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Long-Term Use of Stimulants in Children with Attention Deficit Hyperactivity Disorder

Safety, Efficacy, and Long-Term Outcome

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Abstract

The purpose of this review is to summarize existing data on the long-term safety and efficacy of stimulant treatment, and how long-term stimulant treatment of children with attention deficit hyperactivity disorder (ADHD) affects their outcome. Existing controlled studies of children with ADHD treated and untreated with stimulants, as well as long-term prospective follow-up studies, are reviewed. Children with ADHD treated with stimulants for as long as 2 years continue to benefit from the treatment, with improvements observed in ADHD symptoms, comorbid oppositional defiant disorder, and academic and social functioning, with no significant problems of tolerance or adverse effects. Long-term, prospective follow-up studies into adulthood show that stimulant treatment in childhood has slight benefits regarding social skills and self-esteem. Long-term adverse effects from stimulant treatment in childhood regarding adult height or future substance abuse have not been supported by existing studies.

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References

  1. Schachter HM, Pham B, King J, et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention deficit disorder in children and adolescents: a meta-analysis. CMAJ 2001; 165(11): 1475–88

    PubMed  CAS  Google Scholar 

  2. NIH Consensus Development Program-110. Diagnosis and treatment of attention deficit hyperactivity disorder. Consensus development conference statement. Bethesda (MD): National Institutes of Health, 1998

    Google Scholar 

  3. Safer DJ, Zito JM, Fine EM. Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics 1996; 98: 1084–8

    PubMed  CAS  Google Scholar 

  4. Safer DJ, Malever M. Stimulant treatment in Maryland public schools. Pediatrics 2000; 106: 533–9

    Article  PubMed  CAS  Google Scholar 

  5. Zito JM, Safer DJ, dos Reis S, et al. Trends in the prescribing of psychotropic medication to preschoolers. JAMA 2000; 283: 1025–30

    Article  PubMed  CAS  Google Scholar 

  6. Rappley MD, Mullan PB, Alvarez AJ, et al. Diagnosis of attention deficit disorder and the use of psychotropic medication in very young children. Arch Pediatr Adolesc Med 1999; 153: 1039–45

    PubMed  CAS  Google Scholar 

  7. Connor DF. Preschool attention deficit hyperactivity disorder: a review of prevalence, diagnosis, neurobiology, and stimulant treatment. J Dev Behav Pediatr 2002; 23 (1 Suppl.): S1–9

    Article  PubMed  Google Scholar 

  8. Weiss M, Jain U, Garland J. Clinical suggestions for management of stimulant treatment in adolescents. Can J Psychiatry 2000; 45: 717–23

    PubMed  CAS  Google Scholar 

  9. Spencer T, Biederman J, Wilens T, et al. Pharmacotherapy of attention deficit disorder across the life cycle. J Am Acad Child Adolesc Psychiatry 1996; 35: 409–32

    Article  PubMed  CAS  Google Scholar 

  10. Hechtman L, Abikoff H. Methylphenidate and multimodal treatment in attention deficit hyperactive disorder. In: Jensen PS, Hibbs ED, editors. Psychosocial treatment research with children and adolescents. Washington, DC: APA Press, 1996: 341–69

    Google Scholar 

  11. MTA Cooperative Group, Jensen P, Arnold LE, et al. A 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder (ADHD). Arch Gen Psychiatry 1999; 56: 1073–86

    Article  Google Scholar 

  12. MTA Cooperative Group, Hinshaw S, Swanson J, et al. Moderators and mediators of treatment response for children with ADHD: the MTA Study. Arch Gen Psychiatry 1999; 56: 1088–96

    Article  Google Scholar 

  13. Hechtman L, Abikoff H. Multimodal treatment plus stimulants vs stimulant treatment in ADHD children: results from a two-year comparative treatment study. Annual Meeting of the American Academy of Child and Adolescent Psychiatry; 1995 Oct 18–26; New Orleans (LA)

  14. Gillberg C, Melander H, von Knorring A, et al. Long-term central stimulant treatment of children with attention-deficit hyperactivity disorder: a randomized double-blind placebo-controlled trial. Arch Gen Psychiatry 1997; 54: 857–64

