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Long-term effects of stimulant treatment on ADHD symptoms, social–emotional functioning, and cognition

  • Lizanne Schweren (a1), Pieter Hoekstra (a1), Marloes van Lieshout (a2), Jaap Oosterlaan (a2), Nanda Lambregts-Rommelse (a3), Jan Buitelaar (a3) (a4), Barbara Franke (a3) (a5) and Catharina Hartman (a1)...
Abstract
Background

Methodological and ethical constraints have hampered studies into long-term lasting outcomes of stimulant treatment in individuals with attention-deficit/hyperactivity disorder (ADHD). Lasting effects may be beneficial (i.e. improved functioning even when treatment is temporarily ceased) or detrimental (i.e. worse functioning while off medication), but both hypotheses currently lack empirical support. Here we investigate whether stimulant treatment history predicts long-term development of ADHD symptoms, social–emotional functioning or cognition, measured after medication wash-out.

Methods

ADHD symptoms, social–emotional functioning and cognitive test performance were measured twice, 6 years apart, in two ADHD groups (stimulant-treated versus not stimulant-treated between baseline and follow-up). Groups were closely matched on baseline clinical and demographic variables (n = 148, 58% male, age = 11.1). A matched healthy control group was included for reference.

Results

All but two outcome measures (emotional problems and prosocial behaviour) improved between baseline and follow-up. Improvement over time in the stimulant-treated group did not differ from improvement in the not stimulant-treated group on any outcome measure.

Conclusions

Stimulant treatment is not associated with the long-term developmental course of ADHD symptoms, social–emotional functioning, motor control, timing or verbal working memory. Adolescence is characterised by clinical improvement regardless of stimulant treatment during that time. These findings are an important source to inform the scientific and public debate.

