Almost 11% of children have been diagnosed with Attention Deficit Hyperactivity Disorder or ADHD and 70% of them receive medication for it. Two new studies provide valuable information on ADHD diagnoses and the long term effects of medical therapy.
Both of the studies are database studies of thousands of children and with any database study there is some risk of confounding and bias. This means that there is a chance that future database studies of similar quality or better quality studies like randomized controlled trials might find the same or opposite results. However, they are the best data we have on the topic area to date. The first study is from Taiwan where the cut-off date for entering preschool and for regular school is August 31. They looked at the kids born in August who just made the cut off and compared them to kids born in September did not make the cut off and entered a year later. Those kids starting preschool or elementary school being relatively younger were more likely to be diagnosed as having ADHD and receiving medication for ADHD than those who were relatively older. This implies that the diagnosis of ADHD in some children might reflect immaturity and not real disease and supports what many parents are coming to appreciate; if your child is not mentally ready to start school it might make sense to hold them back and give them more time to mature or to appreciate that expecting your child to measure up to kids who are relatively older might not be reasonable in kindergarten or first grade. This is similar to data collated in the book Outliers by Malcolm Gladwell where they show that kids who just make the cut-off age to play hockey, soccer, and baseball are much less likely to ever play professionally and those who just miss the cut-off and are held back a year are the most likely to become professional athletes. It is a self-fulfilling prophecy where relatively younger kids struggle, don’t enjoy it as much and are less willing to put in the time and effort versus those who have earlier success.
People know that ADHD medications can increase mental focus and reduce impulsive actions which improve school performance. But do they do anything over the longer term to benefit the children? That has not been adequately studied but the second study does touch on this. In this study conducted in South Carolina they looked at the long term impact of treating ADHD with medications versus not treating them. Kids receiving medication for their ADHD were 7% less likely to have a substance-abuse disorder, 3% less likely to contract a sexually transmitted disease, and 2% less likely to be injured in their teenage years. By controlling impulsive actions and given them a better ability to think through the implications of their actions, kids on medications made fewer risky lifestyle choices. This should comfort parents opting to treat their children with medication.
In very young children, it is hard to tease out natural immaturity versus ADHD and this should be thought through before handing out a diagnosis to someone for whom the benefits might not warrant the risks. However, if your child truly has ADHD, therapy is not only effective in the short run, improving focus and school performance, but is also beneficial over the long term in reducing risky behaviors in the children’s teenage years.
Dr. Michael White, UConn School of Pharmacy