Randomised placebo-controlled trials (RCTs) which assessed ADHD treatments for adults with any subtype of ADHD, attention-deficit disorder (ADD), hyperkinetic disorder or minimal brain dysfunction were included in the review. Studies of the following treatments were eligible: amphetamine mixture, dextroamphetamine sulphate, methylphenidate HCl, dexmethylphenidate HCl, modafinil, atomoxetine HCl and bupropion HCl.
The primary outcomes were incidence of clinical response and change from baseline in ADHD symptom scores and adverse events including sleep or appetite disturbances, anxiety and serious cardiovascular events. Secondary outcomes were ADHD drug misuse or diversion, impact on current or past substance use disorders, and treatment discontinuations.
Included studies were mainly conducted in outpatient settings of specialist clinics or university hospitals. Methylphenidate was the most commonly used treatment. The mean age of patients was 38 years and most (59 per cent) were male. Where reported, most patients had a combined subtype of ADHD. Affective and anxiety disorders were the most common comorbidities reported. Clinical response was the most commonly reported outcome.
Two reviewers independently assessed the studies for inclusion; disagreements were resolved by consensus.