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Meta-analysis / Everyday Life / kids

What happens to non-drug treatments when you blind the raters

A meta-analysis separated outcomes rated by people who knew what the child had received from those rated by people who didn't. The gap was large.

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The short version

Meta-analysis · kids · 2013

Randomised trials of non-pharmacological ADHD treatments were pooled twice: once using all outcome ratings, once using only blinded ratings.

Most apparent benefits on core symptoms weakened considerably under blinded assessment.

Some dietary interventions held up better than the psychological ones on core symptoms.

01

What they studied

  • The authors systematically reviewed randomised controlled trials of dietary interventions (elimination diets, food colouring exclusion, fatty acid supplementation) and psychological interventions (behavioural, cognitive training, neurofeedback) for children with ADHD.
  • Each analysis was run using the most proximal (often unblinded) raters and then again restricted to probably-blinded assessments.
02

What they found

  • Unblinded ratings showed sizeable benefits across most intervention types.
  • Restricting to blinded ratings substantially reduced or removed the effect on core ADHD symptoms for several interventions.
  • The authors concluded that better evidence was needed before recommending several popular approaches for core symptom reduction.
03

Why it matters

  • It's a caution about how ADHD claims travel: 'it worked for us' is real experience but is exactly what blinded analysis is designed to test.
  • It also doesn't mean these approaches are useless — reduced conflict, better routines and calmer evenings are outcomes the core-symptom measure never captured.
04

What it doesn't mean

  • This isn't evidence that behavioural support doesn't help families; it's evidence about a narrow outcome measure.
  • It concerns children. It is not a verdict on adult psychological treatment.
  • A weak group effect doesn't mean no child responded.

The bigger picture

Well established methodologically and widely cited. It reshaped how the field reads any ADHD intervention trial without blinded outcomes.

EvidenceStrong

Original research

Authors
Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., and colleagues
Study title
Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments
Journal
American Journal of Psychiatry
Year
2013
Study design
Systematic review and meta-analysis of randomised controlled trials
DOI
10.1176/appi.ajp.2012.12070991
View original study

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