CRD Summary: The authors concluded that atomoxetine reduces attention-deficit/hyperactivity disorder symptoms in children and adolescents. The evidence presented appears to support the authors’ conclusion, but poor reporting of review methods, the lack of information about individual studies, and differences between the studies make it difficult to adequately assess the robustness of the authors’ conclusions.

CRD Commentary: The review addressed a clear question that was defined in terms of the participants, interventions, outcomes and study design. Several relevant sources were searched but no specific attempts to minimise publication or language bias were reported, so other studies might have been missed; the potential for publication bias was assessed but results from the two tests were inconsistent. Validity was assessed using specified criteria and the results of this assessment reported. Methods were used to minimise reviewer error and bias in the extraction of data, but it is unclear whether similar steps were taken at the study selection and validity assessment stages. There was little information about the individual studies: patient characteristics, drug dose, treatment duration and results data were not reported, which makes it difficult to know how generally applicable the results from the review are. The data were pooled in meta-analyses, statistical heterogeneity was assessed, and meta-regression used to examine the influence of potential confounders. The evidence presented appears to support the authors’ conclusion, but incomplete reporting of review methods, lack of information about individual studies, and differences between the studies make it difficult to adequately assess the robustness of the authors’ conclusions.