View Full Version : Does ADHD medication treatment prevent the development of other disorders?


MuscleMama
02-16-10, 10:11 AM
David Rabiner, Ph.D. - Attention Research Update
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The short-term benefits of stimulant medication treatment for ADHD have been clearly demonstrated in literally hundreds of studies. Although not all children benefit, the best available evidence suggests that roughly around 80% of treated children realize a significant reduction in their ADHD symptoms.

However, despite compelling evidence that medication treatment generally yields significant short-term benefits, evidence of longer-term benefits is modest. For example, although ADHD increases the risk that children will develop a variety of other psychiatric disorders, little research has examined whether medication treatment reduces this risk. And, the conclusion reached in a recent article reviewing the effect of medication treatment on academic outcomes was that although stimulant treatment improves short-term academic performance, there is "...no data that extend this beneficial effect to long-term academic outcomes."

Important new information on the possible long-term effects of stimulant medication treatment was provided in a study published last year in the journal Pediatrics Pediatrics, 124[/I], 71-78. Participants in this study were 112 white males diagnosed with ADHD when they were 6 to 17 years old (average age was roughly 11 years old). Over the next 10 years, 92 of these youth were treated with stimulant medication and 39 were not; the average duration of treatment was 6 years. Treated and untreated youth did not differ at baseline on ADHD severity, social class, family intactness, or rates of co-occurring psychiatric problems.

At the ten-year follow-up, youth (who were now mostly in their early 20's) and their parents were administered a structured psychiatric interview to determine whether the youth had experienced any of the following psychiatric disorders since their initial ADHD diagnosis: major depression, any of the anxiety disorders, oppositional defiant disorder (ODD), conduct disorder (CD), and bipolar disorder. The researchers also learned whether youth had ever repeated a grade. By comparing the rates of different disorders in each group,the researchers could learn whether stimulant medication treatment may have 'protected' youth from developing other psychiatric problems.


- [B]Results -

Participants with ADHD who were treated with stimulants were significantly less likely to have developed major depression, multiple anxiety disorders, ODD, or CD during the 10-year follow-up period. In fact, treated children were only about one-fifth as likely as non-treated children to develop any of these disorders and these differences were all statistically significant. Treated children were also less likely to have repeated a grade. Group differences in the rate of bipolar disorder did not differ significantly, but was in the same direction as for the other disorders.


- Summary and Implications -

Results of this 10-year follow-up study provides intriguing evidence that stimulant medication treatment protects children with ADHD from developing additional psychiatric disorders. This was true even though treated and untreated children did not differ at baseline on several factors that might be associated with the development of additional difficulties over time.

The authors suggest several possible explanations for their findings. First, they argue that efficacious stimulant therapy "...may interrupt the pathogenic trajectory leading towards other disorders." Perhaps effective treatment with stimulants helps children experience greater success at school and in their relationships with family and peers, and this reduces the likelihood of other significant problems developing.

Alternatively, the authors acknowledge that factors related to whether or not youth receive medication treatment for ADHD - and which they did not measure in their study - may explain the differences that were found. In other words, group differences in the frequency with which psychiatric disorders developed might have little to do with any protective effects of medication, but could instead be related to other factors associated with whether children received medication treatment in the first place.

For example, perhaps children who received medication treatment were also more likely to receive a variety of other supports to help them overcome the difficulties associated with ADHD. If this were the case, then the reduced rates of disorder among treated children might be explained by these other supports rather than reflecting any protective benefits provided by medication. Unfortunately, the design of the study does not permit a clear resolution for these different explanation of the findings.

Resolving this issue scientifically would require a long-term randomized controlled trial in which children were randomly assigned to either receive or never receive medication treatment for ADHD. However, because medication is an effective treatment for ADHD - at least in the short-term - this study could never be done as withholding medication treatment for an extended period would be unethical.

Because a long-term randomized-controlled trial of medication treatment is unlikely to ever be done, conclusively documenting the long-term benefits of medication treatment may not be possible. However, studies such as this one can provide suggestive evidence of long-term benefits, even though important methodological limitations prevent definitive conclusions from being made. If additional studies like this obtain similar results, greater support for the long-term benefits of medication treatment would be provided. Until that time, however, these results are best regarded as encouraging but by no means conclusive.

Dizfriz
02-16-10, 12:11 PM
From the article:

"Participants with ADHD who were treated with stimulants were significantly less likely to have developed major depression, multiple anxiety disorders, ODD, or CD during the 10-year follow-up period. In fact, treated children were only about one-fifth as likely as non-treated children to develop any of these disorders and these differences were all statistically significant. Treated children were also less likely to have repeated a grade. Group differences in the rate of bipolar disorder did not differ significantly, but was in the same direction as for the other disorders. "

This is quite interesting but much of it is not overly surprising but some if it is. It is known that ADHD and major depression is linked especially (as I remember) ADHD combined with CD. ODD is very much linked to ADHD and a number of studies have shown that very often when ADHD is treated, ODD is reduced or goes away. The same can probably be said for some forms of CD at least the ones that are extensions of ODD. I suspect that CD that is more related to Antisocial Personality Disorder (psychopathology) is not effected all that much. It is also well validated that untreated ADHD'ers are much more likely to repeat a grade.

I would not expect Bipolar to be all that much changed by medication but I suspect that the expression of the disorder may well be different at least to some degree. I do not know enough about the connections between Anxiety and ADHD to really comment on this (need to do some study).

Although we are fairly aware of some of this it is always nice to see it confirmed with good research.

I very much like the discussion of other factors that may come into play.

MuscleMama, thanks for posting it, I had not read my copy yet.

Dizfriz