Do kids ever outgrow the need for ADHD medication?

[Anonymous]

I did.
I took Ritalin from about age 10 to age 25.
I learned ways to compensate for my ADHD. I have checks and double checks for everything I do. I still live a somewhat scattered and disorganized life but I have a full time job, 3 elementary aged kids who live active lives and a husband who works long hours. I make it work and have become quite adept at never missing things that are really important (which to me is any deadline that involves the kids (school due dates, games, practices) or important things at work. The rest of life can sometimes be a little crazy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am always surprised how little research people do on this. The evidence is that ADHD meds do not improve school performance in the long term. http://www.wsj.com/articles/SB10001424127887323368704578593660384362292

I can't read that particular article since I don't subscribe to WSJ, but I have read other articles published around the same time, including several that quoted/cited the WSJ article. From what I've read, the evidence on impact on grades/academic performance is much more mixed than you're presenting it, with some studies finding an improvement in long-term performance. Also, some of the studies referenced as supporting the notion that medication doesn't help are from the 70s, back when both understand of ADHD and available medication options were very different than they are today, reducing the relevance of that research to modern treatment. Finally, as someone else said, treatment of ADHD is about so much more than just grades; to suggest otherwise is deeply ignorant.

Pp you are correct: the effects observed are extremely mixed depending on study population and design. And really, none have accomplished what we all really want to know as they do a poor job at systematically following families over time and collecting data in a standardized way during that process. There is a preschool one from Hopkins that did a slightly better job at this, but they ironically even seemed to miss discussing one of the main messages from their own data... At the end of their follow up time, medicated ADHD kids still lagged behind kids without ADHD in the ADHD severity scale and other measures they used. However, the medicated kids also showed a major increase in gains when they started meds relative to non ADHD kids, and they maintained those gains over time! So while they still were maybe lower than non ADHD kids at the end (which is what the authors focused on), these kids significantly closed the gap once they started meds.

The problem is many of the people conducting these studies aren't that savvy with methodology and so they rely on biostatisticians for help who are less aware of the biological mechanisms and relevant nuances of the data.

And then some reporter from a newspaper decides to play scientist and make wide sweeping statements that even they can't possibly understand the origins of.

Well, this is what the Hopkins press release form 2013 has to say about the study:

" The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found."

http://www.hopkinschildrens.org/ADHD-Symptoms-Persist-for-Most-Young-Children-Despite-Treatment.aspx

I am sure that ADHD meds make a difference for some kids -- but the fact is that you should understand the literature and have a doctor who is willing to discuss all these questions with you in detail. The science is far from clear here.

ADHD meds have been miraculous for MY kid so that is all that counts for us.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am always surprised how little research people do on this. The evidence is that ADHD meds do not improve school performance in the long term. http://www.wsj.com/articles/SB10001424127887323368704578593660384362292

I can't read that particular article since I don't subscribe to WSJ, but I have read other articles published around the same time, including several that quoted/cited the WSJ article. From what I've read, the evidence on impact on grades/academic performance is much more mixed than you're presenting it, with some studies finding an improvement in long-term performance. Also, some of the studies referenced as supporting the notion that medication doesn't help are from the 70s, back when both understand of ADHD and available medication options were very different than they are today, reducing the relevance of that research to modern treatment. Finally, as someone else said, treatment of ADHD is about so much more than just grades; to suggest otherwise is deeply ignorant.

Pp you are correct: the effects observed are extremely mixed depending on study population and design. And really, none have accomplished what we all really want to know as they do a poor job at systematically following families over time and collecting data in a standardized way during that process. There is a preschool one from Hopkins that did a slightly better job at this, but they ironically even seemed to miss discussing one of the main messages from their own data... At the end of their follow up time, medicated ADHD kids still lagged behind kids without ADHD in the ADHD severity scale and other measures they used. However, the medicated kids also showed a major increase in gains when they started meds relative to non ADHD kids, and they maintained those gains over time! So while they still were maybe lower than non ADHD kids at the end (which is what the authors focused on), these kids significantly closed the gap once they started meds.

The problem is many of the people conducting these studies aren't that savvy with methodology and so they rely on biostatisticians for help who are less aware of the biological mechanisms and relevant nuances of the data.

And then some reporter from a newspaper decides to play scientist and make wide sweeping statements that even they can't possibly understand the origins of.

