ADHD Medication Benefits Increase Over Time

ADHD medication research symptoms improve quickly higher brain functions take longer

A landmark study offers good news about the cumulative benefits of ADHD medications taken over time. Excerpt:

Results showed that adult ADHD patients who received drug treatment for more than two years had fewer symptoms and less psychological distress compared to those treated for two years or less.

Just yesterday, a consulting client asked me, “How long will it take after starting medication for my ADHD to start seeing the benefit?” My answer was the same as given in my  first book (Is It You, Me, or. Adult A.D.D.?)

  • Symptoms tend to get better within weeks.
  • Functioning gets better within months.
  • Perhaps most important, careful observation may identify changes in development taking place over years. For example, the individual who never had a friend now makes and keeps them. Another who could not keep a job has now kept one for a year.

In other words, this 2013 study seems to confirm one important phenomenon:  “Higher-order” functioning does not typically improve immediately after starting medication. (Even if, by some miracle, you happen upon the best type of medication for you in the early days of treatment. It typically takes a few months.)

Rather, medication strengthens these brain functions more gradually over time. Of course, some symptoms can be alleviated immediately — suddenly, you “see” that sock lying on the floor or how to clear that garage of longstanding clutter. But the more complex Executive Functions? Those connections might take longer to develop.

ADHD medication research shows symptoms improve quickly higher brain functions take longer

 

What Are Higher Brain Functions?

A 2003 clinical guide, Neuroscience in Medicine, includes these as the so-called higher brain functions:

  • Intellectual function
  • Memory
  • Speech and language
  • Complex perception
  • Orientation
  • Attention
  • Judgment
  • Planning, and
  • Decision-making

Implications for the Famous MTA Study

Psychologist Alan Sroufe
Psychologist Alan Sroufe

Another reason this study is important: Many people who should know better, including psychologist Alan Sroufe writing in a New York Times op-ed, have spread far and wide sensationalized misinterpretations of a well-known study called the MTA. That stands for the Multi-Modal Treatment of Attention-Deficit/Hyperactivity Disorder.  This study funded by the U.S. National Institute of Mental Health.

The MTA is a long-term, rigorous, multi-site study examining the effects of medication and other strategies on school-age children with ADHD.

Detractors such as Sroufe claim the MTA offered proof that medications stop working after two years. They do not. The truth is more complicated.  In other words, they either are willfully misinterpreting the study or, honestly, they just don’t understand it. The Child Mind Institute posted a short, clear essay on this topic: What We Know About the Long-term Effects of ADHD Medications.

Preeminent ADHD Expert Rebuts Sroufe’s Op-Ed

Lily Hechtman, MD, FRCP
Lily Hechtman, MD, FRCP

A preeminent ADHD expert and McGill University psychiatris professor, Lily Hechtman, MD, FRCP, countered Sroufe’s op-ed. Posted at the website of CADDRA (Canada’s ADHD professional organization) in response to the same op-ed appearing in Canada’s National Post, Dr. Hecthmann wrote (National Post Article January 31st, 2021 — Ritalin Gone Wrong):

Dr Sroufe refers to the exhaustive study of the use of stimulant medication for ADHD, the Multimodal Treatment Study of Children with ADHD (MTA), funded by the National Institutes of Health in the United States. This is the largest and most comprehensive treatment study of ADHD that has ever been conducted and one of the seven international study sites was in Montreal.

The study proved conclusively that stimulant medication, given on a regular basis and in a supervised setting, is very effective for treating the symptoms of ADHD.

The article [the op-ed from Sroufe] chose to focus on follow-ups to this study that were inconclusive but fails to explain this is largely due to poor compliance once children and adolescents left a vigorous study protocol.



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What is not said is that long-term randomized studies on the effects of ADHD medication are incredibly expensive and difficult to conduct; they are also unethical as they would involve children given a placebo for years for the purpose of a study. When participants leave the controlled research environment created within a study, community follow-up is often poor.

MTA: Skeptics’ Favorite Whipping Post

When it comes to misinterpreting the MTA findings, it’s not just the academics with an ax to grind (they’re miffed that medication works better than their specialized “therapies”). It’s also the anti-ADHD zealots. Moreover, it is also certain people seeking to exploit the “ADHD Market” by offering their dubious “alternative” services. Please consider your ADHD information sources carefully.

The study was led by Michael B. Lensing, MA, of Oslo University Hospital in Norway. Read more at: Four-year outcome in psychopharmacologically treated adults with attention-deficit/hyperactivity disorder: a questionnaire survey.

