Can Long-Term ADHD Medication Improve Symptoms and Daily Functioning in Children and Teens?

What you need to know

• This 2-year study followed children and teens with ADHD as they took medication, looking at changes in symptoms, daily functioning, and co-occurring conditions.
• ADHD symptoms improved significantly and quickly for most participants, with benefits maintained over the 2 years.
• Daily functioning in areas like family life and school behavior also improved, though to a lesser degree than core ADHD symptoms.
• Some co-occurring conditions like depression and anxiety improved with ADHD treatment, while others like autism showed little change.
• Side effects were generally mild, with decreased appetite being most common. Few participants stopped treatment due to side effects.

Background on ADHD and treatment

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that affects about 5% of children worldwide. It can cause significant difficulties with attention, hyperactivity, and impulsivity that interfere with daily life. Many children with ADHD also have co-occurring conditions like autism spectrum disorder, anxiety, or learning disabilities.

Medication is a common and effective treatment for ADHD symptoms in the short-term. However, less is known about the long-term effects of ADHD medication on overall functioning and quality of life. Some previous studies have suggested that benefits may decrease over time as children stop taking medication.

This study aimed to look at the effects of ADHD medication over a 2-year period in children and teens, focusing not just on core ADHD symptoms but also on daily functioning and co-occurring conditions. The goal was to get a more complete picture of how ADHD treatment impacts children’s lives over time.

About the study

The researchers followed 128 children and adolescents with ADHD, aged 6-18 years, for 2 years as they took ADHD medication. Importantly, the study included participants with a range of co-occurring conditions that are common in ADHD but often excluded from medication trials. This included:

• 31% with autism spectrum disorder
• 24% with some autism traits
• 59% with oppositional behaviors
• 32% with anxiety
• 16% with dyslexia or language disorders
• 17% with borderline intellectual functioning

Participants were prescribed ADHD medication (primarily stimulants like methylphenidate) by their doctors and had regular follow-up visits over the 2 years. At these visits, the researchers assessed:

• ADHD symptom severity
• Overall functioning and improvement
• Daily functioning in areas like family life, school, and social activities
• Co-occurring conditions
• Side effects

Key findings on ADHD symptoms and functioning

ADHD symptom improvement

The study found significant improvements in ADHD symptoms that occurred quickly and were maintained over the 2 years:

• After just 1 month of treatment, ADHD symptoms had improved substantially for most participants.
• At the 2-year point, 88-91% of participants were rated as “much improved” or “very much improved” compared to the start of the study.
• 61% of participants had ADHD symptoms in the normal range (similar to children without ADHD) after 2 years of treatment.

These results suggest that ADHD medication can lead to significant, lasting improvements in core symptoms for many children and teens when treatment is continued long-term.

Daily functioning improvements

The researchers also looked at changes in daily functioning across different areas of life using a scale called the WFIRS-P. They found:

• Moderate improvements in overall daily functioning
• Largest improvements in family life and life skills
• Smaller improvements in school learning and social activities

While daily functioning did improve, the changes were not as large as the improvements seen in core ADHD symptoms. This suggests that medication alone may not be enough to fully address all the challenges that children with ADHD face in their day-to-day lives.

Effects on co-occurring conditions

An important aspect of this study was looking at how ADHD treatment affected other conditions that often occur alongside ADHD. After 1 year of treatment:

• Oppositional behaviors improved in 70-77% of participants who had these issues at the start
• 82% of those with depressive symptoms at the start no longer had these symptoms
• 50-61% of those with anxiety symptoms showed improvement
• Autism symptoms showed little change in most participants

These findings indicate that treating ADHD may have positive effects on some co-occurring conditions, particularly oppositional behaviors, depression, and anxiety. However, autism symptoms appear less responsive to ADHD medication alone.

Side effects and treatment adherence

Side effects were generally mild, with decreased appetite being the most common (affecting 34% of those on stimulant medications). Other side effects included:

• Low mood (21%)
• Sleep problems (13%)
• Irritability (12%)
• Anxiety (11%)

Most side effects were temporary, lasting only 1-2 months. Only 12 participants (about 9%) stopped or switched medications due to side effects. Overall, 78% of participants completed the full 2-year study, suggesting that most children and teens were able to continue treatment long-term.

Conclusions and implications

• Long-term ADHD medication treatment led to significant improvements in core symptoms that were maintained over 2 years for most participants.
• Daily functioning also improved, though to a lesser degree than core symptoms. This suggests additional supports may be needed to fully address functional impairments.
• ADHD treatment may help improve some co-occurring conditions like depression and anxiety, but has less impact on autism symptoms.
• Side effects were generally mild and did not prevent most participants from continuing treatment long-term.

These findings support the potential benefits of long-term ADHD medication treatment for many children and teens. However, the results also highlight that medication alone may not be sufficient to address all challenges associated with ADHD. A comprehensive treatment approach that includes behavioral interventions, school accommodations, and supports for co-occurring conditions may be needed to optimize outcomes.

It’s important to note that this was an observational study without a control group, so we can’t definitively say that all improvements were due to medication alone. Additionally, the study only included children whose families agreed to medication treatment, so the results may not apply to all children with ADHD.

Overall, this research provides valuable information on the long-term effects of ADHD treatment in real-world conditions. It can help inform decisions about ADHD management for children, families, and healthcare providers. Future research examining even longer-term outcomes and comparing different treatment approaches will be important to further guide ADHD care.