ADHD is often treated with medications that targetneurotransmittersystems in the brain, particularlydopamineand norepinephrine.
Stimulant medications, such as methylphenidate and amphetamines, are the most commonly prescribed and have been shown to be effective in reducing core ADHD symptoms of inattention, hyperactivity, and impulsivity.
Medication management is often combined with behavioral and psychosocial interventions for optimal outcomes.
It is advisable to speak to a medical professional about ADHD medication and the risks involved. This article is meant to serve as a review of clinical research only.
Key Points
Rationale
Attention-deficit/hyperactivity disorder (ADHD)is a prevalent neurobiological disorder affecting up to 11% of children and 5% of adults, and is associated with high rates of adverse functional outcomes (Faraone et al., 2003; Polanczyk et al., 2014).
While stimulant medications have been shown to improve ADHD core symptoms (Faraone et al., 2006), less is known about their effects on ADHD-associated functional impairments (Faraone & Glatt, 2010).
A recent qualitative review suggested beneficial effects of ADHD medication on several functional outcomes (Chang et al., 2019), but did not include a meta-analysis.
Therefore, this systematic review and meta-analysis aimed to quantitatively assess the effects of ADHD medications, particularly stimulants, on a wide range of ecologically valid functional outcomes using data from large databases and registries.
Method
The authors conducted a systematic literature search of PubMed, PsycINFO, MEDLINE, and Web of Science for studies published before January 2019 that examined the effects of ADHD medications on functional outcomes using population-wide or large insurance claims databases.
Of the 40 articles meeting inclusion criteria, 21 had extractable data for meta-analysis.
Procedure
This was asystematic reviewandmeta-analysisof observational studies using population-based and insurance claims databases.
Sample
The included studies had sample sizes ranging from 5718 to over 146,000,000 individuals with ADHD. Most studies were from non-U.S. countries.
Measures
Functional outcomes examined included mood disorders, suicidality, criminality, substance use disorders, accidents/injuries, traumatic brain injury, motor vehicle crashes, and academic outcomes. Medication adherence was also assessed.
Statistical Analysis
Random-effects meta-analyses were conducted using odds ratios for dichotomous outcomes and hazard ratios for time-to-event data. Heterogeneity was assessed with the I2 statistic.
Results
The systematic review and meta-analyses found that ADHD medication treatment, mostly with stimulants, was associated with significantly decreased risks for:
Non-significant protective effects were also seen for:
Within-individual analyses consistently showed larger protective effects during periods of medication adherence vs non-adherence.
Insight
This comprehensive review provides strong evidence that ADHD medications, especially stimulants, can mitigate a wide range of serious and costly adverse outcomes associated with the disorder.
The findings underscore the importance of early diagnosis and treatment, as well as promoting medication adherence.
Future studies should examine potential moderators and mediators of these protective medication effects. Given that most studies focused on stimulants, more research is needed on long-term functional outcomes with non-stimulants.
Strengths
This review has several methodological strengths:
Limitations
Despite several strengths, there are some notable limitations of this review:
Implications
The accumulating evidence that medication treatment of ADHD reduces the risks of highly impairing and costly outcomes has major clinical and societal implications. Clinicians should prioritize early identification and evidence-based management of ADHD.
Promoting long-term medication adherence appears critical for maintaining therapeutic benefits.
At a policy level, improving access to ADHD care and supports may yield significant returns in helping individuals achieve better functional outcomes while reducing societal costs and burdens associated with untreated ADHD.
References
Primary reference
Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes.Journal of psychiatric research,123, 21-30.https://doi.org/10.1016/j.jpsychires.2020.01.006
Other references
Chang, Z., Ghirardi, L., Quinn, P. D., Asherson, P., D’Onofrio, B. M., & Larsson, H. (2019). Risks and benefits of attention-deficit/hyperactivity disorder medication on behavioral and neuropsychiatric outcomes: a qualitative review of pharmacoepidemiology studies using linked prescription databases.Biological psychiatry,86(5), 335-343.https://doi.org/10.1016/j.biopsych.2019.04.009
Faraone, S. V., Biederman, J., Spencer, T. J., & Aleardi, M. (2006). Comparing the efficacy of medications for ADHD using meta-analysis.MedGenMed: Medscape General Medicine, 8(4), 4.
Faraone, S. V., & Glatt, S. J. (2009). A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes.The Journal of clinical psychiatry,71(6), 3475.
Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition?.World psychiatry,2(2), 104.
Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis.International journal of epidemiology,43(2), 434-442.https://doi.org/10.1093/ije/dyt261
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
