BackgroundAttention 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.MethodWe 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.ResultsSixty‐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.ConclusionsThe 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.

中文翻译：

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研究综述： 注意力缺陷/多动障碍青少年的药物治疗和非药物治疗 – 文献系统综述


背景注意力缺陷/多动障碍 （ADHD） 在青春期表现出独特的发育表现，对优化的、适合年龄的治疗具有影响。这项为期 10 年的更新是研究青少年 ADHD 治疗的有效性和安全性的系列系统评价中的第三篇。我们广泛研究了对 ADHD 症状、损伤和其他报告结局的疗效。考虑了急性和长期疗效以及治疗调节剂。方法我们对 2013年至 2024 年发表或出版的文章进行了 PubMed、EMBASE 和 PsycINFO 检索，并结合本系列早期综述中确定的手工检索和随机对照试验 （RCT）。纳入了检查对诊断为 ADHD 的青少年 （10.0-19.9 岁） 实施干预措施的安全性或有效性的 RCT。提取和评价研究特征，使用 GRADE 评估证据质量，计算单个研究的效应量并使用森林图进行说明。结果确定了 63 例 RCT。证据质量从高（药物治疗;k = 29）到极低（营养补充、神经反馈、职业治疗;每个 k = 1）不等。药物对 ADHD 症状有一致的强烈影响，而对损伤的影响不一致。不同的认知/行为治疗 （C/BTs） 对 ADHD 症状的影响不一致，但对损伤和执行功能技能的影响强烈一致，对内化症状有中等益处。没有干预措施表明存在重大的安全问题。C/BTs 被证明是长期维持的（治疗后长达 3 年），但证据质量中等，因为参与者不能完全盲于接受治疗。结论C/BTs 和药物的效果似乎是互补的，而不是重复的。建议在治疗开始时将药物和 C/BT 相结合，以最大限度地提高参与度、维持和反应广度（即改善 ADHD 症状/认知表现和应对技巧/功能障碍）。参与策略（例如 动机性访谈）可能会促进吸收。新疗法尚未证明对青少年 ADHD 症状或损伤的影响，但仍然是一个有前途的研究领域。