Many patients, parents and providers have questions about the academic benefits brought about by the use of childhood ADHD medication. Practical questions such as whether continued stimulant medication use results in permanent cognitive improvement or deterioration have been difficult to answer but medical studies have provided some insight into questions such as these.
Animal studies have suggested that stimulant use during pre-adolescence may predispose individuals to problems with motivation as adults but there are not many human studies looking at the question of ADHD drug treatment and academic improvement. One of the studies that tried to answer this question is the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA).
The MTA study occurred at multiple sites and was designed to evaluate the short and long term benefits of ADHD treatment. The study included nearly 600 children, ages 7-9, who were randomly assigned to one of four treatment options. The treatment options included:
- Intensive medication management alone;
- Intensive behavioral treatment alone;
- A combination of both; or
- Routine community care (the control group).
The MTA treatment lasted for 14 months. After the fourteen months, the children were referred back to their community providers. Some of the children continued to receive treatment. Others discontinued their treatment or changed it, based on their individual situation. All the study participants were invited, by the National Institutes of Mental Health, to return to the MTA clinics every one to two years for a check-up of their ADHD symptoms and for an evaluation of their level of functioning.
The initial results of this study indicated that the best treatment for ADHD included a combination of medication and behavioral treatment but after eight years the MTA researchers found that there were no differences in symptoms or functioning among the kids assigned to the four different treatment groups. Children who were no longer taking medication at the eight-year follow-up were generally functioning as well (or as poorly) as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all.
Sixty percent of children who had been medicated during the trial were no longer on medication eight years later. As a whole, the ADHD kids were found to have more academic and social problems compared with their peers who did not have ADHD. They also had more conduct problems including run-ins with police, as well as more depression, and psychiatric hospitalizations.
On the positive side, the kidswho had responded well to any treatment and maintained their gains for two more years tended to be doing the best at eight years. The MTA researchers suggested that ADHD treatments might work more effectively if they were adapted to the specific symptoms of individual children taking into account the changing needs of children and teenagers. The researchers also suggested that this type of approach might be more acceptable to patients and families and, over the long run, might provide better continued treatment and outcomes.
Understanding how drug treatment or other treatments affect people with ADHD in the long term is complicated. Individual genetic and environmental factors will affect treatment response and long term benefits and detriments. Understanding the interaction of specific treatments, genetics and the environment will require more study. Though there is little disagreement, in the medical community, about the long term negative effects of not treating ADHD. There is less agreement about how best to treat ADHD symptoms in the long term and about which treatments provide the longest lasting benefits with the fewest risks.
Visit Tess at http://primarilyinattentiveadd.com for a link to Commanding Attention: A Parent and Patient Guide to More ADHD treatment and for more resources and information on the diagnosis and treatment of ADHD.
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