    Article  PubMed  CAS  Google Scholar 

  15. Schachar RJ, Tannock R, Cunningham C, et al. Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate. J Am Acad Child Adolesc Psychiatry 1997; 36: 754–63

    Article  PubMed  CAS  Google Scholar 

  16. Weiss G, Kruger E, Danielson U, et al. Effects of long-term treatment of hyperactive children with methylphenidate. CMAJ 1975; 112: 159–65

    CAS  Google Scholar 

  17. Loney J, Kramer J, Milich R. The hyperkinetic child grows up: predictors of symptoms, delinquency, and achievement at follow-up. In: Gadow KD, Loney J, editors. Psychosocial aspects of drug treatment for hyperactivity. Boulder (CO): Westview Press, 1981: 381–415

    Google Scholar 

  18. Paternite CE, Loney J, Salisbury H, et al. Childhood inattention-overactivity, aggression, and stimulant medication history as predictors of young adult outcomes. J Child Adolesc Psychopharmacol 1999; 9(3): 169–84

    Article  PubMed  CAS  Google Scholar 

  19. Blouin AGA, Bornstein R, Trites R. Teen-age alcohol use among hyperactive children: a 5-year follow-up study. J Pediatr Psychol 1978; 3: 188–94

    Article  Google Scholar 

  20. Charles L, Stein R. A four-year follow-up study of the effects of methylphenidate on the behavior and academic achievement of hyperactive children. J Abnorm Child Psychol 1981; 9: 495–505

    Article  PubMed  CAS  Google Scholar 

  21. Satterfield J, Hoppe CM, Schell AM. A prospective study of delinquency in 110 adolescent boys with attention deficit disorder and 88 normal adolescent boys. Am J Psychiatry 1982; 139: 797–8

    Google Scholar 

  22. Satterfield JH, Satterfield BT, Cantwell DP. Three-year multimodal treatment study of 100 hyperactive boys. J Pediatr 1981; 98: 650–5

    Article  PubMed  CAS  Google Scholar 

  23. Gittelman R, Mannuzza S, Shenker R, et al. Hyperactive boys almost grown-up. Arch Gen Psychiatry 1985; 42: 937–47

    Article  PubMed  CAS  Google Scholar 

  24. Mannuzza S, Klein RG, Bessler A, et al. Adult outcome in hyperactive boys. Arch Gen Psychiatry 1993; 50: 565–76

    Article  PubMed  CAS  Google Scholar 

  25. Barkley RA, Fischer M, Edelbrock CS, et al. The adolescent outcome of hyperactive children diagnosed by research criteria: an 8-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 1990; 29: 546–57

    Article  PubMed  CAS  Google Scholar 

  26. Fischer M, Barkley RA, Smallish L, et al. Young adult follow-up of hyperactive children: self-report psychiatric disorders comorbidity and the role of childhood conduct problems and teen CD. J Abnorm Child Psychol 2002; 30(5): 463–75

    Article  PubMed  Google Scholar 

  27. Weiss G, Minde K, Werry J, et al. A five-year follow-up of 91 hyperactive school children. Arch Gen Psychiatry 1971; 24: 409–14

    Article  PubMed  CAS  Google Scholar 

  28. Weiss G, Hechtman L. Hyperactive children grown up. New York: Guilford Press, 1993

    Google Scholar 

  29. Hechtman L, Weiss G, Perlman T, et al. Young adult outcome of hyperactive children who received long-term stimulant treatment. J Am Acad Child Adolesc Psychiatry 1984; 23(3): 261–9

    Article  CAS  Google Scholar 

  30. Barkley RA, Fischer M, Smallish L, et al. Does stimulant treatment of ADHD contribute to substance use and abuse: a 13-year prospective study. Pediatrics 2003; 3(1): 97–109

    Article  Google Scholar 

  31. Zeiner P. Body growth and cardiovascular function after extended (1.75 years) with methylphenidate in boys with attention-deficit hyperactivity disorder. J Child Adolesc Psychopharmacol 1995; 5: 129–38

