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Stimulant treatment prevents ADHD-related functional complications
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Treatment with stimulant medications in children with ADHD was linked to a lower risk for functional complications like mood, conduct and substance use disorders, and school problems, study findings published in Journal of Adolescent Health revealed.
“Considering the morbidity and costs associated with the adverse functional outcomes associated with ADHD, if stimulant treatment is shown to have low [numbers needed to treat] on important functional outcomes, it would indicate that such treatment is likely to have high clinical and public health relevance,” Joseph Biederman, MD, of the clinical and research programs in pediatric psychopharmacology and adult ADHD at Massachusetts General Hospital, and colleagues wrote.
To determine the effects of stimulant treatment on important functional outcomes in ADHD using the number needed to treat (NNT) statistic, researchers examined functional outcome data from two longitudinal studies of children with ADHD — one of boys and one of girls — followed prospectively for 10 years, and data from a randomized controlled trial of stimulants on driving performance and behavior.
Biederman and colleagues collected data on medication used, age at onset of treatment and age of treatment termination from the follow-up studies and data from stimulant assessments at baseline and after 6 weeks of treatment on lisdexamfetamine or placebo in the randomized trial. They calculated the NNT statistics using lifetime rates and adjusted NNT statistics accounting for sex, age, socioeconomic status and family intactness.
Overall, 91 male participants with ADHD had lifetime history of stimulant treatment and 39 did not; 115 female participants with ADHD had lifetime history of stimulant use and 30 did not. In the randomized trial, 31 participants received lisdexamfetamine and 30 received placebo. There were no significant interactions between sex and treatment status on functional outcomes, according to the findings.
The results showed that the numbers of patients with ADHD needed to treat with stimulants were:
- three to prevent one from repeating a grade or developing conduct disorder, anxiety disorder and oppositional defiant disorder;
- four to prevent one from developing major depressive disorder or from getting into a car accident;
- five to prevent one from developing bipolar disorder;
- six to prevent one from smoking cigarettes; and
- 10 to prevent one from developing substance use disorder.
"Now we have the evidence allowing us to say that stimulant treatment of ADHD prevents the development of several very serious functional outcomes," Biederman said in a press release. "However, the impact on other serious outcomes — such as PTSD, traumatic brain injury, suicide risk and employment success — still needs to be investigated." – by Savannah Demko
Disclosures: Biederman and colleagues report numerous financial disclosures; please see the full study.