Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eur Psychiatry. 2023 Nov 17;66(1):e90. doi: 10.1192/j.eurpsy.2023.2451.
BACKGROUND: There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS: We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS: The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS: Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
背景:目前已有数百篇关于注意力缺陷多动障碍(ADHD)的系统评价,质量参差不齐。为了帮助人们了解这些文献,我们对 ADHD 的任何主题进行了系统评价综述。
方法:我们检索了 MEDLINE、PubMed、PsycINFO、Cochrane 图书馆和 Web of Science,并根据循证医学 Joanna Briggs 研究所手册进行了质量评估。共有 231 篇系统评价和荟萃分析符合入选标准。
结果:儿童和青少年 ADHD 的患病率为 7.2%,成年人 ADHD 的患病率为 2.5%,但由于现有文献方法学的差异,存在较大的不确定性。ADHD 存在生物和社会风险因素的证据,但由于混杂和反向因果关系,这些证据主要是相关性的,而不是因果关系的。短期药物治疗在减轻症状方面有强有力的证据,特别是兴奋剂。然而,药物治疗在减轻教育程度、就业、药物滥用、伤害、自杀、犯罪和合并的精神和躯体疾病等不良生活轨迹方面的疗效证据有限。药物治疗与睡眠障碍、食欲减退和血压升高有关,但长期使用后潜在的不良反应知之甚少。非药物治疗的疗效证据混杂不一。
结论:尽管有数百篇关于 ADHD 的系统评价,但仍有一些关键问题没有答案。ADHD 的更准确患病率、已记录的风险因素是否具有因果关系、非药物治疗对任何结果的疗效以及药物治疗对减轻 ADHD 相关不良结局的疗效等方面仍存在证据空白。
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