Adhd medications benefis for kids3/21/2024 This finding might be explained because ADHD symptoms may be more subtle in older patients and it may take longer for relapse to occur. Furthermore, the authors found that the effect of continuing methylphenidate was significant in the younger participants (below the median age of 13.8 years) but not in the older group. At the end of the 7-week trial, 40.4% of the patients in the discontinuation group worsened, and only 15.9% of those who continued medication worsened. As the authors state, “Many patients we approached did not want to participate in our discontinuation trial, as they argued that they ‘knew it still worked,’ based on experiences of stopping briefly or when they forgot to take their medication for a day.” This will not come as a surprise to clinicians, as many parents whose children have more severe ADHD are unequivocal about the medication’s efficacy and maintain their children on medication on weekends and during school vacations. Teacher, parent, and clinician assessments (all blind to study group) were performed at baseline and at 7 weeks.Īlthough the design was to enroll a sample of 120 participants, with 60 in each group, only 94 were enrolled, because of recruitment difficulties. The participants had to be on a stable regimen of either 36 mg or 54 mg of extended-release methylphenidate for the past 4 weeks they then entered a blinded study in which they were randomly assigned either to remain on this dosage for 7 weeks or to undergo a 3-week taper to placebo followed by 4 weeks on placebo. ( 10) report on the first double-blind placebo-controlled discontinuation study in ADHD patients who were continuously treated with methylphenidate for at least 2 years. In this issue of the Journal, Matthijssen et al. A common question that is asked is whether the patient has “grown out of” his or her ADHD, such that the medication can be discontinued. There is also the practical clinical question as to how long to maintain a child or adolescent with ADHD on stimulants. The MTA could not address the question of the efficacy of stimulant medication use beyond 1 year, so there is a need to reliably establish the long-term benefits of stimulant use in ADHD treatment. Not surprisingly, given this very low medication exposure, no relationship was found between ADHD outcome and medication usage. This latter group consisted of only 35 individuals, or 7.3% of the sample. Based on this definition, the MTA sample was broken down into three groups: negligible (always below the minimum at all time points interviewed), inconsistent (below the minimum in most follow-ups), and consistent (above the minimum at all time points). The MTA defined being on “minimal” medication as taking 10 mg of methylphenidate (or its equivalent) per day more than 50% of the time. Medication usage was assessed by interviewing the patient or caretakers-always an issue, as patients tend to overreport their adherence to medication regimens. The most recent follow-up examined medication usage, ADHD outcome, and growth at age 25 ( 9). After the first year, all participants in the MTA sought whatever treatment was available, and as a result, the exposure to medication treatment was highly variable as the years wore on. Previously, the Multimodality Treatment of ADHD study (MTA) found that after 14 months, structured medication management was superior to behavioral treatment alone or treatment as usual in the community ( 8). Reviews call attention to the fact that there have been no long-term studies of stimulant use beyond 1 year ( 6), and this fact is often brought up by the lay media in discussions of the treatment of ADHD ( 7). The short-term efficacy of stimulants in ADHD is well established ( 5), yet despite eight decades of clinical use, there continues to be angst over it. These figures are in line with data from other studies ( 3) and are below the estimated 7% 1-year prevalence of childhood ADHD ( 4). Based on data from over 6 million individuals in an insurance database, the 2008 annual prevalence for filled stimulant prescriptions was found to be 4.6% for children ages 6–12 years, 3.7% for adolescents (13–18 years), and 1.6% for young adults (19–24 years) ( 2). Stimulant medications have been used to treat symptoms of attention deficit hyperactivity disorder (ADHD) for over 80 years, longer than the use of antibiotics to treat infection ( 1).
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