Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based
William J Barbaresi1, Slavica K Katusic, Robert C Colligan
1*Department of Pediatric and Adolescent Medicine, Division of Developmental and Behavioral Pediatrics; †Department of Health Sciences Research, Division of Clinical Epidemiology; ‡Department of Psychiatry and Psychology; and §Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN.
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 Psychiatry
- Neurodevelopmental Disorders
- Pharmacological Treatments
Background:
- Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Stimulant medications are a primary treatment for ADHD, but long-term childhood treatment data is valuable.
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.
Main Methods:
- Retrospective cohort study of 379 children with ADHD from the 1976-1982 Rochester, MN, birth cohort.
- Review of complete medical records, analyzing stimulant treatment episodes.
- Comparison of treatment outcomes by gender, DSM-IV ADHD subtype, and stimulant type.
Main Results:
- 77.8% of children received stimulant treatment; boys were more likely to be treated.
- Favorable response rates were high (73.1%) and comparable across genders and ADHD subtypes.
- Dextroamphetamine was associated with more side effects than methylphenidate, though efficacy was similar.
Conclusions:
- Stimulant medication is an effective treatment for childhood ADHD, consistent with clinical trial findings.
- Treatment initiation and duration varied by ADHD subtype.
- Gender did not significantly impact treatment duration, side effects, or response rates.
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, DSMIV 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.
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