Skip to the content

Pharmacological And Non-Pharmacological treatment of ADHD in Pre-schoolers: a systematic review and network meta-analysis: the PANPAP study

Lead applicant: Professor Samuele Cortese

Co-applicants: Andrea Cipriani, Corentin Gosling, Luis Farhat, Cinzia Del Giovane

Background: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) have problems with attention and need to move more than most children. About 5% of school-aged children and 2% of pre-schoolers have ADHD, respectively. This translates into almost 10,000 pre-schoolers with ADHD in the South West England area. Interventions for ADHD include pharmacological and non-pharmacological treatments. When not treated, ADHD entails a significant burden to society, estimated at more than £20,000 per year. Therefore, it is important to detect and treat ADHD in the early years to prevent the negative consequences of ADHD later in life. Experts and ADHD support groups agree that the NHS does not meet the needs of pre-schoolers with ADHD. Currently, there are either long waiting lists or no services for pre-schoolers with ADHD in the NHS. To provide the best care for pre-schoolers with ADHD, we need to make sure that the NHS offers treatments that work well and are safe. In 2018, the National Institute for Health and Care Excellence (NICE) recommended mainly non-pharmacological interventions (behavioral interventions) for the treatment of pre-schoolers with ADHD. Back then, there was a paucity of studies on other non-pharamcological interventions and on medications for ADHD in pre-schoolers. Since 2018, there has been an increasing number of studies on other types of interventions (e.g., family-based interventions and diet) and on medications. There has also been an increasing trend in some countries (e.g., USA) to use medications for pre-schoolers with ADHD. Therefore, we need to understand which is the best intervention for pre-schoolers with ADHD.

Aim: To compare the efficacy and safety of pharmacological and non-pharmacological interventions for ADHD in pre-schoolers. 

Methods: We will not do a new study, which would be very expensive. Rather, we will use a new type of research, called “network meta-analysis”. This approach uses data from available studies to compare different types of treatments even when they have not been compared directly in the individual available studies. Therefore, we will first systematically search for published and unpublished studies of any pharmacological or non-pharmacological treatment for pre-schoolers with ADHD. We will then combine the information from these studies with a state-of-the-art statistical approach. We will finally assess the quality of the studies included in the analysis and the strength of the evidence that we will generate. We are well known experts in this type of research. The study will be conducted at the University of Southampton, in collaboration with international researchers, including a statistician with renowned expertise in this type of analysis.

Impact: The findings of our research are expected to inform future regional, national and international guidelines on the treatment of ADHD in pre-schoolers. As such, our results will be disseminated to local commissioners and policy makers, NICE, and international guidelines groups such as the European ADHD Guidelines Group. We will also disseminate our findings to associations of families with children with ADHD in the Wessex area, at the national (for example, National Attention Deficit Disorder Information and Support Service, ADDISS), and international level (ADHD Europe).