The pharmacological treatments for ADHD have been recently
reviewed and graded by the SIGN group (Scottish Intercollegiate Guidelines
Network, 2001).
Statements of evidence
ia) Evidence obtained from meta-analysis of randomized
controlled trials.
ib) Evidence obtained from at least one randomized controlled
trial.
iia) Evidence obtained from at least one well-designed controlled
study without randomization.
iib) Evidence obtained from at least one other type of
well-designed quasi-experimental study.
iii) Evidence obtained from well-designed non-experimental
descriptive studies, such as comparative studies, correlation
studies and case studies.
iv) Evidence obtained from expert committee reports or opinions
and/or clinical experiences of respected authorities.
Grades of recommendations
a) Requires at least one randomized controlled trial as part
of a body of literature of overall good quality and consistency
addressing the specific recommendation.
(Evidence levels Ia, Ib)
b) Requires the availability of well conducted clinical
studies but no randomized clinical trials on the topic of
recommendation.
(Evidence levels IIa, IIb, III)
c) Requires evidence obtained from expert committee reports or
opinions and/or clinical experiences of respected authorities.
Indicates an absence of directly applicable clinical studies of
good quality.
(Evidence level IV)
Psychostimulants (methylphenidate and
dexamphetamine)
Immediate release preparations:
Evidence level Ia
Recommendation A
Extended release preparations:
Extended release methylphenidate preparations (Licensed in
UK)
OROS methylphenidate (Concerta-XL®)
Evidence level Ib (
Pelham et al.
2001;
Wolraich et al.
2001)
Recommendation A
Extended release methylphenidate preparations (Licensed in US
but not UK):
Metadate CD® (To be marketed in UK as Equasym-XL)
Ritalin-LA®
Pivotal clinical trial data held "on file" by manufacturers but not
published in peer reviewed journals therefore not graded at
present.
Extended release amphetamine preparations (Licensed in US but
not UK):
Adderall XR™
Evidence level Ib (
Greenhill et
al. 2002)
Recommendation A
Tricyclic Antidepressants:
Evidence level Ia
Recommendation A
Other treatments (ungraded due to lack of evidence or
contradictory evidence):
Clonidine
Guanfacine
Bupropion
Venlafaxine