    Article  Google Scholar 

  32. Klein R, Mannuzza S. Hyperactive boys almost grown up (III): methylphenidate effects on ultimate height. Arch Gen Psychiatry 1988; 45: 1131–4

    Article  PubMed  CAS  Google Scholar 

  33. Biederman J, Wilens T, Mick E, et al. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics 1999; 104: E20

    Article  PubMed  CAS  Google Scholar 

  34. Loney J, Kramer J, Salisbury H. Medicated versus unmedicated ADHD children: adult involvement with legal and illegal drugs. In: Jensen P, Cooper JR, editors. Diagnosis and treatment of attention deficit hyperactivity disorder. Kingston (NJ): Civic Research Institute, 2002

    Google Scholar 

  35. Huss M, Lehmkuhl U. Methylphenidate and substance abuse: a review of pharmacology, animal, and clinical studies. J Atten Disord 2002; 6: S65–71

    PubMed  Google Scholar 

  36. Burke JD, Loeber R, Lahey BB. Which aspects of ADHD are associated with tobacco use in early adolescence? J Child Psychol Psychiatry 2001; 42: 493–502

    Article  PubMed  CAS  Google Scholar 

  37. Lambert NM, Hartsough CS. Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. J Learn Disabil 1998; 31: 533–44

    Article  PubMed  CAS  Google Scholar 

  38. Conners K, Epstein J, March J, et al. Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. J Am Acad Child Adolesc Psychiatry 2001; 40(2): 159–67

    Article  PubMed  CAS  Google Scholar 

  39. Swanson J, Kraemer H, Hinshaw S, et al. Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 2001; 40(2): 167–79

    Article  Google Scholar 

  40. Biederman J, Lopez F, Boellner S, et al. A randomized, double-blind, placebo-controlled, parallel-group study of SLI381 in children with attention deficit/hyperactivity disorder. Pediatrics 2002; 110(2): 1–9

    Article  Google Scholar 

  41. Wolraich ML, Greenhill L, Pelham W, et al. Randomized, controlled trial of oros methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108(4): 883–92

    Article  PubMed  CAS  Google Scholar 

  42. Greenhill LL, Halperin JM, Abikoff H. Stimulant medications. J Am Acad Child Adolesc Psychiatry 1999; 38(5): 503–12

    Article  PubMed  CAS  Google Scholar 

  43. Conrad WG, Insel J. Anticipating the response to amphetamine therapy in the treatment of hyperkinetic children. Pediatrics 1967; 40: 96–8

    Google Scholar 

  44. Wilkinson GS. The wide range achievement test-revised: administration manual. Wilmington (DE): Wide Range, Inc., 1993

    Google Scholar 

  45. Wechsler D. Wechsler adult intelligence scale-III. San Antonio (TX): The Psychological Corporation, 1997

    Google Scholar 

  46. Ackerman PT, Dykman RA, Peters JE. Teenage status of hyperactive and non-hyperactive learning disabled boys. Am J Orthopsychiatry 1977; 47: 577–96

    Article  PubMed  CAS  Google Scholar 

  47. Riddle KD, Rapoport JL. A 2-year follow-up of 72 hyperactive boys. J Nerv Ment Dis 1976; 162: 126–34

    Article  PubMed  CAS  Google Scholar 

  48. Hathaway SR, McKinley JC. Minnesota multiphasic personality inventory-2: manual for administration and scoring. Minneapolis (MN): University of Minnesota Press, 1989

    Google Scholar 

  49. Fischer M, Barkley RA, Fletcher KE, et al. The adolescent outcome of hyperactive children: predictors of psychiatric, academic, social, and emotional adjustment. J Am Acad Child Adolesc Psychiatry 1993; 32(2): 324–32

    Article  PubMed  CAS  Google Scholar 

  50. Lambert N, Hartsaugh C, Sassone D. Persistence of hyperactivity symptoms from childhood to adolescence. Am J Orthopsychiatry 1987; 57: 22–31

