ReviewCNS drugs2021
A Practical, Evidence-informed Approach to Managing Stimulant-Refractory Attention Deficit Hyperactivity Disorder (ADHD).
Review in CNS drugs, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Tolerance and Tachyphylaxis to Medications for Attention-Deficit/Hyperactivity Disorder (ADHD): A Systematic Review of Empirical Studies.CNS drugs · 2026Pooled it
- Treatment Outcomes With Licensed and Unlicensed Stimulant Doses for Adults With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.JAMA psychiatry · 2024Pooled it
- Improving Methylphenidate Titration in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Randomized Controlled Trial Using Placebo-Controlled Titration Implemented in Clinical Practice.Paediatric drugs · 2024Trial
- Pharmacotherapies for Attention-Deficit/Hyperactivity Disorder and Risk of Suicidal Behavior: A Within-Individual Study of Stimulants, Atomoxetine, and Alpha-2 Agonists.Biological psychiatry global open science · 2026Article
- Emotion Dysregulation in Children with ADHD: Irritability is Associated with EEG-Measured Frontal Alpha Asymmetry in Response to Emotional Stimuli.Research on child and adolescent psychopathology · 2026Article
- Cell-Specific Vulnerability of Human Glioblastoma and Astrocytoma Cells to Mephedrone-An In Vitro Study.Molecules (Basel, Switzerland) · 2025Article
- ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions.CNS drugs · 2025Review
- Default Mode Network Functional Connectivity As a Transdiagnostic Biomarker of Cognitive Function.Biological psychiatry. Cognitive neuroscience and neuroimaging · 2025Review
- Single-dose methylphenidate induces shift in functional connectivity associated with positive longer term clinical response in adult attention-deficit/hyperactivity disorder.Scientific reports · 2025Article
- Attention-deficit/hyperactivity disorder.Nature reviews. Disease primers · 2024Review
- Common practical questions - and answers - at the British Association for Psychopharmacology child and adolescent psychopharmacology course.Journal of psychopharmacology (Oxford, England) · 2023Review
- Tolerance to Stimulant Medication for Attention Deficit Hyperactivity Disorder: Literature Review and Case Report.Brain sciences · 2022Review
- Viloxazine for Attention-Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis of Randomized Clinical Trials.Journal of central nervous system disease · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Stimulants (methylphenidate or amphetamines) are the recommended first-line option for the pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD). However, some patients with ADHD will not respond optimally to stimulants. Here, we discuss strategies to manage stimulant-refractory ADHD, based on the recommendations advanced in clinical guidelines, knowledge of expert practice in the field, and our own clinical recommendations, informed by a comprehensive literature search in PubMed, PsycInfo, EMBASE + EMBASE classic, OVID Medline, and Web of Science (up to 30 March 2021). We first highlight the importance of stimulant optimization as an effective strategy to increase response. We then discuss a series of factors that should be considered before using alternative pharmacological strategies for ADHD, including poor adherence, time action properties of stimulants (and wearing-off of effects), poor tolerability (that prevents the use of higher, more effective doses), excessive focus on or confounding from presence of comorbid non-ADHD symptoms, and tolerance. Finally, we consider the role of non-stimulants and combined pharmacological approaches. While the choice of medication for ADHD is still to a large extent based on a trial-and-error process, there are reasonably accepted data and guidelines to aid in clinical decision-making. It is hoped that advances in precision psychiatry in the years ahead will further guide prescribers to tailor medication choice to the specific characteristics of the patient.
Indexed as
Identifiers
34403134What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.