Supplementary file 1_School-based randomized controlled trials for ADHD and accompanying impairments: a systematic review and meta-analysis.pdf

IntroductionChildren and young people with Attention Deficit Hyperactivity Disorder (ADHD) face disproportionate challenges due to core symptoms of ADHD (i.e., inattention and hyperactivity) interfering with academic, social, and behavioural functioning. The significant rise in the prevalence of ADHD and difficulties experienced by children and young people over recent years has put a lot more emphasis on school-based interventions. Despite this, and the tremendous amount of randomised controlled trials (RCTs) reporting school-based interventions for ADHD over the past decades, there has been no systematic reporting of the pooled effects of such trials in the literature.
MethodsThis study seeks, for the first time, to report the effects of school-based RCTs on the core symptoms of ADHD and other difficulties, i.e., academic, social, emotional and behavioural (i.e., externalising). Search was performed in three journals, for interventions from 1980 to 2024 that targeted school-aged children (4 to 18 years old) with ADHD.
ResultsIn total, 26 randomised controlled trials met the inclusion criteria, 22 (n = 1962) of which were included in our meta-analyses. Our findings showed that school-based based randomised controlled trials were effective in improving combined ADHD (d = −0.28, p < 0.0001), inattention (d = −0.33, p < 0.0001), academic performance (d = 0.37, p < 0.0001), and social skills (d = 0.28, p < 0.001), and reducing externalising problems (d = −0.32, p = 0.001). There was no significant effect for hyperactivity/impulsivity (d = −0.09, p = 0.22)
DiscussionOur findings showed that school-based randomised controlled trials improve a range of difficulties experienced by children and young people with ADHD, but lack focus on hyperactivity/impulsivity. Future interventions would benefit from a more comprehensive focus on hyperactivity/impulsivity for system-wide improvement. Issues related to high levels of heterogeneity and potential reporter bias are further discussed.

引言：患有注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder, ADHD）的儿童青少年面临着不成比例的挑战——ADHD的核心症状（即注意缺陷与多动）会干扰其学业、社交与行为功能。近年来，ADHD患病率显著上升，儿童青少年群体所经历的困境愈发凸显，使得基于校园的干预措施受到更多关注。尽管近数十年来已有大量随机对照试验（randomised controlled trials, RCTs）报道了针对ADHD的校园干预方案，但现有文献尚未对这类试验的合并效应进行系统性综述报道。

方法：本研究首次系统性报道基于校园的RCT对ADHD核心症状及学业、社交、情绪与行为（即外化行为）相关困境的干预效应。研究检索了3种期刊中1980年至2024年间针对4至18岁学龄期ADHD儿童青少年的干预研究。

结果：最终共有26项随机对照试验符合纳入标准，其中22项（样本量n=1962）被纳入本研究的荟萃分析。结果显示，基于校园的随机对照试验可有效改善ADHD整体症状（d=−0.28, p<0.0001）、注意缺陷症状（d=−0.33, p<0.0001），提升学业表现（d=0.37, p<0.0001）与社交技能（d=0.28, p<0.001），并降低外化行为问题（d=−0.32, p=0.001）；但该类干预对多动/冲动症状无显著改善效果（d=−0.09, p=0.22）。

讨论：本研究结果表明，基于校园的随机对照试验可改善ADHD儿童青少年所面临的多类困境，但对多动/冲动症状的干预效果不足。未来的干预研究应更全面地关注多动/冲动症状，以实现全系统层面的症状改善。本研究还进一步讨论了高异质性及潜在报告偏倚等相关问题。