    Article  PubMed  CAS  Google Scholar 

  51. Biederman J, Faraone S, Milberger S, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry 1996; 53(5): 437–46

    Article  PubMed  CAS  Google Scholar 

  52. Safer D, Allen R, Barr E. Depression of growth in hyperactive children on stimulant drugs. N Engl J Med 1972; 287: 217–20

    Article  PubMed  CAS  Google Scholar 

  53. Safer DJ, Allen RP. Factors influencing the suppressant effects of two stimulant drugs on the growth of hyperactive children. Pediatrics 1973; 51: 660–7

    PubMed  CAS  Google Scholar 

  54. Safer DJ, Allen RP, Barr E. Growth rebound after termination of stimulant drugs. Pediatrics 1975; 86: 113–6

    Article  CAS  Google Scholar 

  55. Mattes JA, Gittelman R. Growth of hyperactive children on maintenance regimen of methylphenidate. Arch Gen Psychiatry 1983; 40: 317–21

    Article  PubMed  CAS  Google Scholar 

  56. Reeve E, Garfinkel B. Neuroendocrine and growth regulations: the role of sympathomimetic medication. In: Greenhill LL, Osmon BB, editors. Ritalin: theory and patient management. New York: Mary Ann Liebert, 1991: 289–300

    Google Scholar 

  57. Spencer TJ, Biederman J, Harding M, et al. Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays? J Am Acad Child Adolesc Psychiatry 1996; 35: 1460–9

    Article  PubMed  CAS  Google Scholar 

  58. Goldman L, Genel M, Bezman R, et al. Diagnosis and treatment of attentiondeficit/hyperactivity disorder. JAMA 1998; 279: 1100–7

    Article  PubMed  CAS  Google Scholar 

  59. Volkow N, Wang G, Fowler J, et al. Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. Am J Psychiatry 1998; 155: 1325–31

    PubMed  CAS  Google Scholar 

  60. Biederman J, Wilens T, Mick E, et al. Is ADHD a risk factor for psychoactive substance use disorders: findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 1997; 36(1): 21–9

    Article  PubMed  CAS  Google Scholar 

  61. Hechtman L. Adolescent outcome of hyperactive children treated with stimulants in childhood: a review. Psychopharmacol Bull 1985; 21: 178–91

    PubMed  CAS  Google Scholar 

  62. Kramer J, Loney J, Whaley-Klahn M. The role of prescribed medication in hyperactive youths’ substance use. In: Scientific Proceedings of the American Psychological Association. Los Angeles (CA): American Psychological Association, 1981

    Google Scholar 

  63. Barkley RA, Fischer M, Edelbrock CS, et al. The adolescent outcome of hyperactive children diagnosed by research criteria (III): mother-child interactions, family conflicts and maternal psychopathology. J Child Psychol Psychiatry 1991; 32(2): 233–55

    Article  PubMed  CAS  Google Scholar 

  64. Milberger S, Biederman J, Faraone SV, et al. ADHD is associated with early initiation of cigarette smoking in children and adolescents. J Am Acad Child Adolesc Psychiatry 1997; 36(1): 37–44

    Article  PubMed  CAS  Google Scholar 

  65. Wilens TE, Faraone SV, Biederman J, et al. Does stimulant therapy of attentiondeficit/hyperactivity disorder beget later substance abuse: a meta-analytic review of the literature. Pediatrics 2003; 111: 179–85

    Article  PubMed  Google Scholar 

  66. Barkley RA. Does stimulant treatment medication therapy for ADHD in children predispose to later drug use? ADHD Report 2003; 11(1): 2–7

    Article  Google Scholar 

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Acknowledgements

The author receives research support from the National Institute of Mental Health, Purdue Pharma, Jensen Ortho, and Shire Pharmaceuticals.

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  1. Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, 4018 St Catherine Street West, Montreal, Quebec, H3Z-1P2, Canada

    Lily Hechtman & Brian Greenfield

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Correspondence to Lily Hechtman.

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Hechtman, L., Greenfield, B. Long-Term Use of Stimulants in Children with Attention Deficit Hyperactivity Disorder. Pediatr-Drugs 5, 787–794 (2003). https://doi.org/10.2165/00148581-200305120-00002

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