Methylphenidate for ADHD in children and adolescents: throwing the baby out with the bathwater
Methylphenidate for ADHD in children and adolescents: throwing the baby out with the bathwater
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DOI：
10.1136/eb-2016-102461
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发表时间：
2016-11-01
影响因子：
5.2
通讯作者：
Wong, Ian C. K.
中科院分区：
文献类型：
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作者：
Banaschewski, Tobias;Buitelaar, Jan;Wong, Ian C. K.
最近的一项科克伦综述评估了哌甲酯治疗儿童和青少年注意力缺陷多动障碍（ADHD）的疗效。尽管在荟萃分析中发现了ADHD症状减轻的中到大型效应量，但作者得出结论，证据质量较低，因此这些效应的真实程度仍然不确定。我们确定了一些主要问题的审查，在域的研究纳入，方法的质量评估和解释有关的严重不良事件的数据，以及临床意义的报告的影响。我们还发现了用于估计主要结局效应量的数据提取中的错误。考虑到所有这些缺点，科克伦综述中关于证据状态不确定的结论是错误的。专业人士、家长和患者应该参考以前的评论和现有的指南，其中包括哌甲酯作为ADHD的安全有效的治疗策略之一。
A recent Cochrane review assessed the efficacy of methylphenidate for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Notwithstanding the moderate-to-large effect sizes for ADHD symptom reduction found in the meta-analysis, the authors concluded that the quality of the evidence is low and therefore the true magnitude of these effects remains uncertain. We identified a number of major concerns with the review, in the domains of study inclusion, approaches to quality assessment and interpretation of data relating to serious adverse events as well as of the clinical implications of the reported effects. We also found errors in the extraction of data used to estimate the effect size of the primary outcome. Considering all the shortcomings, the conclusion in the Cochrane review that the status of the evidence is uncertain is misplaced. Professionals, parents and patients should refer to previous reviews and existing guidelines, which include methylphenidate as one of the safe and efficacious treatment strategies for ADHD.