Evidence Based Evaluation Of Clinical Research On Attention Deficit Hyperactivity Disorder

Objective: Through the analysis of domestic and foreign research of etiology,mechanisms and treatment on attention deficit hyperactivity disorder (ADHD), so as toprovides the valuable evidence to the clinician do clinical research and make treatmentdecision.Methods: VIP、wanfang、CNKI、Cochrane library、Pubmed、EMCC databases weresearched, Two independent reviewers extracted data and assess the methodology quality. Thequalitative analysis was applied whlie the homogeneity of researches was poor If they hadhomogeneity, the Meta-analysis should be conducted by the Cochrane Collaboration’s RevMan5.0software. In addition, two researchers also independently screened and evaluated therelevant system evaluation literature. Methodology quality and report quality of includedreviews were evaluated by OQAQ scale and PRISMA scale.Results:（1）The overview of evidence shows that ADHD incidences was more closelyrelated to multiple factor inheritance， including dopamine system, serotonin system,catecholamine phenol-o-methyl shift enzyme and monoamine oxidase, and synaptic bodysustain protein-25(SNAP-25). The evidences shows that the relevance among severalcandidate genes including DAT1, DRD4, DRD5,5HTT, HTR1B, and SNAP25and ADHDwere weak(OR：1.02to1.65). Further, significant heterogeneity was observed for theassociations between ADHD and several candidate genes（I2>50）. The meta-analysis of studyof gene-environment interactions indicated that the genetic factors accounted for71%to73%，while the environmental effects were small to moderate（.2）The summary analysis of availableevidence showed that an effect size (ES) was1.0, The effect sizes (ESs) of atomoxetine，extended-release guanfacine and extended-release clonidine accounted for0.7. And IRstimulant（sES=0.99）and LA stimulant（sES=0.95）have similar effect sizes, which greater thanthat for nonstimulants（ES=0.57）. But the meta analysis showed that there were significantdifference in ADHD-RS attention deficit component score table and CGI-ADHD-S scale scorebetween atomoxetine group and methylphenidate group[WMD=1.65,95%CI (2.04,1.26), P<0.00001=0.23, WMD,95%CI (40,0.06), P=0.008], and both in ADHD-RS total score scale and hyperactivity/impulse score table were not statistically different. The analysis of studies onPsychological and social treatment found large mean ESs for neurofeedback on inattention(0.8097) and impulsivity（0.6862），but a low mean ESs for hyperactivity. The mean SMD forall of these studies was0.67(95%CI=0.54-0.80)，but reported drop-out rates were around10%in the included15studies and there was larger clinical heterogeneity in these studies. Theoverall ESs of combined treatments in improving attention deficit，hyperactivity, impulsive,social skills and learning disabilities were respectively1.27,1.27,0.91,0.90and0.19.（3）Ofthe21literatures included in the analysis, the highest and lowest scores of methodology qualitywere7.5and4respectively. The average score was5.24±1.03and14literatures met all nineitems.The main problems were insufficient in search strategy, bias in data selection, lack ofrigorous quality assessment for included original studies and so on. The average score of reportquality were18.93±2.91and the main problems were incomplete report in abstract, datacollection and analysis methods, bias control and so on. A part of meta-analysis had largerheterogeneity between the included original study (the study of the enrolled, methodology,results measurement)，which induced the contradiction results.Conclusions:(1)ADHD is closely relevant to polygenic inheritance, environmental,gene-gene interaction and gene-environment interaction closely relationship, especially causedby a variety of the biological-psychology-society factors.(2) For the core symptoms ofADHD，the effects for IR stimulants and LA stimulants were similar, whinch were greater thannonstimulants（atomoxetine、guanfacine and clonidine）, but behavior therapy is comparable tothe aboved nonstimulants and less than that of stimulants. The results of meta analysis showcombined treatments can alleviate attention deficit and hyperactivity, which is better thanstimulants by small number of included studies. The combined adminstration of drug therapy,social and psychological intervention or individual therapy treatment for children with ADHDcan decrease the core symptoms of ADHD and improve children’s social functions.(3) Thereare few Systematic reviews on ADHD in China. The datas about Systematic reviews on ADHDmainly come from European and American. And both of the methodology quality and reportquality of included literatures have some problems, which need to be further improved.