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Tijdschrift voor Psychiatrie 60 (2018) 5, 315 - 325

Review article

N-of-1 trials in child and adolescent psychiatry: a closer look at stimulants

E. Mordijck, M. Danckaerts, P. Onghena

background An N-of-1 trial is a clinical trial studying the response of an individual to a particular intervention or different interventions in an objective, systematic way.
aim To evaluate both the applications and the methodology of N-of-1 trials in child and adolescent psychiatry.
method A systematic review using PubMed and Embase assessing N-of-1 trials published during the period 1986 – July 2016 with the following key-word: ‘N-of-1’.
results 20 articles were included. All articles used N-of-1 trials to evaluate the effect of stimulant medications in children and adolescents with adhd. Most articles recommended the use of the N-of-1 methodology in clinical practice, despite the large variation in methodology and in outcome interpretation of N-of-1 trials. The 20 articles didn’t meet the current quality standards for N-of-1 trials.
conclusion Despite the advantages of N-of-1 trials, the applications in child and adolescent psychiatry turn out to be rather limited and specific. N-of-1 trials have more to offer regarding both clinical practice and research in child and adolescent psychiatry. If the methodological recommendations are sufficiently met, N-of-1 trials could provide a useful and applicable tool for the child- and adolescent psychiatrist to offer individual patient care.

keywords adhd, child- and adolescent psychiatry, N-of-1 trials, stimulant medication, systematic review