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Evidence / 2018

systematic-review

Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis

Cortese S, Adamo N, Del Giovane C, et al. (2018). The Lancet Psychiatry.

Population
Children, adolescents and adults with ADHD
Sample
Network meta-analysis of randomised trials (see paper for trial count)
Condition
ADHD
Medication focus
Stimulants and non-stimulants used for ADHD
Jurisdiction
International
Last reviewed
1 September 2026
PMID
30097390
DOI
10.1016/S2215-0366(18)30269-4

Plain-language finding

Network meta-analysis estimating comparative efficacy and tolerability of oral ADHD medications. Taking efficacy and safety together, the authors supported methylphenidate in children and adolescents, and amphetamines in adults, as preferred first pharmacological choices in those age groups — at the population level.

Important limitation

Trial populations are not the same as clinic populations. Short-term outcomes dominate. Tolerability in trials is not the same as long-term lived experience. Network meta-analysis assumptions matter.

Why we cite this

Key comparative efficacy and tolerability synthesis for ADHD medicines.

adhd · stimulant · efficacy · network-meta-analysis

Supported by clinical guidelines, regulatory information, systematic reviews, or well-established pharmacological knowledge. Still describes populations, not an individual.

Claims this source supports

  • For many people with ADHD, stimulant medicines can reduce core ADHD symptoms compared with placebo. That is a population finding, not a promise that a particular medicine will help a particular person.

    Last reviewed 1 September 2026

  • One plausible possibility is that improved attentional discrimination gives some people more capacity to recognise internal signals that were already present. Current research supports interoceptive differences in ADHD and supports changes in attentional regulation with treatment. The complete pathway from stimulant treatment to improved interoceptive awareness has not been established.

    Last reviewed 1 September 2026