Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based
William J Barbaresi1, Slavica K Katusic, Robert C Colligan
1Department of Pediatric and Adolescent Medicine, Division of Developmental and Behavioral Pediatrics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. barbaresi.william@mayo.edu
Insights
Stimulant medication effectively treats childhood attention-deficit hyperactivity disorder (ADHD), with comparable outcomes across genders and ADHD subtypes. Dextroamphetamine showed more side effects than methylphenidate.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Stimulant medications are a primary treatment modality for ADHD.
- Long-term treatment outcomes and comparisons across subtypes and medications require further investigation.
Purpose of the Study:
- To provide detailed information on stimulant medication treatment for children with ADHD.
- To analyze treatment patterns, effectiveness, and side effects based on gender, ADHD subtype, and medication type.
- To compare real-world childhood ADHD treatment outcomes with clinical trial data.
Main Methods:
- Retrospective cohort study of 379 children with ADHD from the 1976-1982 Rochester, MN, birth cohort.
- Medical records were reviewed to analyze stimulant treatment history and outcomes.
- Comparisons were made based on gender, DSM-IV ADHD subtype, and stimulant medication type (dextroamphetamine, methylphenidate).
Main Results:
- 77.8% of children received stimulant treatment; boys were 1.8 times more likely to be treated than girls.
- Favorable treatment response occurred in 73.1% of episodes, with no significant gender difference.
- Treatment initiation was earlier for combined/hyperactive-impulsive ADHD types; duration was longer for combined type. Dextroamphetamine had more side effects than methylphenidate.
Conclusions:
- Stimulant medication treatment for childhood ADHD is effective and comparable to clinical trial findings.
- Gender and ADHD subtype did not significantly impact treatment response or side effect likelihood.
- While effective, dextroamphetamine was associated with a higher incidence of side effects compared to methylphenidate.
Abstract:
The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSM-IV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.
More Related Videos
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
01:28Drug Therapy
Antianxiety Medications
01:23Drugs Acting on Autonomic Ganglia: Stimulants
Ganglionic stimulants activate NM nicotinic receptors in autonomic ganglia, falling into two categories: nicotine mimetics [e.g., lobeline, dimethylpiperazine, tetramethylammonium] and muscarinic receptor agonists [e.g., muscarine, methacholine]. The first category's action is rapid and blocked by nicotinic receptor antagonists, while the second category's action is delayed and blocked by atropine-like agents. Nicotine, an alkaloid, affects the heart rate by stimulating sympathetic or...