One good quality RCT (N = 119) found that CBT significantly improved self- and parent-reported ADHD symptoms compared to usual care. Cognitive training was judged to have low strength of evidence. Cogmed working memory training improved symptom scores compared to a waitlist control in one fair quality RCT (N = 52) but not in one good quality RCT (N = 75). Cognitive trainingĬognitive training did not significantly improve symptom scores compared to placebo training in three good quality RCTs (N = 225) or compared to an alternative cognitive and compensatory training in one fair quality RCT (N = 105). Finally, one poor quality RCT (N = 91) reported no differences in parent-reported symptoms for neurofeedback with methylphenidate and compared to methylphenidate alone. Neurofeedback was judged to have insufficient evidence. A third good quality RCT (N = 90) reported no significant changes in symptom scores compared to treatment as usual. One good quality randomised controlled trial (RCT, N = 102) reported improvement in parent-rated ADHD symptoms compared to attention skills training and another (N = 104) reported improvement in parent- and teacher-rated ADHD symptoms compared to cognitive training or a waitlist control. The outcomes on standardised ADHD symptom rating scales are summarised below (see Kemper et al., 2018, for the full review). However, the follow-ups were typically short, controls varied, and the outcomes assessed were different across studies. Most were randomised controlled trials with good or fair quality. Random effects meta-analysis was conducted for comparisons with at least three studies, which was only possible for the effect of omega-3/6 supplementation compared to placebo on teacher (n=3) and parent ratings (n=4) of ADHD symptoms. The Strength of Evidence was also assessed as insufficient, low, moderate, or high according to the AHRQ guide, which addresses limitations, consistency, directness, precision, and reporting bias. Studies were rated as good, fair, or low quality, and were specific to each outcome measured. The quality of studies and potential for bias were assessed on the Cochrane risk-of-bias tool for randomised studies and the Newcastle-Ottawa scale for observational studies. Disagreements were resolved through discussion or a third expert. Two authors screened each abstract, title, and full text article, and extracted the data.
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