ADHD: Why Early Onset Can Lead to a Decade of Medication

ADHD is a disorder that causes inattention, agitation and impulsivity, especially in children and adolescents. Treatment with medications, such as methylphenidate, can help control symptoms, but there are still questions about their long-term effects. A study in Finland showed that many children, especially younger boys, use these medications for several years. This highlights the importance of closely monitoring the use and effects of these medications over time.

Attention deficit hyperactivity disorder, better known as ADHD, is a common condition that affects brain development. Children and adolescents with ADHD often have difficulty paying attention, are very agitated (hyperactive) and act impulsively, that is, they do things without thinking much about them first.

These symptoms can significantly disrupt school, social and even family life. It is estimated that between 3% and 7% of children have ADHD, and symptoms usually appear between the ages of 7 and 16. In many cases, ADHD continues into adulthood, in about half of people diagnosed in childhood, especially in those who also have other psychological problems.

Medication is one of the most common ways to treat ADHD, and well-controlled studies have shown that these medications can significantly reduce symptoms in the short term, usually within 3 months. In addition, when ADHD is treated, there is a lower risk of accidents, poor grades in school, and aggressive behavior. 

However, there are still doubts about the long-term benefits of these medications, as longer studies are scarce or have limitations. For example, studies are not always able to separate the effects of medication from other factors that influence the child's life, such as family support or school environment.

Another important point is that the most positive studies sometimes only include children who have already responded well to medication, which can make the results seem better than they really are.

In Finland, for example, medical guidelines recommend that children aged 6 and over diagnosed with ADHD consider taking medication, with methylphenidate being the most recommended. This medication, which is a stimulant, has been used for many years and, in studies lasting up to six months, has not been shown to cause serious side effects.

However, it is common for it to cause minor effects, such as difficulty sleeping or loss of appetite.

Even so, scientists point out that the evidence on the positive and negative effects of continued use of these medications is still weak, and studies that evaluate the long-term effects more rigorously are rare.

As the use of these medications has increased around the world, a concern has arisen: are we treating them well or are we just masking the problems? Some suggest that prolonged use can hinder growth or even lead to worse school performance in some cases.

Another point is that many patients end up stopping taking the medication over time. In a large follow-up study, for example, less than a third of children were still taking the medication after 8 years, compared with almost two-thirds after just over 1 year.

We still know little about how long children actually take ADHD medications in the real world. Some studies suggest that between 50% and 75% continue treatment after a year, but few have followed patients for longer.

A recent study conducted in nine countries showed that among younger children (aged 4 to 11), about half were still on treatment after five years. Among adolescents, the tendency was to stop taking medication earlier. Boys and girls showed similar patterns.

With this in mind, a group of researchers in Finland decided to study in more depth how long children and adolescents actually continue to take ADHD medication.

They analyzed data from almost 41,000 young people between the ages of 6 and 18 who started treatment between 2008 and 2019. To find out how long each person used the medication, the scientists consulted national drug purchase records. The follow-up lasted, on average, almost 4 years.

The results showed that, on average, the young people took the medication for just over 3 years. Boys remained on treatment for longer than girls.

In addition, the younger the child started treatment, the longer they tended to remain on the medication. Boys between 6 and 8 years old, for example, were those who remained in treatment the longest, with an average of more than 6 years.. 

Probability of continued use of ADHD medication over time among boys, by age at treatment initiation. The Kaplan-Meier curve shows that boys who started treatment between the ages of 6 and 8 (red line) had the longest duration of medication use, with over 50% still on treatment after 6 years. As age at initiation increases, treatment duration tends to decrease. Boys who started between the ages of 16 and 18 (dotted blue line) had the lowest continuation, with a sharp decline in the first few years. This suggests that the earlier treatment is initiated, the greater the chance that it will be maintained for longer.

In summary, this study shows that, in practice, treatment with ADHD medications can last for many years, especially among younger boys, well beyond the time frames typically studied in traditional clinical research. These data help to better understand how ADHD is treated in real life and highlight the importance of continuing to study the effects and safety of long-term use of these medications.

READ MORE:

Duration of ADHD medication treatment among Finnish children and adolescents ‒ a nationwide register study. 

Terhi A. Kolari, Miika Vuori, Hanna Rättö, Eveliina A. Varimo, Eeva T. Aronen, Kari Auranen, Leena K. Saastamoinen, and Päivi T. Ruokoniemi 

Eur Child Adolesc Psychiatry (2025). 

https://doi.org/10.1007/s00787-025-02735-4

Abstract:

To study the duration of attention-deficit/hyperactivity disorder (ADHD) medication treatment among children and adolescents by sex and age group in Finland during 2008–2019. This was a descriptive, population-based register study covering all Finnish children and adolescents aged 6–18 years who initiated their first ADHD medication treatment period between January 1, 2008 and December 31, 2019 (n = 40691). To establish the duration of use we collected data from the register of Dispensations reimbursable under the National Health Insurance Scheme register. The median follow-up time was 3.8 years (Q1 = 1.7, Q3 = 7.1). Treatment duration was calculated as the interval between the date of the first and last purchase with a cut-off of 365 days allowed between purchases. The durations were estimated using Kaplan-Meier survival times. The median duration of ADHD medication treatment was 3.2 years (95% CI 3.2, 3.3, Q1 = 1.0 95% CI 0.9, 1.0, Q3 = 6.8 95% CI 6.7, 7.0). Sex and age significantly influenced treatment duration (p <.0001 and p <.0001). Boys had longer treatment duration than girls and the younger the subject, the longer the duration of usage. Boys aged 6–8 years (32.4% of the subjects) exhibited the longest treatment duration with a median of 6.3 years (95% CI 6.2, 6.5, Q1 = 2.6 95% CI 2.5, 2.7, Q3 = 9.4 years 95% CI 9.2, 9.6). The duration of ADHD medication treatment among children in the real-world clinical setting goes well beyond the data available from randomized controlled trials and extends for several years especially among young boys.