ADHD – diagnostics and treatment, organization of the health care and patient involvement

This document was published more than 2 years ago. The nature of the evidence may have changed.

Conclusions

  • Current data suggests that the diagnosis, treatment and monitoring of ADHD should continue to be handled by specialists. Studies are needed to determine how health care and society’s efforts should be organised and
    coordinated to best help those with ADHD. The diagnostic instruments used to diagnose ADHD also need to be better studied. It is also important that drug treatment is monitored in order to control the effects and side effects, and to minimise the risk of the drugs being distributed outside the patient group. Taken together, this indicates that diagnosis, treatment, and monitoring of ADHD should remain within specialist care.
  • Many different non-pharmacological interventions and treatments are currently in use, but our understanding of their benefits, risks, and costs need improvement. Of the 30 different non-pharmacological methods for treating ADHD identified in this report, we were unable to find sufficient scientific evidence to assess the efficacy of any. Cognitive behavioural therapy may be effective when provided as an adjuvant therapy to adults with ADHD who have persistent symptoms despite drug treatment. However, even this must be confirmed by independent studies.
  • Both methylphenidate and atomoxetine relieve ADHD symptoms during short-term treatment (3 weeks to 6 months) of children and adults with ADHD (Moderately strong scientific evidence). Due to a lackof studies assessing long term effects, it was not possible to assess the effects of prolonged treatment (>6 months). The same applies to assessing whether the risk of substance abuse in adulthood is effected in individuals who have been treated with central nervous system stimulants as a child. There was also insufficient evidence to determine the efficacy of drug treatments for individuals with any form of addiction.
  • Common side effects during short-term treatment with atomoxetine that have been documented in clinical trials include nausea and loss of appetite. For children, weight loss and pulse rate increase are also common sideeffects. For adults, dry mouth and erectile dysfunction are common side effects. The primary side effect of methylphenidate is loss of appetite. Abdominal pain is a typical side effect for children. Common side effects for adults in clude loss of appetite, nausea, dry mouth, sleep disorders, headaches, and weight loss (Limited scientific evidence).
  • Schools and health care providers should work to empower individuals with ADHD and their families, as well as help them develop better social support. Although there is no available research indicating how this can be best achieved, we know that the families of children with ADHD as well as adults with ADHD feel alienated and largely lack sufficient social support. It was also documented that the parents of children with ADHD feel dependent on healthcare providers, while having misgivings about treatment options, and feeling frustrated over poor service and lack of influence over their situation.
  • Both parents and school staff feel they are insufficiently informed about ADHD, which could affect their attitudes and limit their ability to influence the situation in a meaningful way. Medicating children with ADHD leads to mixed feelings of both relief and doubts among parents. Both adults with ADHD and parents of children with ADHD feel that medication alone is not sufficient, even if the medication is effective. 

How to cite this report: SBU. ADHD – diagnostics and treatment, organization of the health care and patient involvement. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2013. SBU report no 217 (in Swedish).

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SBU Assessment presents a comprehensive, systematic assessment of available scientific evidence. The certainty of the evidence for each finding is systematically reviewed and graded. Full assessments include economic, social, and ethical impact analyses.

SBU assessments are performed by a team of leading professional practitioners and academics, patient/user representatives and SBU staff. Prior to approval and publication, assessments are reviewed by independent experts, SBU’s Scientific Advisory Committees and Board of Directors.

Published: 6/11/2013
Contact SBU: registrator@sbu.se
Report no: 217
http://www.sbu.se/adhd_2013e