Article type
Year
Abstract
Background: attention deficit hyperactivity disorder (ADHD) is characterized by the persistence of inattention, hyperactivity, and impulsivity. These symptoms usually impair academic achievement and can motivate the start of ADHD medication. Methylphenidate is the drug most commonly prescribed; however, systematic reviews of randomized clinical trials suggest that it does not lead to relevant improvements in academic performance. As academic achievement is a complex outcome, it is relevant to investigate it in non-controlled studies that can demonstrate the impact of medication use in the real world.
Objectives: to assess the 'real world' effectiveness of methylphenidate for improving academic performance in students with ADHD.
Methods: we conducted a systematic review of observational studies (Protocol registration: PROSPERO CRD42016038140). We performed electronic searches in MEDLINE, Embase, LILACS, PsycInfo, and ERIC to obtain the studies. We also conducted handsearches and searches in grey literature databases. Studies evaluating treatment with methylphenidate compared to no treatment or other pharmacological/nonpharmacological alternatives used in ADHD were eligible. Adapted versions of the Newcastle-Ottawa Scale were used to assess the risk of bias of the included studies.
Results: eight studies (in nine reports) were included in the review: three cohort, two before-and-after, and three cross-sectional studies. They involved 11,268 children and adolescents aged 6 to 18 years. The doses of methylphenidate ranged from 10 mg/day to 72 mg/day, and the duration of the treatment was from 2.6 months to 4.25 years. In five of the eight studies, the authors concluded that methylphenidate improves academic performance. However, two of the three studies at the lowest risk of bias concluded that the drug is ineffective. Four studies assessed the long-term use of methylphenidate, and three concluded that it does not lead to better outcomes in school. The studies have considerable limitations and great heterogeneity regarding methodological design and academic performance measurement criteria.
Conclusion: despite evidence from observational studies indicating that short-term use of methylphenidate may improve outcomes in the school environment, the available scientific literature does not support firm conclusions about the real benefits of methylphenidate in students with ADHD.
Patient or healthcare consumer involvement: the global consumption of methylphenidate has been increasing since the 1990s. Among the possible explanations for this increase are the rising number of ADHD diagnoses; the increased use among adults; misdiagnoses and inappropriate prescriptions; intense marketing of the drug, and its utilization for recreational purposes. In this context, it is extremely important to analyse the evidences about the effectiveness and safety of methylphenidate.
Objectives: to assess the 'real world' effectiveness of methylphenidate for improving academic performance in students with ADHD.
Methods: we conducted a systematic review of observational studies (Protocol registration: PROSPERO CRD42016038140). We performed electronic searches in MEDLINE, Embase, LILACS, PsycInfo, and ERIC to obtain the studies. We also conducted handsearches and searches in grey literature databases. Studies evaluating treatment with methylphenidate compared to no treatment or other pharmacological/nonpharmacological alternatives used in ADHD were eligible. Adapted versions of the Newcastle-Ottawa Scale were used to assess the risk of bias of the included studies.
Results: eight studies (in nine reports) were included in the review: three cohort, two before-and-after, and three cross-sectional studies. They involved 11,268 children and adolescents aged 6 to 18 years. The doses of methylphenidate ranged from 10 mg/day to 72 mg/day, and the duration of the treatment was from 2.6 months to 4.25 years. In five of the eight studies, the authors concluded that methylphenidate improves academic performance. However, two of the three studies at the lowest risk of bias concluded that the drug is ineffective. Four studies assessed the long-term use of methylphenidate, and three concluded that it does not lead to better outcomes in school. The studies have considerable limitations and great heterogeneity regarding methodological design and academic performance measurement criteria.
Conclusion: despite evidence from observational studies indicating that short-term use of methylphenidate may improve outcomes in the school environment, the available scientific literature does not support firm conclusions about the real benefits of methylphenidate in students with ADHD.
Patient or healthcare consumer involvement: the global consumption of methylphenidate has been increasing since the 1990s. Among the possible explanations for this increase are the rising number of ADHD diagnoses; the increased use among adults; misdiagnoses and inappropriate prescriptions; intense marketing of the drug, and its utilization for recreational purposes. In this context, it is extremely important to analyse the evidences about the effectiveness and safety of methylphenidate.
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