Stimulant medication use in childhood and adolescence and its impact on later life outcomes
Meichenbaum, David Louis
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Despite hundreds of studies that have demonstrated stimulant medication to be an effective short-term treatment for ADHD, few studies have explored whether stimulant medication ameliorates negative outcomes occurring later in life. Current practice supports the wide use of stimulant medication as a primary treatment for children diagnosed with ADHD. Thus, understanding the impact of prolonged stimulant medication use is critical. This study examined whether stimulant medication use predicts outcomes in adolescents and young adults with ADHD when childhood characteristics, such as childhood symptoms, severity and demographics, and current stimulant medication use are controlled. Three hundred and fifty-four subjects with a childhood diagnosis of ADHD were evaluated during childhood and again, on average, eight years later. It was hypothesized (1) that longer stimulant medication use would improve functioning (parent-rated ADHD/ODD symptoms, parent-rated impairment, academic achievement, and delinquency) in adolescence and adulthood, and (2) that the length of stimulant medication use would interact with childhood variables resulting in findings of greater benefits of prolonged medication use on outcomes for subjects who had more severe symptoms and impairment in childhood. Duration of lifetime stimulant medication use was not associated with overall functioning, achievement scores or delinquency in adolescence and young adulthood. Counterintuitive to what was expected, higher lifetime stimulant medication use was associated with higher ratings of current symptoms of ADHD and oppositionality for adolescents and greater symptoms of ADHD in young adults. There were no meaningful significant interactions found between length of stimulant medication use and childhood characteristics predicting later outcomes. Further, current stimulant medication use was not associated with current symptomatology or functioning. The research and clinical implications of these findings are considered.