Recommendations for research
The guideline committee has made the following recommendations for research.
1 Children and young people aged 5 to 18 years – brief, group-based, ADHD-focused, parent-training intervention
What is the clinical and cost effectiveness, and optimum length, of a brief parent-training intervention for parents and carers of children and young people with attention deficit hyperactivity disorder (ADHD) aged 5 to 18 years?
There was no clear evidence identified about the benefit of formal parent-training programmes for ADHD symptoms in children and young people aged 5 to 18 years. The cost effectiveness of these programmes was unclear, partly because of uncertainty over the number of sessions and the length of programme needed to achieve clinical benefit. This research recommendation would help address these uncertainties.
What is the clinical and cost effectiveness of ADHD medications in people with ADHD and tic disorders, a history of psychosis or mania, or personality disorder?
No evidence was identified to justify different medication choices in people with ADHD and tic disorders, a history of psychosis or mania, or emotional dysregulation. These groups are often excluded from trials. There are reasons (for example, mechanism of action of medication options, previous reports of adverse effects) to suspect that these groups may respond differently to different drugs, but a lack of trials to confirm this. Primarily there are some concerns that stimulant medication may worsen the symptoms of any of these coexisting conditions and therefore non-stimulant medication should be preferred.
What is the clinical and cost effectiveness of ADHD medications in people with ADHD with no previous medication for the condition?
Most of the evidence to support the recommendations for medication choices for people with ADHD comes from studies in people who have previously received medication. Therefore, these studies often include a population not representative of the people with newly diagnosed ADHD. There may be differing levels of efficacy of the various treatment options in people who have received no previous medication for ADHD.
What is the clinical and cost effectiveness of various ADHD prescribing strategies when monotherapy has failed?
This guideline makes recommendations for the medication choices for people with ADHD up to the point at which common monotherapies are exhausted. There is very little evidence to guide healthcare professionals beyond this point, particularly with regard to whether there is a benefit of prescribing stimulant and non-stimulant medication together.