Most Children With ADHD Stay on Stimulant Medication, Study Shows

Stimulant medication continued to be used by most children three to six years after the conclusion of research known as the Preschool ADHD Treatment Study (PATS) in which they had participated. About 1 in 4 children was no longer taking medication, and about 1 in 10 was on an antipsychotic. Antipsychotic treatment was associated with more comorbidity.

Those are the findings of a prospective, naturalistic follow-up study of PATS by Benedetto Vittielo, M.D., of the National Institute of Mental Health, and colleagues at several other institutions, published in the Journal of Child and Adolescent Psychiatry. 

They reassessed 206 of the 303 children who had participated in PATS at three years and 179 children at six years after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50 percent of the days in the previous six months.

At year three, overall, 34 percent were on no pharmacotherapy, 41.3 percent were on stimulant monotherapy; 9.2 percent on atomoxetine (alone or with a stimulant); 8.3 percent on an antipsychotic, usually together with a stimulant; and the remaining 7.2 percent were on other pharmacotherapy. Overall, 65.0% were on an indicated ADHD medication.

At year six, just under 27 percent were on no pharmacotherapy, 40.2 percent were on stimulant monotherapy, 4.5 percent on atomoxetine, alone or with a stimulant, 13.4 percent on an antipsychotic, and 15.1 percent on other pharmacotherapy. Overall, 70.9% were on an indicated ADHD medication.

Antipsychotic treatment was associated with more comorbidity, in particular disruptive behavior disorders and pervasive development disorders, and a lower level of functioning.

For related information, see the Psychiatric News article “Study Assesses Association Between Weight Gain, ADHD Medication.”

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Preschoolers With ADHD Maintain Symptoms

Four-year-olds with attention-deficit/hyperactivity disorder (ADHD) still retain significant levels of symptoms when they reach age 10, according to the latest report from a long-term study of children with the disorder, reported in the March Journal of the American Academy of Child and Adolescent Psychiatry. Researchers led by Mark Riddle, M.D., a professor of psychiatry and behavioral sciences at Johns Hopkins Hospital, followed 207 children (75 percent male) from an average age of 4.4 to an average age of 10.4 as part of the Preschool ADHD Treatment Study (PATS).

Symptom severity declined from ages 4 to 7, but changed little afterwards. Whether the children were taking medications made little difference in severity of symptoms after age 7. A diagnosis of oppositional defiant disorder and/or conduct disorder increased the risk of an ADHD diagnosis by 30 percent at age 10. Even with the use of medications, symptoms and impairment remain, concluded the researchers. “Development of more effective ADHD intervention strategies is needed for this age group.”

For more in Psychiatric News about ADHD in young children, click here. Also see the American Journal of Psychiatry here.

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