The treatment of attention-deficit hyperactivity disorder: an annotated bibliography and critical appraisal of published systematic reviews and metaanalyses.
BACKGROUND
The Agency for Health Care Policy and Research charged the McMaster Evidence-based Practice Center with conducting a comprehensive systematic review of the literature on the treatment of attention-deficit hyperactivity disorder (ADHD), with input from various groups of stakeholders. One strategy used to avoid duplication of work included a critical appraisal of existing systematic reviews and metaanalyses.


OBJECTIVE
To identify and appraise published metaanalyses and systematic reviews on the treatment of ADHD and to produce an annotated bibliography.


METHODS
Medline, Cumulative Index in Nursing and Allied Health (CINAHL), Healthstar, Psycinfo, and Embase were searched to September 1998; the Cochrane Database (1998 issue 3), selected Internet sites, and the files of investigators were also reviewed.


METHODS
Review articles described as systematic reviews or metaanalyses or including a Methods section were identified independently by 3 reviewers.


METHODS
Two reviewers extracted, by consensus, relevant information on the name, methodological quality, ADHD-related aspects (comorbid disorders, family characteristics) of those reviews; data on the population, study setting, interventions, and outcomes evaluated by the reviews were also retrieved.


RESULTS
Thirteen reviews, published from 1982 to 1998, were included. Eight included metaanalysis and 5 a qualitative review. Nonpharmacological treatments were mentioned in 6 reviews and combination therapies in 3. One review focused on the treatment of adults. Forty-seven drugs and 20 adverse effects were mentioned. Most reviews had major methodological flaws.


CONCLUSIONS
Most published systematic reviews and metaanalyses on the treatment of ADHD have limited value for guiding clinical, policy, and research decisions. A rigorous, systematic review following established methodological criteria is warranted.
Jadad
A R
AR
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario. jadada@fhs.mcmaster.ca
Booker
L
L
Gauld
M
M
Kakuma
R
R
Boyle
M
M
Cunningham
C E
CE
Kim
M
M
Schachar
R
R
D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D006801:Humans; D015201:Meta-Analysis as Topic