Systematic Review of National and International Guidelines on ADHD

Abstract

Introduction:

ADHD is a well-established neurodevelopmental disorder affecting a significant population across the lifespan. Driven by the need to provide adequate clinical care, several national and international medical societies have published guidelines on ADHD. Our objectives were to compare the recommendations set out by these guidelines and their methodological quality.

Methods:

To meet the inclusion criteria the guidelines had to be published by national or international medical societies or governmental bodies and focus on diagnosis or management of ADHD. To assess their methodological quality we used the Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.

Results:

We identified 13 guidelines on diagnosis and/or management of ADHD meeting our inclusion criteria. They represented the recommendations from 9 different bodies from 4 different countries and 1 European group. All guidelines made recommendations on both diagnosis and treatment. Seven made recommendations concerning children and adolescents, four are about ADHD in adulthood and two made brief comments on specific aspects of treatment in adulthood. All groups have used DSM-IV criteria but differed on their assessment recommendations to varying degrees. All of them recommended stimulants as the core of pharmacological treatment. Only one (NICE 2008) recommends specifically methylphenidate as the first-line treatment.

Discussion:

Most of the diagnostic and treatment recommendations are consistent across the guidelines with few but important exceptions. This may reflect differences of service provision and target audiences. Convergent recommendation of psychostimulant treatment and differences with respect to psychosocial interventions reflect the strength (and weakness) of underlying evidence.