Original Title: Interventions psychosociales chez les jeunes de moins de 18 ans qui présentent un trouble du déficit de l’attention/hyperactivité (TDAH)

Authors' objectives: In the last few years, a group of pediatricians issued a warning regarding the increase in diagnoses and prescription of ADHD-specific medication among Quebec children. In 2020, the need to improve access to services and to promote psychosocial interventions as well as the multimodal treatment approach was highlighted in a report from the Commission de la santé et des services sociaux du Québec. To address these concerns, action 4.10 of the Plan d’action interministériel en santé mentale 2022–2026 was developed, aimed at establishing a diagnosis and service trajectory guide for youth with ADHD or related problems. This work is supported by an interministerial committee led by the ministère de la Santé et des Services sociaux du Québec (MSSS), which includes actors from the ministère de l’Éducation du Québec (MEQ) and the ministère de l’Enseignement supérieur (MES), responsible for reviewing the ADHD diagnosis and service trajectory based on best practices as well as drafting a reference document for the continuum of care. This committee is responsible for reviewing the ADHD diagnosis and service trajectory based on best practices, as well as drafting a reference framework for the trajectory. In that context, INESSS produced the current report, which aimed at updating the 2018 report that assessed the efficacy of psychosocial interventions to decrease ADHD symptoms and improve functioning in youth aged under 18 diagnosed with ADHD. The current report extended the previous work by adding new psychosocial interventions that had not been assessed in 2018, and by exploring literature on psychosocial interventions that could help decrease ADHD symptoms and improve functioning in young adults aged 18 to 25 diagnosed with ADHD.

Authors' results and conclusions: RESULTS (#1 EFFECTIVENESS OF BEHAVIOURAL AND COGNITIVE-BEHAVIOURAL INTERVENTIONS FOR YOUTH UNDER 18): under 18 Behavioural interventions seem effective in reducing ADHD symptoms and improving global and social functioning among school-aged children and adolescents with symptoms or a diagnosis of ADHD. However, the evidence on cognitive behavioural interventions specifically is limited. (#2 EFFECTIVENESS OF PARENT TRAINING INTERVENTIONS FOR YOUTH UNDER 18): Parent training interventions appear effective in reducing ADHD symptoms and improving family functioning in preschool and school-aged children with a diagnosis of ADHD. (#3 EFFECTIVENESS OF OTHER PSYCHOSOCIAL INTERVENTIONS FOR YOUTH UNDER 18): With regard to cognitive training, neurofeedback, organization and planning skills interventions, mindfulness-based interventions, psychological education, and social skills training, the evidence is limited or does not clearly demonstrate the effectiveness in reducing ADHD symptoms or improving functioning in youth. (#4 EFFECTIVENESS OF PSYCHOSOCIAL INTERVENTIONS FOR YOUNG ADULTS AGED 18 TO 25 YEARS): Among young adults aged 18 to 25 years, the current report, based on an exploratory review of the scientific literature, suggests that cognitive-behavioural interventions seem effective in reducing inattention and improving perceived academic functioning. (#5 OTHER BENEFITS OF PSYCHOSOCIAL INTERVENTIONS): Psychosocial interventions are generally perceived as helpful in reducing ADHD symptoms or related difficulties in youth. The analysis of evidence from the scientific literature on stakeholders’ perceptions, the grey literature, as well as contextual and experiential data, has highlighted that some psychosocial interventions might be associated with benefits beyond the outcomes of interest in the current report, although their clinical efficacy in reducing ADHD symptoms and improving functioning has not been clearly demonstrated. Specifically: • according to the scientific literature on stakeholders’ perceptions, the grey literature, as well as the advisory committee members, psychological education can help to better understand ADHD and promote acceptance of the diagnosis; • according to the grey literature and the advisory committee members, organization and planning skills interventions are perceived as helpful by youth and benefit their general functioning without adverse effects, at a low cost. CONCLUSION: The literature reviewed as well as the stakeholders and committees consulted, consistently with INESSS’s 2018 work, emphasized the importance of recommended interventions being made available at the right time, in collaboration with the youth and their family, and tailored to their needs.

Authors' recommendations: 1. Given the clinical effectiveness and the consistency of the data sources, and their perceived acceptability, INESSS is of the opinion that: • behavioural interventions should be offered to school-aged children and adolescents with symptoms or a diagnosis of ADHD to reduce ADHD symptoms and improve global and social functioning. 2. Considering the available evidence and with the consensus of the advisory committee, INESSS is of the opinion that: • interventions focusing exclusively on organization and planning skills interventions, mindfulness-based interventions, and psychological education interventions could be considered for their potential benefits on the development and overall well-being of youth under 18 years old with symptoms or a diagnosis of ADHD, although the effectiveness of these interventions in reducing ADHD symptoms and improving functioning has not been clearly demonstrated. 3. Considering the available evidence, given the limited data and their methodological limitations, and in the absence of a clear demonstration of clinical effectiveness, INESSS is of the opinion that: • more research is needed to evaluate the effectiveness of cognitivebehavioural interventions and interventions focusing exclusively on social skills training to reduce symptoms and improve functioning of young people under 18 years old with symptoms or a diagnosis of ADHD. 4. Further, INESSS is of the opinion that: • the available data do not allow recommending, with a sufficiently high level of confidence, cognitive training and neurofeedback to reduce symptoms and improve functioning of young people under 18 years old with symptoms or a diagnosis of ADHD. Based on data from an exploratory review of the scientific literature and with the consensus of a group of experts, cognitive-behavioural interventions might be considered to reduce symptoms of inattention and improve perceived academic functioning of young adults aged 18 to 25 years with symptoms or a diagnosis of ADHD.

Authors' methods: A literature review based on a rapid review method was used to address the evaluation questions relating to efficacy and safety of psychosocial interventions for youth under 18. The quality of the scientific evidence was rated. To address the evaluation question pertaining to psychosocial interventions for young adults aged 18 to 25, an exploratory review of the literature was conducted. Contextual and experiential data on the effect, relevance, acceptability, and applicability of psychosocial interventions to meet young people’s needs were collected among youth and parents of youth with ADHD symptoms or diagnosis or related problems, schoolteachers and principals, as well as representatives of associations and support organizations for individuals with ADHD. The current work was supported by an expert advisory committee that included clinicians and health and social services professionals, academic researchers, and administrators in the Réseau de la santé et des services sociaux (RSSS), as well as by a monitoring committee. To mobilize and integrate knowledge, scientific, contextual and experiential data were integrated using a multidimensional approach and were subjected to a deliberative process that resulted in recommendations.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/ServicesSociaux/INESSS_Interventions_psychosociales_TDAH_Avis.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)