I welcome your comments.

—Gina Pera

MORE FROM GINA

17 thoughts on “ADHD Medication Benefits Increase Over Time”

  1. Hello,
    I was diagnosed with ADD about 3 years ago as an adult, and have been on medication since. I actually found your site because I was searching for information on long-term effects (both effectiveness and onset of new side effects). Lately I just haven’t felt that the medication has been as effective, and I’ve seen some changes in my mood overall.

    Your post makes the comment: “These people claim the MTA offered proof that medications stop working after two years. (They don’t! the truth is more complicated!).” Can you explain what this means a little more, or point me in the direction of another post that discusses it? Specifically, why do people believe the medications stop working after a couple years and what the “more complicated” answer is.

    Thanks

    1. Hi Kat,

      There are so many misconceptions and even propaganda-tropes on the Internet. If I addressed all of them, it would be another unpaid full-time job! 🙂

      Bottom line is: The MTA subjects’ medication “stopped working” because they stopped taking it—or they relied on “community care”. That is, prescribers in the community, not the more careful and attentive prescribers who worked with them for the study.

      Other reasons the medications “stop working”:

      1. Over-relying on the stimulant to propel one through the day instead of implementing supportive strategies.
      2. Developing sleep deficits
      3. Eating a poor diet, therefore depriving the brain and medication of the building blocks of neurotransmitters.
      4. The prescriber failing to account for co-existing conditions (e.g. depression, anxiety, etc.) that could be exacerbated by a stimulant alone and therefore reduce effectiveness.

      When it comes to Adderall, it has a different mechanism of action, compared to the other stimulants. And it can actually deplete cells of key neurotransmitters.

      Just a few possibilities!

      g

  2. HECKFREAKINGYEAH!

    I’m sorry, this study just makes me do a happy dance. It makes perfect sense to me as to why it takes two years: the medication brings clarity quickly, but you have to build habits over time.

    I’m at two and a half years medicated, and I’m just now starting to see the overall balancing of life-issues (like keeping friends, maintaining momentum towards goals, long-term patience with my kids, etc.)

    My husband, on the other hand, just got diagnosed last week. 🙂

    Ms. Pera, I kid you not, we were in marriage counseling, and the counselor mentioned (for the 50th time) how some of his “quirks” were due to super-high intelligence. I raised my hand like a 3rd grader: “Um, how come if I lose things, miss bills, can’t find my glasses, can’t get the house clean, and get the kids to school late, that I have ADHD, and am desperately trying to manage it—but if he does the same thing, it’s because he’s a genius?” She smiled, nodded, and said, “No, you’re brilliant too. And he has ADHD.” It took him more than a year to follow-up on that statement, and I’m honestly fine with that. He had to come to his own conclusions, without me leading him by a hook in the nose. Now, he’s passionate about managing his ADHD well, and rejoiced with me at the thought of having a more even keel two years from now.

    Thanks for all you do.

    –djy

    1. ACCCKKKKK!!!!

      “Um, how come if I lose things, miss bills, can’t find my glasses, can’t get the house clean, and get the kids to school late, that I have ADHD, and am desperately trying to manage it—but if he does the same thing, it’s because he’s a genius?”

      I love you, Dotty!! THIS is genius!!!!!

      And I am just thrilled for both of you. Congratulations!!!

      g

  3. Hi Gina, thanks for sharing this wonderful information. Hehe people with ADD need to have patience regarding their medication.

    1. Ha! And isn’t that a Catch-22-type joke, Dave! First, they have to be organized and persistent enough to slog through the maze we call our mental-health system. Then they have to be methodical and careful in noticing the progress (or side effects) with medication, even if their physicians don’t help them with this. Then they are expected to wait more than two years to see the full effect of medication. 🙂

      It is a testament to the willpower and perseverance that many people with ADHD do, in fact, have that they stick it out. 🙂

  4. And more re: the findings:

    Our study has 4 main findings. First, among participants,
    a majority reported ongoing treatment with ADHD medi-
    cation after more than 4 years. Second, current treatment
    was associated with fewer self-reported ADHD symptoms
    and better mental health functioning. Third, pharmacologic
    treatment for more than 2 years was associated with better
    outcome. Fourth, psychiatric comorbidity at baseline pre
    dicted poorer outcome.

