Table 36Study information and evidence summary table for trials of stimulant medication versus psychological interventions

Stimulant medication versus psychological intervention
Total number of studies (number of participants)6 (462)
Study IDBROWN1985
FIRESTONE1981
FIRESTONE1986
GITTELMAN-KLEIN1976
KLEIN1997
MTA1999
Age5–12 years
Benefits (end of treatment)
Core ADHD symptoms at end of treatment (teacher-rated)SMD −0.72 (−1.12 to −0.32)
Quality: High
K = 5, N = 392
Core ADHD symptoms at end of treatment (parent-rated)SMD −0.45 (−0.66 to −0.23)
Quality: High
K = 4, N = 350
Conduct at end of treatment (teacher-rated)SMD −0.48 (−0.70 to −0.25)
Quality: High
K = 3, N = 321
Conduct at end of treatment (parent-rated)SMD −0.22 (−0.43 to −0.01)
Quality: High
K = 3, N = 355
Social skills at end of treatment (teacher-rated)SMD −0.33 (−0.57 to −0.08)
Quality: High
K = 2, N = 258
Social skills at end of treatment (parent-rated)SMD −0.08 (−0.33 to 0.17)
Quality: High
K = 1, N = 151
Emotional outcomes at end of treatment (teacher-rated)SMD 0.14 (−0.10 to 0.39)
Quality: High
K = 2, N = 158
Emotional outcomes end of treatment (parent-rated)SMD −0.23 (−0.45 to −0.01)
Quality: High
K = 3, N = 331
Benefits (3–6 months post treatment)
Core ADHD symptoms at 3 months post-treatment (teacher-rated)SMD −0.20 (−1.08 to 0.68)
Quality: Moderate
K = 1, N = 20
Core ADHD symptoms at 3 months post-treatment (parent-rated)SMD −0.82 (−1.74 to 0.11)
Quality: Moderate
K = 1, N = 20
Benefits (7–12 months post-treatment)
Core ADHD symptoms at 7–9 months post-treatment (teacher-rated)SMD −0.53 (−1.23 to 0.17)
Quality: Moderate
K = 1, N = 35
Core ADHD symptoms at 10 months post-treatment (parent- and teacher-rated composite score)SMD −0.25 (−0.49 to −0.01)
Quality: High
K = 1, N = 267
Conduct at 7–9 months post- treatment (parent-rated)SMD −0.32 (−1.02 to 0.38)
Quality: Moderate
K = 1, N = 34
Conduct at 10 months post- treatment (parent- and teacher-rated composite score)SMD −0.10 (−0.34 to 0.14)
Quality: High
K = 1, N = 267
Social skills at 10 months post- treatment (parent- and teacher-rated composite score)SMD −0.07 (−0.31 to 0.17)
Quality: High
K = 1, N = 267
Benefits (13–24 months post-treatment)
Core ADHD symptoms at 19–21 months post-treatment (teacher-rated)SMD 0.00 (−0.88 to 0.88)
Quality: Moderate
K = 1, N = 20
Core ADHD symptoms at 19–21 months post-treatment (parent-rated)SMD 0.58 (−0.32 to 1.48)
Quality: Moderate
K = 1, N = 20
Core ADHD symptoms at 13–24 months post-treatment (parent- and teacher-rated composite score)SMD −0.06 (−0.21 to 0.09)
Quality: High
K = 1, N = 242
Conduct at 22 months post- treatment (parent- and teacher-rated composite score)SMD 0.00 (−0.25 to 0.25)
Quality: High
K = 1, N = 243
Social skills at 22 months post- treatment (parent- and teacher-rated composite score)SMD −0.04 (−0.29 to 0.21)
Quality: High
K = 1, N = 243
Education outcomes at end of treatment
Reading at end of treatmentSMD −0.10 (−0.30 to 0.09)
Quality: High
K = 5, N = 397
Mathematics at end of treatmentSMD 0.01 (−0.20 to 0.22)
Quality: High
K = 4, N = 358
Education outcomes at 3–6 months post-treatment
Reading at 3 months post-treatmentSMD 0.11 (−0.77 to 0.99)
Quality: Moderate
K = 1, N = 20
Mathematics at 3 months post-treatmentSMD 0.57 (−0.32 to 1.47)
Quality: Moderate
K = 1, N = 20
Education outcomes at 7–12 months post-treatment
Reading at 7–10 months post-treatmentSMD −0.05 (−0.27 to 0.18)
Quality: High
K = 2, N = 301
Education outcomes at 13–24 months post-treatment
Reading 19–22 months post-treatmentSMD 0.03 (−0.22 to 0.27)
Quality: High
K = 2, N = 260
Dichotomous outcomes
Leaving study for any reasonData not pooled
BROWN1985: 0% (medication) versus 0% (psychological)
FIRESTONE1986: 0% versus 0%
MTA1999: 6% versus 2%
Non-responders at end of treatmentRR 0.61 (0.50 to 0.76)
Quality: High
K = 4, N = 366
Non-responders at 10 months post-treatmentRR 0.91 (0.77 to 1.07)
Quality: High
K = 4, N = 288

From: 11, COMBINING AND COMPARING PSYCHOLOGICAL AND PHARMACOLOGICAL INTERVENTIONS

Cover of Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults.
NICE Clinical Guidelines, No. 72.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society (UK); 2009.
Copyright © 2009, The British Psychological Society & The Royal College of Psychiatrists.

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