New Study Holds Additional Support for Benefits of Stimulant Use in ADHD

Emerging evidence adds to the growing support that stimulant medication may have benefits beyond that of improving symptomology. A newly published qualitative literature review found stimulants may provide neuroprotective effects for children with ADHD.¹

In their analysis, the researchers included magnetic resonance imaging -based neuroimaging case-control and placebo controlled studies (N = 29) that examined patients with attention-deficit/hyperactivity disorder on and off psychostimulants. Five relevant review studies were also included. “With only a few exceptions, the data on the effect of therapeutic oral doses of stimulant medication suggest attenuation of structural and functional alterations found in unmedicated ADHD subjects relative to findings in controls,” the authors wrote. The protective findings were consistent across the studies despite the heterogeneity of the methodologies. They concluded, “Our review suggests that therapeutic oral doses of stimulants decrease alterations in brain structure and function in subjects with ADHD relative to unmedicated subjects and controls.”

Indeed, the thinking about medications for ADHD have gone from concern over neurotoxicity to accepting its neutrality to the notion of neuroprotection, said Timothy Wilens, MD, in a recent talk.² For instance, it is known that children with ADHD show cortical thinning.³ Wilens discussed a study looking at neuroanatomic magnetic resonance images for children with ADHD who received psychostimulant medication and compared cortical thickness with images from age-matched children with ADHD not receiving medication and typically developing children.⁴ The researchers found that cortical thickness in the group of youth with ADHD who received psychostimulants was similar to the typically developing youth. On the other hand, youth with ADHD who were not receiving medications showed more rapid thinning.

Add the neuroprotective benefits to the psychosocial benefits. For instance, Wilens said stimulants seem to have a protective effect against substance abuse, with an increased use of substances found in untreated groups. In addition, untreated ADHD in teens often lead to academic failure, lowered self-esteem, increased risk of antisocial behavior, and increased risk-taking behavior. Wilens pointed to a large Swedish study (N = 25,656) of criminality and ADHD that found a 32% and 41% reduction in criminality for patients with ADHD taking medications versus those not taking medications for men and women, respectively.⁵ In their conclusion, the study authors noted, “Among patients with ADHD, rates of criminality were lower during periods when they were receiving ADHD medication…[raising] the possibility that the use of medication reduces the risk of criminality among patients with ADHD.”

With a plethora of evidence supporting safety, efficacy, and these neuro- and social protective effects, stimulant treatment should be part of a treatment plan, he said. To help ease parental and patient concerns about these medications, Wilens said clinicians should properly educate them on the disorder, set reasonable treatment expectations, and provide psychosocial supports and resources.

References:

1. Spencer TJ, Brown A, Seidman LJ, Valera EM, et al. Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging–based neuroimaging studies. J Clin Psychiatry. 2013;74:902-917.
2. Wilens T. ADHD across the lifespan: an update. Presented at US Psychiatric and Mental Health Congress. Thursday, October 3, 2012.
3. Shaw P, Lalonde F, Lepage C, et al. Development of cortical asymmetry in typically developing children and its disruption in attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2009;66:888-896.
4. Shaw P, Sharp WS, Morrison M, et al. Am J Psychiatry. Psychostimulant treatment and the developing cortex in attention deficit hyperactivity disorder. Am J Psychiatry. 2009;166:58-63.
5. Lichtenstein P, Halldner L, Zetterqvist J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367:2006-2014.