. There were small positive effects for youth-directed psychosocial treatment, parent support, neurofeedback, and nutrition/supplements. In general, cognitive training and school interventions were not helpful.

So should we just start everyone on medications? The caveat to this is that medications were associated with more side effects than any of the other treatment modalities.

Again, there is a lot of information in these 2 systematic reviews that I did not include in this blog. I encourage you to pay attention to both of these articles.

Close Modal

or Create an Account

Close Modal
Close Modal