{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:36:56Z","timestamp":1792604216953,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2025,10,3]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n To assess the effects of and related evidence certainty of interventions for attention deficit\/hyperactivity disorder (ADHD) across an individual\u2019s lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Umbrella review and platform for shared decision making.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary.<\/jats:p>\n <\/jats:sec>\n \n Eligibility criteria for selecting studies<\/jats:title>\n \n Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)),\n \n acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite).\n <\/jats:p>\n <\/jats:sec>\n \n Data synthesis<\/jats:title>\n Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes (\n https:\/\/ebiadhd-database.org\/<\/jats:ext-link>\n ) was developed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n Open Science Framework\n https:\/\/osf.io\/ugqy6\/<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmj-2025-085875","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T01:35:18Z","timestamp":1764207318000},"page":"e085875","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making"],"prefix":"10.1136","volume":"391","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-9344","authenticated-orcid":false,"given":"Corentin J","family":"Gosling","sequence":"first","affiliation":[{"name":"Laboratoire DysCo, Universit\u00e9 Paris Nanterre, 92000 Nanterre, France"},{"name":"Department of Child and Adolescent Psychiatry, Institut Robert Debr\u00e9 du Cerveau de l\u2019enfant Robert Debr\u00e9 Hospital, APHP, Paris, France"},{"name":"Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Garcia-Argibay","sequence":"additional","affiliation":[{"name":"Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"},{"name":"Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK"},{"name":"School of Medical Sciences, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden"},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"De Prisco","sequence":"additional","affiliation":[{"name":"Bipolar and Depressive Disorders Unit, Hospital Cl\u00ednic de Barcelona, Imaging of Mood and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Arrondo","sequence":"additional","affiliation":[{"name":"Mind-Brain Group, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana\u00ebl","family":"Ayrolles","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Institut Robert Debr\u00e9 du Cerveau de l\u2019enfant Robert Debr\u00e9 Hospital, APHP, Paris, France"},{"name":"Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Antoun","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Institut Robert Debr\u00e9 du Cerveau de l\u2019enfant Robert Debr\u00e9 Hospital, APHP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge","family":"Caparos","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris 8, Laboratoire DysCo, Saint-Denis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Catal\u00e1n","sequence":"additional","affiliation":[{"name":"Psychiatry Department, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Facultad de Medicina y Odontolog\u00eda, University of the Basque Country UPV\/EHU, Centro de Investigaci\u00f3n en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barakaldo, Bizkaia, Spain"},{"name":"Early Psychosis: 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EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"},{"name":"Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Fico","sequence":"additional","affiliation":[{"name":"Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain"},{"name":"Departament de Medicina, Institut de Neuroci\u00e8ncies (UBNeuro), Universitat de Barcelona (UB), Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Eudave","sequence":"additional","affiliation":[{"name":"School of Education and Psychology, University of Navarra, Pamplona, 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Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Jurek","sequence":"additional","affiliation":[{"name":"Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"},{"name":"P\u00f4le de Psychiatrie de l\u2019Enfant et de l\u2019Adolescent, Centre Hospitalier Le Vinatier, Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikail","family":"Nourredine","sequence":"additional","affiliation":[{"name":"Developmental EPI (Evidence synthesis, Prediction, Implementation) Laboratory, Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK"},{"name":"Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, 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