Long-term outcomes of childhood ADHD stimulant use trajectories

Background. Stimulant medication is the first-line pharmacological treatment option for children with attention-deficit/hyperactivity disorder (ADHD). However, long-term effects remain unclear. Therefore, we explored long-term (>12 years) outcomes of childhood stimulant medication use, using data from the NeuroIMAGE cohort. Method. Childhood (up to Mage=16.14, SDage=3.48) stimulant treatment trajectories were detected using K-means clustering based on age at initiation, stop age, total and maximum daily dose, and duration and variability of stimulant use in 324 children. The trajectories were compared across seven domains of adult outcomes (controlling for multiple testing) including psychiatric status, behavioral and emotional functioning, academic and professional functioning, adaptive functioning, neurocognitive functioning, physical health, and healthcare service use. Results. In 143 adults with childhood ADHD (Mage=28.34, SDage=3.74, 65% males) three stimulant treatment trajectory groups were detected: early-and-intense (n=46), late-and-moderate (n=63), and stimulant-naïve (n=34). The three groups did not differ on most adult outcomes, but group differences were observed for the adaptive, neurocognitive and physical functioning domains on the measures risk perception, cognitive flexibility, and sleep quality. The early-and-intense group had the most favorable mean scores (trend effects) compared to the other groups. Findings did not change after controlling for age and sex. Discussion. Stimulant medication use in childhood did not predict long-term outcomes in those with childhood ADHD in our sample, with a few exceptions, including some positive outcomes related to risk perception, cognitive flexibility, and sleep quality in those with longer and higher dosages. Our findings suggest