Copyright
Corresponding author
Author for correspondence: Lizanne Schweren, E-mail: l.j.s.schweren@umcg.nl
References
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Abikoff, H, Hechtman, L, Klein, RG, Weiss, G, Fleiss, K, Etcovitch, J et al. (2004) Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Journal of the American Academy of Child and Adolescent Psychiatry 43(7), 802811.
Biederman, J, Monuteaux, MC, Spencer, T, Wilens, TE and Faraone, SV (2009) Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics 124(1), 7178.
Biederman, J, Petty, CR, O'Connor, KB, Hyder, LL and Faraone, SV (2012) Predictors of persistence in girls with attention-deficit/hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatrica Scandinavica 125(2), 147156.
Chang, Z, D'Onofrio, BM, Quinn, PD, Lichtenstein, P and Larsson, H (2016) Medication for attention-deficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study. Biological Psychiatry 80(12), 916922.
Charach, A, Ickowicz, A and Schachar, R (2004) Stimulant treatment over five years: adherence, effectiveness, and adverse effects. Journal of the American Academy of Child and Adolescent Psychiatry 43(5), 559567.
Coghill, DR, Seth, S, Pedroso, S, Usala, T, Currie, J and Gagliano, A (2014) Effects of methylphenidate on cognitive functions in children and adolescents with attention-deficit/hyperactivity disorder: evidence from a systematic review and a meta-analysis. Biological Psychiatry 76(8), 603615.
Conners, CK, Erhardt, D and Sparrow, AP (1999) Conner's Adult ADHD Rating Scales: CAARS. North Tonawanda, NY: Multi-Health Systems.
Conners, CK, Sitarenios, G, Parker, JDA and Epstein, JN (1998 a) The Revised Conners’ Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology 26(4), 257268.
Conners, CK, Sitarenios, G, Parker, JDA and Epstein, JN (1998 b) Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology 26(4), 279291.
Huang, Y, Wang, L and Chen, C (2012) Long-term neurocognitive effects of methylphenidate in patients with attention deficit hyperactivity disorder, even at drug-free status. BMC Psychiatry 12, 194.
Kaiser, ML, Schoemaker, MM, Albaret, JM and Geuze, RH (2014) What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature. Research in Developmental Disabilities 36C, 338357.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P et al. (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36(7), 980988.
Klein, C, Wendling, K, Huettner, P, Ruder, H and Peper, M (2006) Intra-subject variability in attention-deficit/hyperactivity disorder. Biological Psychiatry 60(10), 10881097.
Lichtenstein, P, Halldner, L, Zetterqvist, J, Sjolander, A, Serlachius, E, Fazel, S et al. (2012) Medication for attention-deficit/hyperactivity disorder and criminality. New England Journal of Medicine 367(21), 20062014.
Molina, BSG, Hinshaw, SP, Swanson, JM, Arnold, LE, Vitiello, B, Jensen, PS et al. and MTA Cooperative Group (2009) The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry 48(5), 484500.
MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry 56(12), 10731086.
Noreika, V, Falter, CM and Rubia, K (2013) Timing deficits in attention-deficit/hyperactivity disorder (ADHD): evidence from neurocognitive and neuroimaging studies. Neuropsychologia 51(2), 235266.
Rubia, K, Noorloos, J, Smith, A, Gunning, B and Sergeant, J (2003) Motor timing deficits in community and clinical boys with hyperactive behavior: the effect of methylphenidate on motor timing. Journal of Abnormal Child Psychology 31(3), 301313.
Schweren, LJS, Hartman, CA, Heslenfeld, DJ, van der Meer, D, Franke, B, Oosterlaan, J et al. (2015) Thinner medial temporal cortex in adolescents with attention-deficit/hyperactivity disorder and the effects of stimulants. Journal of the American Academy of Child and Adolescent Psychiatry 54(8), 660667.
Shaw, P, De Rossi, P, Watson, B, Wharton, A, Greenstein, D, Raznahan, A et al. (2014) Mapping the development of the basal ganglia in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 53(7), 780789.e11.
Shaw, P, Sharp, WS, Morrison, M, Eckstrand, K, Greenstein, DK, Clasen, LS et al. (2009) Psychostimulant treatment and the developing cortex in attention-deficit/hyperactivity disorder. American Journal of Psychiatry 166(1), 5863.
Swanson, JM, Hinshaw, SP, Arnold, LE, Gibbons, RD, Marcus, S, Hur, K et al. (2007) Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. Journal of the American Academy of Child and Adolescent Psychiatry 46(8), 10031014.
Swanson, JM, Kraemer, HC, Hinshaw, SP, Arnold, LE, Conners, CK, Abikoff, HB et al. (2001) Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry 40(2), 168179.
Tsai, C, Huang, Y, Wu, C, Hwang, F, Young, K, Tsai, M et al. (2013) Long-term effects of stimulants on neurocognitive performance of Taiwanese children with attention-deficit/hyperactivity disorder. BMC Psychiatry 13, 330.
van Lieshout, M, Luman, M, Twisk, JW, van Ewijk, H, Groenman, AP, Thissen, AJ et al. (2016) A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood. European Child and Adolescent Psychiatry 25(9), 10071017.
van Widenfelt, BM, Goedhart, AW, Treffers, PDA and Goodman, R (2003) Dutch version of the strengths and difficulties questionnaire (SDQ). European Child Adolescent Psychiatry 12(6), 281289.
von Rhein, D, Mennes, M, van Ewijk, H, Groenman, AP, Zwiers, MP, Oosterlaan, J et al. (2015) The NeuroIMAGE study: a prospective phenotypic, cognitive, genetic and MRI study in children with attention-deficit/hyperactivity disorder. Design and descriptives. European Child and Adolescent Psychiatry 24(3), 265281.
Willcutt, EG, Doyle, AE, Nigg, JT, Faraone, SV and Pennington, BF (2005) Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry 57(11), 13361346.
Yang, L, Cao, Q, Shuai, L, Li, H, Chan, RC and Wang, Y (2012) Comparative study of OROS-MPH and atomoxetine on executive function improvement in ADHD: a randomized controlled trial. International Journal of Neuropsychopharmacology 15(1), 1526.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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