Long-term benefits of ADHD meds questioned

More than 6% of all children in the U.S.  take medications for ADHD, with significant increases in just the past few years.

And while there’s a great deal of controversy over the potential side effects and over-use of these drugs, their efficacy is less frequently called into question.  For most children, ADHD medications seem to induce  drastic and immediate improvements in behavior and attitude.

However, a recent article in Nature from Katherine Sharp examined the  long-term effects of ADHD meds on academic performance and found no evidence to support lasting benefits for children taking them:

As the drugs have become more widespread, so has their cultural cachet. Stimulant medications have gained a reputation for turbo-charging the intellect. Even news stories critical of their use refer to them as “good-grade pills”, “cognitive enhancers” and “mental steroids”.

For most people with ADHD, these medications — typically formulations of methylphenidate or amphetamine — quickly calm them down and increase their ability to concentrate. Although these behavioural changes make the drugs useful, a growing body of evidence suggests that the benefits mainly stop there. Studies indicate that the improvements seen with medication do not translate into better academic achievement or even social adjustment in the long term: people who were medicated as children show no improvements in antisocial behaviour, substance abuse or arrest rates later in life, for example. And one recent study suggested that the medications could even harm some children1.

After decades of study, it has become clear that the drugs are not as transformative as their marketers would have parents believe. “I don’t know of any evidence that’s consistent that shows that there’s any long-term benefit of taking the medication,” says James Swanson, a psychologist at the University of California, Irvine.

It’s important to note  that these medications can, and often do, provide a short-term boost that can be incredibly helpful for a child’s development. Sharp writes,

Many researchers think that a stint on medication, when it is needed, can create an upward spiral of self-esteem that may make a crucial difference to a child’s life — but there are no hard data to support this. “It may be that treatment doesn’t translate into better grades” in the long term, Volkow says. “But what I’d like to see is, are those kids overall better integrated?”

Some experts think that the focus on academic achievement is misguided — that the point of the drugs has never been to improve children’s grades, or increase their chances of admission to the best universities. “Medications are given for their short-term effects,” says Swanson. “Don’t expect medication to get rid of every problem a child has. But if the problem right now is not passing the second grade, or not having any friends in the third grade, we can do something about that now.”

Thus, it may be the case that the meds are working exactly  as intended, and it is we who are placing unreasonable expectations on these drugs.  We may need to look to other, non-pharmacological strategies for improving attention skills long-term.