A review of three studies on young people with attention-deficithyperactivity disorder (ADHD), reveals for the first times the extent to which stimulant therapy reduces the development and severity of mood disorders, conduct problems, substance use disorders, and other problems. The study, which was conducted by Massachusetts General Hospital researchers, is being published online. Journal of Adolescent Health.
“Our study shows that early treatment with stimulant medication can have very strong protective effects against the onset of ADHD-associated functional complications such as mood and anxiety disorders and conduct and oppositional disorder, addictions, driving impairments, and academic failure,” said Joseph Biederman MD, chief of Pediatric Psychopharmacology at MGH and MassGeneral Hospital for Children. It measures the effectiveness of stimulant treatment in reducing specific functional outcomes by quantifying the improvements.
Previous studies on stimulant treatment for ADHD had limitations. They only looked at ADHD in boys and did not calculate the extent of the protective effects. The current study determined the NNT statistic (number of people needed to treat), which is commonly used to prove the effectiveness and efficiency of an intervention. NNT stands for number of people receiving medication or other treatment that is needed to prevent a certain unwanted outcome. The lower NNT indicates effectiveness.
To calculate the NNT required to prevent certain outcomes, the investigators used data from three studies previously published. Two of these studies were prospective long-term studies of children diagnosed with ADHD. One was for boys and one was for girls. Some stimulants were used while others were not. The third study was double blind, randomized study of young adults diagnosed with ADHD. It measured their performance on a driving simulator upon entry and after six weeks of treatment with stimulants or placebos. The average age of participants in the long term studies was 11 years at study entry and 20 years at follow up. The current investigation only considered those with ADHD. Participants in the driving study ranged from 18 to 26 years old.
The NNTs for the outcomes were quite low, according to our tests.
- To prevent one student from repeating a grade or developing conduct disorder or anxiety disorders, or other oppositional-defiant conditions, three ADHD participants had to be treated.
- Four participants with ADHD had to be treated in order to prevent them from experiencing major depression or an accident during the driving simulator.
- Five participants with ADHD had to be treated in order to prevent them from developing bipolar disorder. Six were to stop one from smoking cigarettes and ten were to prevent one developing a substance abuse disorder.
Treatment had no effect on the outcome of the treatment, other than the fact that participants were younger and more protected from substance abuse disorders.
“Now, we have the evidence allowing to say that stimulant therapy of ADHD prevents several very serious functional outcomes,” said Biederman who is a professor at Harvard Medical School of Psychiatry. “However the impact on other serious outcomes such as suicide risk, post-traumatic Stress disorder, traumatic brain injuries, suicide risk, and employment success needs to be explored” Is your team planning to conduct such studies?
Materials provided by Massachusetts General Hospital. Note: Content can be edited for style or length.