Pro’s outweigh con’s for taking stimulants for ADHD

Posted on by Prof. Barbara Franke

Many parents are hesitant to treat their children suffering from ADHD with stimulants like methylphenidate. They may be generally hesitant of using prescription drugs on children, or are afraid that the stimulant might be addictive. This is very understandable, but recent studies in the large Scandinavian population and patient registries convincingly show that pro’s outweigh con’s in the longterm effects of stimulant treatment for ADHD.

Population registries offer a great opportunity to investigate psychiatric disorders in a large number of subjects, across different social classes and in wide age ranges, without researchers having to depend on the active contribution of individuals to a research project. The registry-based research of the Swedish research group of Henrik Larsson and the Danish researchers around Søren Dalsgaard clearly shows that earlier claims about stimulants increasing likelihood of addiction are not real – on the contrary, stimulants actually reduce the risk for addiction in patients with ADHD [1]. Their research shows that the increased risk of substance use disorders is likely based on sharing of (genetic) risk factors, as first-degree relatives of patients with ADHD (i.e. their parents, siblings, or children) also showed an increased risk of becoming addicted, also if they do not have ADHD [2]. In addition, the registry-based research shows that treating ADHD with stimulants reduces the risk for comorbidities like depression [3]. Criminal behaviour, which is known to be more frequently observed in people with ADHD than in the general population (even if comorbidity with conduct disorder is accounted for [4]), was reduced to baseline levels in periods of life, in which patients had been on stimulant treatment [5]. Furthermore, traffic accidents and injuries [6] as well as the risks for committing suicide [7] or dying prematurely of other (non-natural) causes [8] was reduced in those taking medication against ADHD. Several of the publications also point to the fact that the effect is stronger for those that receive a diagnosis and medication treatment earlier in life.

It is not yet known, whether similar reductions might also be reached with other types of (non-pharmacological) therapy. What seems clear from this work, however, as well as suggested by many other publications, is that ADHD should not be left untreated.

References

  1. Chang, Z., P. Lichtenstein, L. Halldner, B. D’Onofrio, E. Serlachius, S. Fazel, N. Langstrom, and H. Larsson, Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry, 2014. 55(8): p. 878-85.
  2. Skoglund, C., Q. Chen, J. Franck, P. Lichtenstein, and H. Larsson, Attention-deficit/hyperactivity disorder and risk for substance use disorders in relatives. Biol Psychiatry, 2015. 77(10): p. 880-6.
  3. Chang, Z., B.M. D’Onofrio, P.D. Quinn, P. Lichtenstein, and H. Larsson, Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Depression: A Nationwide Longitudinal Cohort Study. Biol Psychiatry, 2016.
  4. Dalsgaard, S., P.B. Mortensen, M. Frydenberg, and P.H. Thomsen, Long-term criminal outcome of children with attention deficit hyperactivity disorder. Criminal behaviour and mental health : CBMH, 2013. 23(2): p. 86-98.
  5. Lichtenstein, P., L. Halldner, J. Zetterqvist, A. Sjolander, E. Serlachius, S. Fazel, N. Langstrom, and H. Larsson, Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med, 2012. 367(21): p. 2006-14.
  6. Dalsgaard, S., J.F. Leckman, P.B. Mortensen, H.S. Nielsen, and M. Simonsen, Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. The Lancet. Psychiatry, 2015. 2(8): p. 702-9.
  7. Chen, Q., A. Sjolander, B. Runeson, B.M. D’Onofrio, P. Lichtenstein, and H. Larsson, Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ, 2014. 348: p. g3769.
  8. Dalsgaard, S., S.D. Ostergaard, J.F. Leckman, P.B. Mortensen, and M.G. Pedersen, Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet, 2015. 385(9983): p. 2190-6.