The Age Filter: Two 2025 Meta-Analyses Disagree on ADHD Meds and Quality of Life

Yesterday I published a post here about what medication leaves untouched. It leans on one line from a 2025 Lancet Psychiatry paper: across 113 randomised trials and 14,887 adults, no medication improved quality of life.

The line is accurate. It is also one of two verdicts published that year, and the other one points the other way.

So before you quote either of them to a client, check who was in the trials.

Two 2025 meta-analyses, opposite answers

Ostinelli, Cortese and colleagues ran a component network meta-analysis of 113 trials in 14,887 adults. Stimulants and atomoxetine cut core symptoms in the short term. Quality of life did not move, and the effect on executive function was weak and uncertain.

Bellato and colleagues, also 2025, pooled 17 trials and 5,388 participants. They found that amphetamines, methylphenidate and atomoxetine all beat placebo on quality of life, at effect sizes of 0.51, 0.38 and 0.30 (Hedges g). Small to moderate, and not nothing.

I cannot tell you why they disagree. I have not read either full text, and an invented reconciliation would be worth nothing to you.

Sorted by how sure anyone can be: proven, medication cuts core symptoms in the short term. Contested, whether it moves quality of life. Unknown, why two meta-analyses sit on opposite sides of that.

On the first page of results I pulled this week, five of the nine organic results say yes, medication improves quality of life. That is the page your client reads before the session.

Run the age filter

You can ask one question of any paper without paying for the full text: how old were the people in it. Call it the age filter.

Every one of Ostinelli’s 14,887 participants was an adult. Bellato’s pool was mixed: of the 27 studies reviewed, 13 were in adults and 14 in children and adolescents, and a third carried a high risk of bias.

Then the filter turns on me. Bellato’s team tested for an age difference and did not find a significant one. Age does not explain why the two papers disagree, and I am not going to pretend it does.

The filter bites hardest on the paper coaches most want to quote. Sibley and colleagues’ 2025 review in JCPP found that behavioural and cognitive work had inconsistent effects on symptoms, and strong, consistent effects on impairment and executive function. The gains held for up to three years after treatment. That is about as flattering as the research gets for the work coaches actually do.

All 63 of those trials were in 10-to-19-year-olds. None were in adults.

And the review’s own advice is to combine medication and behavioural work from the outset, not to choose between them. That part rarely survives the quoting.

What to say when the evidence disagrees

If I am working with an adult, I weight the adult-only analysis more heavily. That is a judgement about relevance and not a finding, so you are free to weight it differently. What I would not do is hand a client one headline and call it the state of the evidence.

Coaching cannot break the tie either. No randomised trial shows that ADHD coaching works for adults, and the largest dedicated coaching trial is still Field 2013 with 127 randomised college students. That says more about how thin the shelf is than about whether coaching helps.

What stays plausible is the part neither meta-analysis was measuring: the Tuesday afternoon between sessions. One r/adhdwomen poster put it plainly: “the executive dysfunction is still very much there when there’s no deadline or external pressure.”

A symptom score was never built to see that, and it is the same limit the ASRS runs into.

The group evidence has not settled. The person in front of you is the one case you can actually watch, week to week.