background ADHD is a common neuropsychiatric disorder with a strong persistence over time. After an initial clinical response, ADHD medication is typically prescribed for months to years. It is unclear however whether extended use of medication provides long-term benefits beyond control of the key symptoms, and how long medication treatment should continued.
aim To address these issues in a systematic review and provide recommendations about the decision to stop or not to stop adhd medication.
method A systematic review was performed on papers retrieved from PubMed using the search terms adhd and/or psychostimulants, stimulants, methylphenidate, amphetamine, clinical trials, atomoxetine.
results Data of placebo-controlled discontinuation studies and of prospective long-term treatment studies, including the multimodal treatment study of adhd (MTA) provide evidence that intensive medication management leads to a strong reduction of adhd symptoms for a period of two years or so, and also less impairment of functioning. For the majority of children with ADHD, however, long-term follow-up data fail to provide support for long-term advantage of medication treatment beyond symptom control, i.e. for improved social functioning, academic achievement, employment status and less adverse psychiatric outcome.
conclusion Clinical decisions about starting, continuing, and stopping adhd medication have to be made on an individualised basis. Periodic, at least yearly, medication discontinuations should be implemented to check for need and ongoing benefit, and unfounded assumptions about continuing benefit of medication use should be abandoned.