Review: extended stimulant medication is effective in children with attention deficit hyperactivity disorder.

Main results 14 RCTs (1379 participants, 42% in 1 RCT) met the selection criteria. The quality of study methods was low (mean quality score 2.3 out of 5). Behaviour symptoms: methylphenidate was superior to placebo in 4 of 6 RCTs and to thioridazine in 1 RCT and was equivalent to imipramine in 1 RCT. Medication management was equivalent to combined medication and behavioural intervention; both of these interventions were better than behavioural therapy alone or assessment and referral to care in the community (1 RCT). Biofeedback was superior to no treatment (1 RCT), and cognitive behavioural therapy was superior to supportive therapy (1 RCT). Academic performance: combined treatment was superior to community care and behavioural treatment but not to medication management; medication management did not differ from community care and behavioural treatments for academic outcomes (1 RCT). Methylphenidate with or without thioridazine had a greater effect than thioridazine alone (1 RCT). Treatment with electroencephalographic biofeedback led to better results on an intelligence test than did a waiting list control (1 RCT). Social behaviour: 6 of 9 RCTs showed a benefit for either methylphenidate or dextroamphetamine rather than for the addition of parent training, thioridazine, or behavioural treatment. Medication management was equivalent to combined therapy, and both were superior to behavioural treatment alone and to community care; combined treatment led to more improvements in oppositional or aggressive symptoms, teacher rated social skills, and parent–child relationships (1 RCT). Internalising symptoms: 1 RCT showed that cognitive behavioural therapy led to an increase in self esteem. 1 RCT showed that combined treatment reduced parent rated anxiety more than medication management or behavioural therapy; medication management was superior to behavioural therapy for the improvement of internalising symptoms. Behavioural therapy was better than community care for children with ADHD and comorbid anxiety (67% of whom received medication).