Once ADHD, Always ADHD?

Preschool children with ADHD continue to experience severe symptoms six years after diagnosis

February 17, 2013 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) Early detection of ADHD is important for children. But what happens after diagnosis? Do the children improve? Does medication matter?

A recent study attempted to find answers to these questions with a couple hundred kids in a long-term study.

The researchers found that the children's symptoms improved a little for the first few years but then leveled off.

Over six years, the vast majority of the children still suffered ADHD symptoms, regardless of whether they were taking medication.

"Ask your pediatrician for help with your child's behavior."

The study, led by Mark A. Riddle, MD, of the Johns Hopkins University School of Medicine, tracked the long-term changes in attention deficit hyperactivity disorder (ADHD) symptoms in 207 children over six years.

The children were aged 3 to 5 at the start of the study and aged 9 to 12 at the follow-up. Boys comprised 75 percent of the participants.

The children were assessed three months after they were first included in the study, before they had been prescribed medication, and then again three and four years after diagnosis.

The researchers gathered information on the children's symptoms based on ratings from their parents and teachers.

The severity of the children's symptoms decreased from the start of the study to the third year of the study. However, the symptoms remained "moderate-to-severe" for the remaining three years of the study.

In fact, 89 percent of the children still experienced ADHD symptoms at the end of the six years. Further, there was no difference in the severity of the symptoms among children who were taking medication versus those who were not.

The children who also had oppositional defiant disorder and/or conduct disorder were 30 percent more likely to still have ADHD symptoms than those who started the study only with ADHD.

The researchers concluded that the ADHD diagnosis remained stable over the six years. The disorder is "generally chronic, with high symptom severity and impairment, in very young children with moderate-to-severe ADHD, despite treatment with medication," the researchers wrote.

They recommended a need to develop more effective ADHD treatment strategies for young children.

These findings overall are not that surprising, however, according to Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences.

“It important to keep in mind that this study started with children whose ADHD symptoms were bad enough to require medication intervention at quite young ages," Dr. Elliott noted.

"It is indeed disappointing that they not only did not do especially well with available treatment options in the original intervention but also continue to do poorly even at the 6-year follow-up.  However, this is an unusual group of children, so these results do not contradict the many, many studies that show the relative effectiveness of treatment in studies that started with older children and adolescents," he said.

That is not to say, however, that more research is not necessary, he added.

"Still, it underscores the importance of continued research for treatments that do more than just reduce symptoms but actually alter the underlying differences in brain function that cause ADHD and can make it such a chronically disabling disorder," Dr. Elliott said.

The study was published February 11 in the Journal of the American Academy of Child and Adolescent Psychiatry. The research was funded by the National Institute of Mental Health.

Eight of the paper's authors have received research funding, speaker's honoraria, travel funding or consultancy fees from a wide range of medical and pharmaceutical companies.