Well, this is what the Hopkins press release form 2013 has to say about the study:

" The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found."

http://www.hopkinschildrens.org/ADHD-Symptoms-Persist-for-Most-Young-Children-Despite-Treatment.aspx

I am sure that ADHD meds make a difference for some kids -- but the fact is that you should understand the literature and have a doctor who is willing to discuss all these questions with you in detail. The science is far from clear here.

Unless it was a randomized study, where parents did not get to choose whether their kids took medication or not, I think it would be safe to say that the kids who did not take medication had less disabling symptoms than the ones that did. So if they ended up looking the same, that suggests that the medication did, in fact, make a difference.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am always surprised how little research people do on this. The evidence is that ADHD meds do not improve school performance in the long term. http://www.wsj.com/articles/SB10001424127887323368704578593660384362292

I can't read that particular article since I don't subscribe to WSJ, but I have read other articles published around the same time, including several that quoted/cited the WSJ article. From what I've read, the evidence on impact on grades/academic performance is much more mixed than you're presenting it, with some studies finding an improvement in long-term performance. Also, some of the studies referenced as supporting the notion that medication doesn't help are from the 70s, back when both understand of ADHD and available medication options were very different than they are today, reducing the relevance of that research to modern treatment. Finally, as someone else said, treatment of ADHD is about so much more than just grades; to suggest otherwise is deeply ignorant.

Pp you are correct: the effects observed are extremely mixed depending on study population and design. And really, none have accomplished what we all really want to know as they do a poor job at systematically following families over time and collecting data in a standardized way during that process. There is a preschool one from Hopkins that did a slightly better job at this, but they ironically even seemed to miss discussing one of the main messages from their own data... At the end of their follow up time, medicated ADHD kids still lagged behind kids without ADHD in the ADHD severity scale and other measures they used. However, the medicated kids also showed a major increase in gains when they started meds relative to non ADHD kids, and they maintained those gains over time! So while they still were maybe lower than non ADHD kids at the end (which is what the authors focused on), these kids significantly closed the gap once they started meds.

The problem is many of the people conducting these studies aren't that savvy with methodology and so they rely on biostatisticians for help who are less aware of the biological mechanisms and relevant nuances of the data.

And then some reporter from a newspaper decides to play scientist and make wide sweeping statements that even they can't possibly understand the origins of.

Well, this is what the Hopkins press release form 2013 has to say about the study:

" The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found."

http://www.hopkinschildrens.org/ADHD-Symptoms-Persist-for-Most-Young-Children-Despite-Treatment.aspx

I am sure that ADHD meds make a difference for some kids -- but the fact is that you should understand the literature and have a doctor who is willing to discuss all these questions with you in detail. The science is far from clear here.

Exactly. Read the actual paper and data. Their data show that those kids who were medicated showed a big improvement that was sustained. Kids who opt to stay on meds are likely more severe than families who choose to not medicate or discontinue.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am always surprised how little research people do on this. The evidence is that ADHD meds do not improve school performance in the long term. http://www.wsj.com/articles/SB10001424127887323368704578593660384362292

I can't read that particular article since I don't subscribe to WSJ, but I have read other articles published around the same time, including several that quoted/cited the WSJ article. From what I've read, the evidence on impact on grades/academic performance is much more mixed than you're presenting it, with some studies finding an improvement in long-term performance. Also, some of the studies referenced as supporting the notion that medication doesn't help are from the 70s, back when both understand of ADHD and available medication options were very different than they are today, reducing the relevance of that research to modern treatment. Finally, as someone else said, treatment of ADHD is about so much more than just grades; to suggest otherwise is deeply ignorant.

Pp you are correct: the effects observed are extremely mixed depending on study population and design. And really, none have accomplished what we all really want to know as they do a poor job at systematically following families over time and collecting data in a standardized way during that process. There is a preschool one from Hopkins that did a slightly better job at this, but they ironically even seemed to miss discussing one of the main messages from their own data... At the end of their follow up time, medicated ADHD kids still lagged behind kids without ADHD in the ADHD severity scale and other measures they used. However, the medicated kids also showed a major increase in gains when they started meds relative to non ADHD kids, and they maintained those gains over time! So while they still were maybe lower than non ADHD kids at the end (which is what the authors focused on), these kids significantly closed the gap once they started meds.

