Effect of Treatment Modality on Long-Term Outcomes in Attention-Deficit/Hyperactivity Disorder: A Systematic Review
Open accessAbstract
BACKGROUND: Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood. METHODS: A systematic search of 12 literature databases using Cochrane's guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment. RESULTS: The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%-75%) or treatment duration (62%-72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length. CONCLUSIONS: While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.
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It remains unknown whether there are sex differences in response to ADHD treatment.
“Furthermore, it remains unknown if there are sex differences in response to treatment [21].”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [21]
The Results section (‘Influence of participant sex on treatment outcomes’; page unavailable) says general sex comparisons are difficult because the evidence is limited. But it also reports that one of four studies directly comparing sexes found a difference in treatment benefit for drug abuse/addictive behavior. Thus, sex differences remain unclear overall, but are not wholly unknown. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMulti-modal treatment has been shown to improve treatment effects in ADHD.
“While psychostimulants are the mainstay of ADHD treatment, multi-modal treatment has been shown to improve treatment effects [21,22].”
From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [21]
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- Authors
- Arnold, L. E., Hodgkins, P., Caci, H., Kahle, J., & Young, S.
- Affiliations
- The Ohio State University (US)
- Centre for Mental Health (GB)
- Corresponding author
- Kahle, Jennifer
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-02-25
- Volume
- 10
- Issue
- 2
- Pages
- e0116407
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4340791
- OpenAlex
- W1985613497
- Cited by
- 111
- References
- 50
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 15 · 2020: 8 · 2019: 10 · 2018: 12 · 2017: 6 · 2016: 10 · 2015: 6
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Eli Lilly and Company
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, long-term outcomes, combination therapy, pharmacotherapy, non-pharmacological treatment, treatment duration, functional outcome, educational outcomes, self-esteem, social function
- MeSH terms
- Adolescent, Age Factors, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Sex Factors, Treatment Outcome, Young Adult
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