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. 2025 Jan;66(1):132-149.
doi: 10.1111/jcpp.14056. Epub 2024 Oct 6.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature

Margaret H Sibley  1   2 , Sabrina Flores  2 , Madeline Murphy  2 , Hana Basu  2 , Mark A Stein  1 , Steven W Evans  3 , Xin Zhao  1   2 , Maychelle Manzano  2 , Shauntal van Dreel  2
Affiliations

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature

Margaret H Sibley et al. J Child Psychol Psychiatry. 2025 Jan.

Abstract

Background: Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered.

Method: We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots.

Results: Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment.

Conclusions: The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Keywords: ADHD; adolescence; treatment trials.

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References

    1. AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention‐deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 894–921.
    1. Agency for Healthcare Research and Quality (AHRQ). (2014). Methods guide for effectiveness and comparative effectiveness reviews. Effective Health Care Program, Rockville, MD. https://effectivehealthcare.ahrq.gov/products/collections/cer‐methods‐guide
    1. Almeida Montes, L.G., Prado Alcántara, H., Martínez García, R.B., De La Torre, L.B., Avila Acosta, D., & Duarte, M.G. (2013). Brain cortical thickness in ADHD: Age, sex, and clinical correlations. Journal of Attention Disorders, 17, 641–654.
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    1. American Psychiatric Association (APA). (2022). Diagnostic and statistical manual of mental disorders (5th edn, text rev.). Washington, DC: American Psychiatric Association.

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