Most studies have concentrated on primary-age children and it
must be remembered that the children in the multi-modal treatment
study of children (MTA) with ADHD study were aged between 7 and 9
years of age, so the results from that study cannot necessarily be
generalised to younger or older children.
In preschool children
Medication is rarely the first choice of treatment for such young
children. There are few quality studies of stimulant medication in
this age group, although there is a large NIMH- sponsored study
being conducted at the moment. The evidence for effectiveness is
less clear in this age group, although recent studies report more
positive outcomes with respect to core ADHD symptoms (Musten et al, 1997;
Spencer et al,
1996). Methylphenidate is not licensed for use in children
under 6 and although dexamphetamine is licensed for use in children
as young as 3 years of age, it has a greater potential for growth
retardation and its use in this age group should probably be under
the supervision of a specialist centre.
In adolescents
Although the BNF and product information sheets still suggest that
stimulant medications should be "usually finally discontinued
during or after puberty", it is now clear that stimulants remain
effective treatments for the symptoms of ADHD during adolescence.
There may, however, be some diminution in response rate during
adolescence. There are other particular issues to bear in mind when
prescribing medication to adolescents:
- Greater non-compliance in this age group
- Increased risk of drug misuse, either personal, or by selling or
passing on medication
- Increased risk of stimulant induced dysphoria
In adults ( Higgins,
1999)
- Less evidence for effectiveness, but clear evidence that are
effective in a proportion of adult sufferers
- Possible lower response rate
- Increased risk of drug misuse
- Possible increased efficacy of tricyclic antidepressants may make
them a candidate for first-line treatment in this
population