4/28/2024 0 Comments Adhd medications benefis for kidsWe aimed to test the hypothesis that continued use of methylphenidate is superior to placebo with regard to ADHD symptom severity in two settings, at home and at school. To enhance the external validity, we included participants who were on dosages as typically prescribed in clinical practice rather than necessarily the most optimal ones. The primary objective of this study was to investigate whether methylphenidate remains beneficial after 2 years of use. To our knowledge, there have been no studies using a discontinuation design to investigate the effects of stopping methylphenidate in children and adolescents. Children and adolescents who were treated in regular clinical practice and had been using methylphenidate for at least 2 years were randomly assigned to either continuation of methylphenidate or gradual withdrawal to placebo. That is why we chose an alternative design, a double-blind randomized placebo-controlled discontinuation design. Obviously, conducting long-term placebo-controlled trials is not viable to address the long-term effectiveness of methylphenidate, as this would require withholding treatments for a long period. Given the high number of children and adolescents using methylphenidate for many years, and the recommendation in several guidelines for annual reconsideration of continuing medication, there is a pressing need to investigate to what extent continued use is still of benefit. ![]() Thus, current evidence for the long-term benefits of methylphenidate is limited to a treatment duration of 2 years at best ( 19– 22), although some studies indicated positive results on substance use risk for patients receiving stimulant medication for more than 2 years ( 23, 24). That is, children who were treated with methylphenidate were not compared with children who received placebo or children who received no treatment. However, the study design did not allow for ruling out effects of the natural course of ADHD on long-term outcomes because of the lack of a control group. In a randomized study ( 19, 20) comparing three treatment modalities (methylphenidate alone, methylphenidate plus multimodal psychosocial treatment, and methylphenidate plus attention control psychosocial treatment), the benefits of methylphenidate remained stable over a 2-year period. This finding was in line with earlier follow-up reports of the MTA study ( 16, 17), and it raises questions about whether long-term medication treatment continues to be beneficial or needed. The most recent long-term report tracked 476 children for 12 to 18 years after they started the controlled phase of the study the authors concluded that those still taking stimulant medication in clinical practice fared no better in the reduction of symptoms or in social functioning than those who had stopped taking medication ( 18). After the 14-month randomized phase, the MTA study conducted naturalistic and observational follow-ups ( 16, 17). From the Multimodal Treatment of ADHD (MTA) study ( 15), a randomized controlled trial comparing four different treatment strategies, we know that methylphenidate, optimally titrated over the course of 14 months, is superior to other treatments: it was found that children taking stimulants alone or combined with behavioral treatment did better than children who received routine community care (which often included treatment with psychostimulants, albeit not necessarily optimally dosed) or behavioral treatment alone. The longest placebo-controlled randomized trial to date was 28 weeks, and it showed a positive effect of methylphenidate on reduction of hyperactivity symptoms (based on parent and teacher ratings of an earlier conceptualization of ADHD that emphasized hyperactivity ). The long-term use of methylphenidate, however, contrasts heavily with the lack of data on long-term benefits of stimulant use. ![]() Indeed, stimulant use over several years has been shown to be increasingly common, across adolescence and into adulthood ( 11), perhaps as a consequence of the ease of use of long-acting methylphenidate preparations ( 12) and of the increased awareness that ADHD often persists into adulthood ( 13). Nevertheless, 60% of children who start stimulant treatment continue to use it beyond 2 years ( 9, 10). ![]() However, the long-term benefits of methylphenidate use remain unclear current treatment guidelines for ADHD state that there is only evidence for effectiveness of up to 2 years of treatment with methylphenidate and recommend that the need for continued treatment be reviewed annually ( 1, 6– 8). Psychostimulant medication, such as methylphenidate, is a first-line pharmacological treatment for children with attention deficit hyperactivity disorder (ADHD) ( 1), and its short-term efficacy is well established ( 2– 5).
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