Treatment Landscape for the Management of ADHD - Episode 12
Transcript: Theresa Cerulli, MD: Tim, what does all this mean, in terms of discussing the efficacy and safety of each of these classes of medications, taking into consideration the short-acting and long-acting stimulants and the nonstimulants?
Timothy E. Wilens, MD: I have to say that many of the people on this panel today have been the ones who have been very involved in study these medications in different models. But across the board, the stimulant medications are highly effective for the treatment of ADHD [attention deficit hyperactivity disorder]. They’re among the most powerful, or I should say most effective, agents that we have of all the psychiatric medications we use. In general, three-quarters of people respond to stimulant therapies. Peoples’ typical responses in terms of how much you drive down their symptoms range from 30% to 50%.
If you want to use a fancy term, they call it effect size. The effect size is roughly 1.0, which is a massive effect size. And this has been demonstrated in what we called naturalistic studies. These are studies in the home. People are at home, and they do standard trials. Again, look at the panelists who have been very involved in these analog classrooms, in these laboratory classrooms, using these exquisitely sensitive systems to monitor every movement of a child and map it out against their blood levels and things like that.
It’s demonstrated to be effective within a half an hour out to 14 to 16 hours depending on the class of medication. I’m actually really impressed with the long-term data too, though. We’ve always said that people say, “One of the shortcomings with the data is that there’s no long-term data.” That’s not true. That’s simply not true. We just published something that looked at this, and there are a host of long-term outcomes data.
If you look at these mega studies, these big registry studies where they can map out treatments over time—looking at who got their medications when, use between kids to those people who are on versus off medications at different times—they’ve demonstrated a number of things. They show long-term reductions in substance-use disorders. They show long-term reductions in criminality, motor vehicle accidents, traumatic brain injuries, and general injuries. They show reductions in mood disorders and reductions in suicidal behaviors.
It’s really great, from a long-term-outcomes standpoint, to say many of the things we talked about earlier—about these severe impairments and consequences of untreated ADHD—are being reversed with ongoing treatment. The vast majority of that treatment in these trials are with the stimulant medications.
Transcript Edited for Clarity