Abstract
Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with intellectual disability in children, and may further compromise learning. Methylphenidate is a first-line treatment for ADHD, however no previous meta-analysis has evaluated its overall efficacy for ADHD in children with comorbid intellectual disability (ID) or borderline intellectual functioning. The PubMed/MEDLINE, Cochrane CENTRAL and ScienceDirect databases were systematically searched from inception through 2018/7/15 for clinical studies that investigated the effects of methylphenidate in children with ADHD and ID. A random-effects model meta-analysis was used for data synthesis. Eight studies (average Jadad score = 2.5) enrolling 242 participants receiving methylphenidate and 181 participants receiving placebo were included. The meta-analysis showed that methylphenidate led to a significant improvement in ADHD symptoms relative to placebo (Hedges’ g = 0.878, p < 0.001). Meta-regression analysis pointed to an association between the dose of methylphenidate and overall improvement in ADHD severity (slope = 1.334, p < 0.001). Finally, there was no significant difference in drop-out rate [odds ratio (OR) = 1.679, p = 0.260] or rate of treatment discontinuation due to adverse events (OR = 4.815, p = 0.053) between subjects receiving methylphenidate and those taking placebos. Our study suggests that methylphenidate retains its efficacy in children with ADHD and borderline intellectual functioning or ID.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with intellectual disability in children, and may further compromise learning
The reliability of data derived from previous studies on the therapeutic effectiveness of methylphenidate in children with intellectual disability (ID) or borderline intellectual functioning is further hampered by crossover designs, short trial durations, differences in dosing regimens, and small sample sizes[4]
We studied the association between changes in clinical symptoms of ADHD and use of methylphenidate at two stages
Summary
Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with intellectual disability in children, and may further compromise learning. Methylphenidate is a first-line treatment for ADHD, no previous meta-analysis has evaluated its overall efficacy for ADHD in children with comorbid intellectual disability (ID) or borderline intellectual functioning. Our study suggests that methylphenidate retains its efficacy in children with ADHD and borderline intellectual functioning or ID. The reliability of data derived from previous studies on the therapeutic effectiveness of methylphenidate in children with ID or borderline intellectual functioning is further hampered by crossover designs, short trial durations, differences in dosing regimens, and small sample sizes[4]. The authors did not conduct meta-analysis to reinforce their conclusion Due to these gaps in the literature, the aim of this systematic review and meta-analysis of randomized controlled trials was to assess the therapeutic effects of methylphenidate in children with ADHD and co-occurring ID or borderline intellectual functioning
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