Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan.
Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
Eur Psychiatry. 2023 Feb 15;66(1):e24. doi: 10.1192/j.eurpsy.2023.11.
There was no previous meta-analysis investigating the efficacy/tolerability of psychostimulants for symptoms of attention-deficit hyperactivity disorder (ADHD) in preschool children.
Databases including PubMed, the Cochrane Library, EMBASE, ScienceDirect, and ClinicalTrials.gov were searched from inception to March 2022 for randomized controlled trials (RCTs) on therapeutic efficacy of psychostimulants against ADHD symptoms in preschool children (age ≤6 years) compared with placebos. Primary outcomes were (a) changes in ADHD symptoms evaluated by validated rating scales from parents'/teacher's observation, or (b) post-intervention improvements in neuropsychological performance. Secondary outcomes were risks of adverse events.
Meta-analysis of nine eligible trials including 544 preschool children (mean age=4.86 years, female=11.98%, median treatment duration=4.33 weeks) supported the efficacy of psychostimulants against global symptoms from observations of parents (Hedges' g=0.6152, p<0.0001) and teachers (Hedges' g=0.6563, p=0.0039). Efficacy of psychostimulants was also noted against symptoms of inattention and hyperactivity/impulsivity, especially the latter (i.e., main symptoms in preschool children). Moreover, male gender, older age, and longer treatment duration were associated with better efficacy. Regarding adverse events, only the risk of poor appetite was higher in the psychostimulant group (odds ratio [OR]=2.39). However, the qualities of evidence were low to very low, indicating potential discrepancy between the true and estimated effect.
Our results showed that psychostimulants might be beneficial for preschool children with ADHD, especially hyperactivity/impulsivity from teachers' observation, with tolerable side effects. Nevertheless, the true magnitude of the effect needs to be confirmed with more research due to low to very low certainty of the evidence.
之前没有荟萃分析研究过精神兴奋剂治疗学龄前儿童注意缺陷多动障碍（ADHD）症状的疗效/耐受性。
从建库到 2022 年 3 月，我们检索了 PubMed、Cochrane 图书馆、EMBASE、ScienceDirect 和 ClinicalTrials.gov 等数据库，以寻找关于精神兴奋剂治疗学龄前儿童（年龄≤6 岁）ADHD 症状与安慰剂相比的疗效的随机对照试验（RCT）。主要结局是（a）通过父母/教师观察评估的 ADHD 症状变化，或（b）干预后神经心理表现的改善。次要结局是不良事件的风险。
对 9 项符合条件的试验（包括 544 名学龄前儿童，平均年龄=4.86 岁，女性=11.98%，中位治疗时间=4.33 周）进行荟萃分析支持了精神兴奋剂对父母观察到的整体症状的疗效（Hedges' g=0.6152，p<0.0001）和教师（Hedges' g=0.6563，p=0.0039）。精神兴奋剂对注意力不集中和多动/冲动症状也有效，尤其是后者（即学龄前儿童的主要症状）。此外，男性、年龄较大和治疗时间较长与疗效更好相关。关于不良事件，只有精神兴奋剂组的食欲不振风险更高（比值比[OR]=2.39）。然而，证据质量为低至极低，表明真实效应和估计效应之间可能存在差异。
我们的结果表明，精神兴奋剂可能对患有 ADHD 的学龄前儿童有益，尤其是教师观察到的多动/冲动，副作用可耐受。然而，由于证据的确定性为低至极低，需要更多的研究来证实真实效应的大小。
