The updated review included 37 trials with more than 2,374 participants and searches through October 2021. Direct comparisons favored stimulants: short-term total-symptom SMD 0.75 (95% CI 0.31–1.19; two studies, 96 participants) and medium-term SMD 0.62 (95% CI 0.10–1.13; one study, 60 participants), with lower scores in stimulant groups.
There was high-certainty evidence that PUFA had no effect on parent-rated total ADHD symptoms compared to placebo in the medium term (standardised mean difference (SMD) -0.08, 95% CI -0.24 to 0.07; 16 studies, 1166 participants).
The updated review included 37 trials with more than 2,374 participants and searches through October 2021. Direct comparisons favored stimulants: short-term total-symptom SMD 0.75 (95% CI 0.31–1.19; two studies, 96 participants) and medium-term SMD 0.62 (95% CI 0.10–1.13; one study, 60 participants), with lower scores in stimulant groups. Most recent located meta-analysis with direct PUFA-versus-stimulant comparisons. Hyperactivity/impulsivity also favored stimulants short term (SMD 0.66, 95% CI 0.25–1.07) and medium term (SMD 0.58, 95% CI 0.07–1.10). One 60-participant long-term comparison showed no difference, which does not establish general equivalence.