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Areas › Focus, starting, and ADHD › Medication and how it works
The best known childhood trial followed its participants into their twenties. The early advantage of the assigned treatment faded, and the group overall was doing worse than comparison peers whichever arm they had been in. That is no reason to refuse treatment, which helped while it was given. It is a reason to keep expectations honest and to keep supporting someone past childhood instead of assuming the work is finished.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
'Give full measure when you measure, and weigh with accurate scales: that is better and fairer in the end' (Quran 17:35). Weighing accurately applies to claims about a treatment as much as it does to goods in a shop.
الإسراء
وَأَوۡفُواْ ٱلۡكَيۡلَ إِذَا كِلۡتُمۡ وَزِنُواْ بِٱلۡقِسۡطَاسِ ٱلۡمُسۡتَقِيمِۚ ذَٰلِكَ خَيۡرࣱ وَأَحۡسَنُ تَأۡوِيلࣰ ا
Give full measure when you measure, and weigh with accurate scales: that is better and fairer in the end
Qur’an 17:35read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In the young adult follow-up of that multimodal treatment study, symptoms persisted, reports from different sources disagreed with each other, and height suppression was recorded, with adult outcomes worse than in comparison peers regardless of treatment arm. It is one cohort with all the usual difficulties of long follow-up. It remains the most direct evidence on this question, so it should not be quietly left out when the durable advantage claim comes up.
Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff HB, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn JH, Jensen PS, Vitiello B, Wigal T, Epstein JN, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray DW, Muenke M, Acosta MT, Arcos-Burgos M, Pelham WE, Kraemer HC, MTA Cooperative Group. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.. Journal of child psychology and psychiatry, and allied disciplines doi
Strength of evidence: one line of research. A single study, or a theoretical account.
A benefit while treatment is running is a different thing from a benefit that outlives it.
If one family of stimulant did nothing, or felt awful, that tells you very little about the other. Methylphenidate and amphetamine work in overlapping but different ways, and plenty of people who do badly on one do well on the other.
One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.
A workable rule for anything new: do not be the first to use it, and do not be the last either. Both ends carry a cost.