Transcript
Announcer:
You’re listening to NeuroFrontiers on ReachMD. On this episode, we’ll hear from Dr. James Swanson, who’s a Professor of Pediatrics at the University of California, Irvine School of Medicine and Founder of the Child Development Center at UC Irvine. He’ll be discussing takeaways from his recent study, called “Tolerance to Stimulant Medications in the Treatment of Children With ADHD.” Here’s Dr. Swanson now.
Dr. Swanson:
I think long-term tolerance to stimulant medication is very important, because it is essential after titration of stimulant medication to effectively treat a child with ADHD. There's a real need to adjust the dose over time, and if that's not done, the effect tends to wane or go away. And I think the underlying reason for that is the development of long-term tolerance.
In the MTA study—the Multimodal Treatment Study of ADHD—we adjusted medication over the first year of a randomized trial, and we found that it was necessary to increase medication about 30 percent over the 14 months of the trial to keep the effect of medication—which was very large—the same.
And in fact, as we increased medication each month when we had a clinic visit, the effect of medication actually tended to wane over time and was reduced about 30 percent by the end of the year. And that always perplexed me. I wondered why the effect wouldn't stay the same when we kept increasing dose to try to maximize the effect. That did surprise me, and I've been investigating the basis for that for the last many years.
I don't want people to get the misimpression that I'm a naysayer about ADHD or about the treatment of stimulant medication, because I'm not. In fact, I am proud of being the first author on the very first paper on the two medication formulations of stimulant medications that are currently used and have been used for twenty years. That's the first control study published on Adderall and also the first control study on Concerta, and both of those medications work well. There are tremendous benefits to children when they're started, and they can benefit the child and the family. They're remarkable.
But the problem is that most children, during childhood or during adolescence, stop medication, even when they need it. And I wondered why. So I think it's important for clinicians to know why their patients might stop medication. And I'm not trying to identify problems with medication. I'm trying to identify limitations, so we can make corrections and try to identify those limitations and identify some unmet needs that we need to address that really haven't been addressed in the last 25 years. It's time to address these issues, and I think clinicians should appreciate that. Most people do realize that when they're seeing patients over time, as they develop from children to adulthood, and we need to have medication that people will not stop using over time.
Announcer:
That was Dr. James Swanson talking about long-term use of stimulant medications for ADHD. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
