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Part II: Long Term Benefits and Safety of ADHD Drug Treatment

Posted Jan 09 2013 9:00am
ADHD Treatment Benefits in the Long-term

In the last post I attempted to answer a question that I get asked a lot.  "What are the benefits and what is the safety, in the long term, of Inattentive ADHD drug treatment?".  Many parents have questions regarding safety and others have questions regarding the positive effects of ADHD drugs on the growing (or grown) brain but the majority of parents and patients want to know if, say ten years from now, they or their child will be the better for having taking ADHD medications.

This is a question that researchers have been looking at for quite some time and the answer is not entirely clear yet. Some longitudinal studies, performed on monkeys and rats, have suggested that stimulant use during pre-adolescence may predispose individuals to depression and to problems with reward processing and motivation as adults.  Human longitudinal studies, however, have not shown that the rate of depression in patients treated with medicine for ADHD is higher than the rate in patients that have not taken ADHD medications.  There are some human studies that suggest that ADHD medications change the brain's reward centers for the worse but these effects have been disputed by some researchers and one longitudinal study found that childhood stimulant use, in fact, brought about brain changes that improved the brain’s motivation and reward centers in adulthood. 

We can talk all day long about reward centers and such but most patients and parents just want to know what medical treatment will give them the best chance at success academically and professionally.
One of the best longitudinal studies that evaluated a portion of this question was the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA). 

The MTA study began in 1992 and was designed to evaluate the short and long term benefits of ADHD treatment.  Children were placed in one of four treatment groups, one group received just ADHD medication, one group received medication and behavioral therapy, one group was treated with just behavioral therapy and one group received no treatment.  The researchers of this study found that the majority of study participants were on no medication by the eight year mark and that the kids who were no longer taking medication at the eight-year follow-up were generally functioning as well (or as poorly) as the children who were still medicated.  

This sounds like horrible news but there was a silver lining.  Some of the kids did better with treatment and the kids who had responded well to any treatment and maintained their gains for two or  more years tended to be doing the best at eight years.  The MTA researchers suggested that ADHD treatments that were adapted to the specific symptoms and changing needs of children and teenagers might be more acceptable to patients and families and, over the long run, might provide better continued treatment and better outcomes.
The MTA also found that behavioral therapy was the best therapy to insure homework completion and acceptance.

I began my journey into "More ADHD Treatment" in 2009 after reading the results of the "MTA At Eight Years", results.  I wrote Commanding Attention so that I could better understand all the other available ADHD treatments.  I realized after reading the MTA study that ADHD drugs might not be the only answer and that, as the MTA researchers suggested, patients (and my kids) might do better if their treatments were tailored and adapted to fit the changing symptoms and needs of kids, teenagers and adults with ADHD.  

Successfully treating ADHD probably requires a "full court press" of treatments.  There is a role for drug treatment but their is definitely, in my opinion, a role for other treatments as well.




http://primarilyinattentiveadd.com
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