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Expert Q&A

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What are the long-term effects of ADHD meds?

Asked by S. Licare, Missouri

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What is the long-term effect of Adderall on a child starting it at age 8? I see there is no appetite from morning to noon, but then the child becomes ravenous from late afternoon until bedtime. How can a child function without eating a good breakfast and getting through the rest of the day at school by picking at lunch? I'm not sure if I want to continue this medication or any other. Can diet alone help?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear S,

In many ways, we know more about answers to your first question than we do about many things in psychiatry. Because for all the controversy surrounding them, stimulants like Adderall have been the subject of thousands of studies. A number of studies have now followed children with attention deficit hyperactivity disorder (ADHD) from childhood through adolescence, and the findings are pretty consistent.

The short answer is that most studies find treatment with medications like Adderall to have good long-term effects on children with ADHD. That is, children with ADHD who receive treatment with Adderall or one of the other psychostimulants do better in multiple areas of their lives than do children with ADHD who don't receive treatment. For example, treatment in childhood is associated with better grades and less substance abuse during the teenage years.

So that is the overall good news. Here's the bad news: As a group, children with ADHD don't do as well in school and have more behavioral and emotional problems through the years than do children without ADHD regardless of how much treatment they get. Notice, please, that I added the qualifier "as a group" to my statement. This is very important, because individual children have very different responses to all manner of treatment, and it turns out this is very important for predicting how they will do over the long haul.

We can see this in the long-term findings from a large study of ADHD funded by the federal government. This study has now followed hundreds of subjects from childhood into adolescence over an eight-year period. A key finding at eight years is that how children responded when they first got either medication or therapy strongly predicted how well they were doing as teenagers. If a child responded very well to initial treatment, he or she was much more likely to be doing well in their lives as teenagers than children who didn't respond well.

Taken together, this is what I think the science says: ADHD is a serious disorder that has long-term negative consequences on a person's life. In general, treatment provides long-term benefit, but it's not perfect, and most children with ADHD continue to struggle into their teen years, compared with their peers without ADHD. If you can find an intervention -- either medication-based or therapy-based -- that produces significant improvements, this is a strong sign that your child will probably do well over the long term, especially if he or she continues with the treatment. This means that it is very worthwhile to keep searching for a treatment that produces clear improvements in your child, even if this requires trials of several medicines, therapists or both.

Your issue about appetite is a fairly common side effect of psychostimulants. If the medication is working for your child, and if you are seeing clear improvements in his school performance and behavior, then I would encourage you to work with your doctor to find ways to alleviate your child's erratic eating. There are multiple stimulant preparations these days that have different patterns of onset and offset and that might help improve this problem.

Now to your final question. I think the bulk of scientific data indicate that for most children with ADHD, diet alone will not significantly improve symptoms. On the other hand, recent studies suggest that certain dietary interventions may be of some benefit and might be worth considering. Several recent studies found that artificial food coloring additives may increase hyperactivity. Supplements with omega-3 and omega-6 fatty acids may be of some benefit -- in some children.

In general, current recommendations are that all children -- regardless of whether or not they have ADHD -- eat a balanced diet heavy on fruits and vegetables and low on fatty junk food. If you find that certain dietary measures help your child, and they are not unreasonable from a nutritional point of view, they may well be worth pursuing. But I would not recommend replacing better-proven therapies with diet changes alone.

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