Pharmacological and non-pharmacological treatment of adults with ADHD: A meta-review
Open accessAbstract
Attention-deficit/hyperactivity disorder (ADHD) is characterised by a persistent and impairing pattern of inattention and/or hyperactivity/impulsivity and it is one of the most common neuropsychiatric conditions. Evidence about interventions of adults with ADHD is growing rapidly and clinicians need a reliable summary of all the best available information in order to better inform their daily practice. We searched MEDLINE, PubMed, PsycINFO and Cochrane databases until 31 May 2016 for systematic reviews about pharmacological and non-pharmacological treatments in adults with ADHD and carried out a meta-review to address clinically relevant questions. We identified a total of 40 papers. Psychostimulants-such as methylphenidate, dexamphetamine, mixed amphetamine salts and lisdexamfetamine-and non-psychostimulants-such as atomoxetine-were the most studied agents. Overall, pharmacological treatments were significantly more efficacious than placebo (standardised mean difference (SMD) 0.45, 95% CI 0.37 to 0.52), albeit less well accepted (OR 1.18, 95% CI 1.02 to 1.36) and tolerated (OR 2.29, 95% CI 1.97 to 2.66). The effects of pharmacological treatment for individuals with co-occurring ADHD and substance use disorder are still uncertain. The evidence for the efficacy and effectiveness of non-pharmacological treatments of ADHD in adults, as well as the combination of pharmacological and non-pharmacological strategies, is only preliminary. In conclusion, while available evidence addressed mainly the efficacy and tolerability of psychostimulants and non-psychostimulants for ADHD core symptoms in the short term, we still need further empirical support for the non-pharmacological and multimodal treatments. A comprehensive evidence-informed hierarchy of ADHD drugs based on their efficacy and tolerability is not yet available but it should be the next research priority in the field.
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Crescenzo et al. note modest improvements in adults with ADHD from omega-3 but emphasize the need for more rigorous trials.
“Crescenzo et al. [181] also note modest improvements in adults with ADHD but emphasize the need for more rigorous trials.”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [181]
The Results discuss improvements with medications and some psychological treatments, and the Abstract calls for further evidence on non-pharmacological treatments. Neither passage addresses omega-3 or trials of omega-3 in adults with ADHD; searches for omega, fish oil, and polyunsaturated fatty acids found no relevant passage. (LLM, conf=0.72)
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- Authors
- De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L.
- Affiliations
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
- Solent NHS Trust (GB)
- King's College London (GB)
- Università Cattolica del Sacro Cuore (IT)
- Venue
- Evidence Based Mental Health
- Publisher
- BMJ
- Published
- 2016-12-19
- Volume
- 20
- Issue
- 1
- Pages
- 4-11
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC10699262
- OpenAlex
- W2565831906
- Cited by
- 150
- References
- 56
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 11 · 2023: 20 · 2022: 22 · 2021: 20 · 2020: 21 · 2019: 8 · 2018: 9 · 2017: 5
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Evidence-Based Mental Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- ePrints Soton (University of Southampton) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Keywords
- adult ADHD, pharmacotherapy, non-pharmacological treatment, psychostimulants, methylphenidate, d-amphetamine, mixed amphetamine salts, lisdexamfetamine, atomoxetine, treatment efficacy, tolerability, substance use comorbidity, multimodal therapy
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Humans, Outcome Assessment, Health Care, Adrenergic Uptake Inhibitors
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