    One of the main challenges in treatment is that “drugs
    don’t work in patients who don’t take them.”
    In studies of ADHD samples, difficulties with compliance with drug
    treatment over time have been reported frequently.

    Although based on self-report, the high percentage of cur-
    rent treatment among participants in our study is striking.
    Possible explanations for our finding can be
    found in the Nordic welfare system, which is based on equal
    treatment conditions, eg, the availability of specialists for all
    inhabitants, and expenses for necessary medical treatment
    are mostly covered by the national welfare system…..

  5. FYI — here is the abstract.

    http://www.ncbi.nlm.nih.gov/pubmed/23419235

    And here is a snippet from the study (which was based on self-reports, not any type of brain-imaging). Not that this supports what I wrote earlier; long-acting stimulants are a better choice than short-acting, if you tolerate them.

    Current Use of ADHD Pharmacotherapy

    At follow-up, 232 subjects (63.0%) reported current
    psychopharmacologic treatment, and, of these, 116 sub
    jects (50.0%) reported use of long-acting methylphenidate,
    while 77 subjects (33.2%) were treated with short-acting
    methylphenidate. Thirty-nine subjects used other ADHD
    medications (mostly dextroamphetamine sulfate or
    atomoxetine). Self-reported treatment adherence, defined
    as not missing a single dose during the last week, was sig-
    nificantly higher when patients were treated with long-acting
    than short-acting stimulant medication (75.7% vs 42.9%;
    75.7% vs 42.9%) Among patients taking atomoxetine
    (n=13), 50.0% reported not having missed a single dose
    during the last week.

    At follow-up, 136 subjects (37.0%) had discontinued drug
    treatment (off-medication group). Nearly half of this group
    had used short-acting methylphenidate as the last medi
    cation before discontinuation. Most frequent reasons for
    discontinuation were adverse events (55.1%), lack of efficacy
    (32.4%), and misuse of medication (16.9%, reported by men
    only). Eleven subjects (8.1%) reported remission as reason
    for stopping medication.

  6. What is unclear to me regarding the study is if the medicine is causing higher functioning over time. Seems to me that neurostimulants only have a medicinal effect during a certain short term duration. The medicine helps an ADHD person meet a deadline or remember to take out the trash and over time the short term alleviation of distraction, inattention and hyperactivity will yield long term success in these “higher functioning” areas. So, circling back to my original statement, is the medicine actually improving the connections from the PFC made throughout the brain or is short term success building on each other?

    1. Good question, Andrew. I think the answer is: We don’t know for sure. 😉

      That said, there is much to be said for 24-7 medication treatment — or as long as possible throughout the day. That allows one to consistently achieve a certain level of functioning and keep building upon success.

      Perhaps some people can get by with a short-acting stimulant, but many people with ADHD do better when they help the brain achieve homeostatis — a predictable flow of neurochemicals. And that means 24-7 strategies. For many people, that’s a low dose of Strattera (24-7) combined with a long-acting stimulant (Concerta, Vyvanse, etc.) — sometimes even a booster dose of the long-acting stimulant in the afternoon.

      Otherwise, it can be like that movie Ground Hog’s day, with the person unable to keep building on the connections made because they’re riding a jagged neurochemical roller coaster.

      This is written quickly, when I’m hungry and tired. But I think you catch my drift!

  7. Joel Rosenberg

    When you refer to meds helping bridge the executive functioning gap over time, are there specific ADHD meds that do this more effectively than others?…and does it actually bridge the gap/malfunction in the pre-frontal cortex, or is there another mechanism at play?

    1. Hi Joel,
      The medications considered the first-line treatment for ADHD are the neurostimulants. Most of the research has taken place with that type of medication.

      We talk about the prefrontal cortex as being the seat of so-called Exeuctive Functions. But in point of fact, the brain is much more complicated, with connections to/from the pfc made throughout the brain.

      I write at length about this in my book: http://www.amazon.com/dp/0981548709/?tag=wwwginaperaco-20

      best,
      g

  8. Pingback: Nuevo estudio: Los beneficios de la medicación aumentan con el tiempo | Dra. Elena Díaz de Guereñu. TDAH en Vitoria-Gasteiz

  9. Well done Gina, many thanks for this update. These note support what we’ve seen for years with responsible med management coupled with specific development of interpersonal skills previously left unattended.

    1. Yes, it is fabulous news. And, I hope it is an encouragement to people just starting out, that it might take a while to achieve full benefits from medication. Patience is often not an ADHD strong suit (but Rx can usually help with that, too!). 😉

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