Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder

• Published in: European child & adolescent psychiatry Vol. 26; no. 11; pp. 1283 - 1307
• Main Authors: Coghill, David R., Banaschewski, Tobias, Soutullo, César, Cottingham, Matthew G., Zuddas, Alessandro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2017; Springer Nature B.V
• Subjects: Adolescents; Adults; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention deficit hyperactivity disorder; Child; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Child, Preschool; Children; Clinical trials; Double-blind studies; Drugs; Efficacy; Functional impairment; Health status; Humans; Hyperactivity; Impulsive behavior; Impulsivity; Medical screening; Medicine; Medicine & Public Health; Pharmacology; Psychiatry; Quality of life; Quality of Life - psychology; Randomized Controlled Trials as Topic; Review; Self evaluation; Statistical analysis; Stimulants; Symptoms; Systematic review; Teenagers; Treatment Outcome; Systematic review; Functional impairment; Randomized clinical trials; Attention-deficit/hyperactivity disorder; Quality of life
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-017-0986-y

Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) experience functional impairment and poor health-related quality of life (HRQoL) in addition to symptoms of inattention/hyperactivity–impulsivity. To synthesize qualitatively the published evidence from randomized, double-blind, placebo-controlled trials of the effectiveness of pharmacotherapy on functional impairment or HRQoL in patients with ADHD, a systematic PubMed searching and screening strategy was designed to identify journal articles meeting pre-specified criteria. Post hoc analyses and meta-analyses were excluded. HRQoL outcomes, functional outcomes and the principal ADHD symptom-based outcome were extracted from included studies. An effect size of 0.5 versus placebo was used as a threshold for potential clinical relevance (unreported effect sizes were calculated when possible). Of 291 records screened, 35 articles describing 34 studies were included. HRQoL/functioning was usually self-rated in adults and proxy-rated in children/adolescents. Baseline data indicated substantial HRQoL deficits in children/adolescents. Placebo-adjusted effects of medication on ADHD symptoms, HRQoL and functioning, respectively, were statistically or nominally significant in 18/18, 10/12 and 7/9 studies in children/adolescents and 14/16, 9/11 and 9/10 studies in adults. Effect sizes were ≥0.5 versus placebo for symptoms, HRQoL and functioning, respectively, in 14/16, 7/9 and 4/8 studies in children/adolescents; and 6/12, 1/6 and 1/8 studies in adults. Effect sizes were typically larger for stimulants than for non-stimulants, for symptoms than for HRQoL/functioning, and for children/adolescents than for adults. The efficacy of ADHD medication extends beyond symptom control and may help reduce the related but distinct functional impairments and HRQoL deficits in patients with ADHD.