The problem is many of the people conducting these studies aren't that savvy with methodology and so they rely on biostatisticians for help who are less aware of the biological mechanisms and relevant nuances of the data.

And then some reporter from a newspaper decides to play scientist and make wide sweeping statements that even they can't possibly understand the origins of.

Well, this is what the Hopkins press release form 2013 has to say about the study:

" The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found."

http://www.hopkinschildrens.org/ADHD-Symptoms-Persist-for-Most-Young-Children-Despite-Treatment.aspx

I am sure that ADHD meds make a difference for some kids -- but the fact is that you should understand the literature and have a doctor who is willing to discuss all these questions with you in detail. The science is far from clear here.

Unless it was a randomized study, where parents did not get to choose whether their kids took medication or not, I think it would be safe to say that the kids who did not take medication had less disabling symptoms than the ones that did. So if they ended up looking the same, that suggests that the medication did, in fact, make a difference.

That could be. But there are still serious questions about even the short-term effectiveness of ADHD stimulant meds. For example, one gold-standards double blind trial of meds showed a decrease in ADHD symptoms as rated by teachers (who were NOT blinded) but NO differences between the untreated and treated group based on blind evaluations. Plus, the study found little academic improvement among the medicated students. Actually the one comforting thing about this study is that neither the treated nor untreated kids subjectively rated their anxiety to be higher, so at least we know we are not creating anxiety disorders by prescribing stimulants to kids:

"The best medium term evidence for CNS stimulant treatment is provided by the U.S. National Institute of Mental Health 14 month Multimodal Treatment (MTA) active comparator RCT of children with ADHD.4 The MTA study randomized 579 children aged 7 to 9 to one of 4 open-label arms: CNS stimulants alone (mostly methylphenidate), behavioural therapy alone, CNS stimulant plus behavioural therapy (combined) or usual care in the community (majority treated with CNS stimulants). The non-blinded teacher rated hyperactive/impulsive scale (range 0 to 3) was statistically significantly lower at 14 months in the two CNS stimulant groups (0.8) as compared to the behavioural therapy group (1.1) and usual care (1.3). This approximate difference was maintained over the 14 months of the trial. However, blinded classroom observer ratings were not significantly different between the 4 groups. In addition children’s self-ratings on the Multidimensional Anxiety Scale for Children did not differ between the 4 groups. Measures of academic achievement, the Wechsler Individual Achievement Test (reading, math and spelling, mean for age = 100, range 40-160) were mostly not significantly different; the only exception being a higher reading subscale score for combined therapy, 99, than behavioural therapy, 96, or usual care, 95."

http://www.ti.ubc.ca/2008/05/31/what-is-the-evidence-for-using-cns-stimulants-to-treat-adhd-in-children/

[Anonymous]

My DC is 11. He has been on meds since age 5. Without them he is a mess--absolutely no ability to focus at all. We don't even do summers off as he cannot function at any activities he does (camp, swim team etc...). I cannot see him off them anytime soon. I also have been told that some people "outgrow" ADHD in their 20's. Only time will tell.

[Anonymous]

Here is a good brief video of Dr. Philip Shaw from NIH discussing research that suggests 20-25% of children with ADHD have a severe adult form, while approximately 33% show complete remission, with the rest being somewhere in between:

https://www.youtube.com/watch?v=SHzVhf1dmbE

[Anonymous]

At 3.5, the dev ped said our son was certain to get a ADHD hyperactive only type diagnosis at age 5. His issues (the reasons we brought him to the dev ped) are social inappropriateness, bouncing off the walls, inability to sit still, too much touching and physicality with others, lack of personal space, etc. She said we would almost certainly want him on meds at age 5 when he was old enough, but that the hyperactive only kids in theory outgrow most of the issues they need medication for by age 7 or 8 as they learn better self regulation (compared with the inattentive kids who really only start to get diagnosed around age 7 or 8 and need the medication ongoing from then on because that's when school really mandates paying attention). However, the doctor said that many of the hyperactive only kids choose to continue medicine because it helps them with focus and order in their lives (I believe these meds help everyone with focus and order, right, regardless of diagnosis?). Son is only 4 and we're still thinking about meds for K - so can't comment on whether this has borne out!