Psychiatric Annals

CME Article 

Long-term Efficacy of ADHD Pharmacotherapy in Children

Richard H. Gilchrist, MD; L. Eugene Arnold, MEd, MD

Abstract

EXCERPT

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder with core symptoms of inattention, overactivity, and impulsivity that adversely affect many domains of function across the lifespan. Numerous short-term studies confirm decrease in core symptoms from pharmacotherapy, primarily stimulants, and more recently atomoxetine. Despite ADHD being a chronic disorder and ADHD pharmacotherapy being one of the most researched topics in child psychiatry, long-term efficacy has been examined only recently. Efficacy for core symptoms through 15 months appears well established, and there is reasonable evidence through 2 years for continued efficacy in some patients. However, evidence beyond 2 years is scant and confounded with self-selection for continuation. In general, evidence for benefit in associated domains (social skills, achievement, family function, internalizing symptoms) is not as impressive as for core symptoms, but there appears to be some benefit through 14 months and possibly 2 years of treatment. The long-term examination of efficacy is complicated by the presence/development of co-morbidities, poor follow-up, poor adherence to prescribed regimens, and the healthcare system’s inability to provide prolonged, careful medication management. Future studies are needed to examine the longer-term (beyond 2 years) effects of medication management when provided at optimal, carefully monitored levels.

ABOUT THE AUTHORS

Richard H. Gilchrist, MD, is Child Psychiatrist, Nationwide Children’s Hospital, and Clinical Assistant Professor, Department of Psychiatry, The Ohio State University. L. Eugene Arnold, MD, is Professor Emeritus, Department of Psychiatry, The Ohio State University.

Address correspondence to: Richard H. Gilchrist, MD, Nationwide Children’s Hospital, 700 Children’s Drive, Timken Hall H 206, Columbus OH 43054; Richard.Gilchrist@osumc.edu.

Dr. Gilchrist has disclosed no relevant financial relationships. Dr. Arnold has disclosed the following relevant financial relationships: Organon, Novartis, and Shire: Consultant; Bristol-Myers Squibb, Eli Lilly, and Shire: Research funding recipient; and McNeil, Novartis, and Shire: Member of Speakers’ Bureau.

EDUCATIONAL OBJECTIVES

  1. Review the core symptoms of ADHD and discuss prevalence estimates in children and adolescents.
  2. Discuss the findings of the Multi-Modal Treatment Study of ADHD (MTA) Cooperative Group and how they relate to the long-term efficacy of stimulant medications in children and adolescents.
  3. Determine the current evidence for the effect of long-term stimulant medication on substance abuse, accidents, risk taking behavior, and quality of life scores in children and adolescents with ADHD.

Abstract

EXCERPT

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder with core symptoms of inattention, overactivity, and impulsivity that adversely affect many domains of function across the lifespan. Numerous short-term studies confirm decrease in core symptoms from pharmacotherapy, primarily stimulants, and more recently atomoxetine. Despite ADHD being a chronic disorder and ADHD pharmacotherapy being one of the most researched topics in child psychiatry, long-term efficacy has been examined only recently. Efficacy for core symptoms through 15 months appears well established, and there is reasonable evidence through 2 years for continued efficacy in some patients. However, evidence beyond 2 years is scant and confounded with self-selection for continuation. In general, evidence for benefit in associated domains (social skills, achievement, family function, internalizing symptoms) is not as impressive as for core symptoms, but there appears to be some benefit through 14 months and possibly 2 years of treatment. The long-term examination of efficacy is complicated by the presence/development of co-morbidities, poor follow-up, poor adherence to prescribed regimens, and the healthcare system’s inability to provide prolonged, careful medication management. Future studies are needed to examine the longer-term (beyond 2 years) effects of medication management when provided at optimal, carefully monitored levels.

ABOUT THE AUTHORS

Richard H. Gilchrist, MD, is Child Psychiatrist, Nationwide Children’s Hospital, and Clinical Assistant Professor, Department of Psychiatry, The Ohio State University. L. Eugene Arnold, MD, is Professor Emeritus, Department of Psychiatry, The Ohio State University.

Address correspondence to: Richard H. Gilchrist, MD, Nationwide Children’s Hospital, 700 Children’s Drive, Timken Hall H 206, Columbus OH 43054; Richard.Gilchrist@osumc.edu.

Dr. Gilchrist has disclosed no relevant financial relationships. Dr. Arnold has disclosed the following relevant financial relationships: Organon, Novartis, and Shire: Consultant; Bristol-Myers Squibb, Eli Lilly, and Shire: Research funding recipient; and McNeil, Novartis, and Shire: Member of Speakers’ Bureau.

EDUCATIONAL OBJECTIVES

  1. Review the core symptoms of ADHD and discuss prevalence estimates in children and adolescents.
  2. Discuss the findings of the Multi-Modal Treatment Study of ADHD (MTA) Cooperative Group and how they relate to the long-term efficacy of stimulant medications in children and adolescents.
  3. Determine the current evidence for the effect of long-term stimulant medication on substance abuse, accidents, risk taking behavior, and quality of life scores in children and adolescents with ADHD.

EXCERPT

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder with core symptoms of inattention, overactivity, and impulsivity that adversely affect many domains of function across the lifespan. Numerous short-term studies confirm decrease in core symptoms from pharmacotherapy, primarily stimulants, and more recently atomoxetine. Despite ADHD being a chronic disorder and ADHD pharmacotherapy being one of the most researched topics in child psychiatry, long-term efficacy has been examined only recently. Efficacy for core symptoms through 15 months appears well established, and there is reasonable evidence through 2 years for continued efficacy in some patients. However, evidence beyond 2 years is scant and confounded with self-selection for continuation. In general, evidence for benefit in associated domains (social skills, achievement, family function, internalizing symptoms) is not as impressive as for core symptoms, but there appears to be some benefit through 14 months and possibly 2 years of treatment. The long-term examination of efficacy is complicated by the presence/development of co-morbidities, poor follow-up, poor adherence to prescribed regimens, and the healthcare system’s inability to provide prolonged, careful medication management. Future studies are needed to examine the longer-term (beyond 2 years) effects of medication management when provided at optimal, carefully monitored levels.

ABOUT THE AUTHORS

Richard H. Gilchrist, MD, is Child Psychiatrist, Nationwide Children’s Hospital, and Clinical Assistant Professor, Department of Psychiatry, The Ohio State University. L. Eugene Arnold, MD, is Professor Emeritus, Department of Psychiatry, The Ohio State University.

Address correspondence to: Richard H. Gilchrist, MD, Nationwide Children’s Hospital, 700 Children’s Drive, Timken Hall H 206, Columbus OH 43054; Richard.Gilchrist@osumc.edu.

Dr. Gilchrist has disclosed no relevant financial relationships. Dr. Arnold has disclosed the following relevant financial relationships: Organon, Novartis, and Shire: Consultant; Bristol-Myers Squibb, Eli Lilly, and Shire: Research funding recipient; and McNeil, Novartis, and Shire: Member of Speakers’ Bureau.

EDUCATIONAL OBJECTIVES

  1. Review the core symptoms of ADHD and discuss prevalence estimates in children and adolescents.
  2. Discuss the findings of the Multi-Modal Treatment Study of ADHD (MTA) Cooperative Group and how they relate to the long-term efficacy of stimulant medications in children and adolescents.
  3. Determine the current evidence for the effect of long-term stimulant medication on substance abuse, accidents, risk taking behavior, and quality of life scores in children and adolescents with ADHD.

10.3928/00485713-20080101-03

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