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Stimulant treatment for ADHD

Published online by Cambridge University Press:  02 January 2018

Rohit Verma
Affiliation:
Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India. Email: rohitverma_aiims@rediffmail.com
Apala Simmi Kumari
Affiliation:
Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India
Vishal Dhiman
Affiliation:
Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India
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Abstract

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Copyright © Royal College of Psychiatrists, 2014 

We read with great interest the article by Groenman et al, Reference Groenman, Oosterlaan, Rommelse, Franke, Greven and Hoekstra1 which highlights an important facet concerning substance use in attention-deficit hyperactivity disorder (ADHD).

The authors suggested, through the generalised estimating equation model, that the risk of developing substance use disorder reverses after 18 years of age, indicating that it may be mediated by modulation in parental support. However, we wish to raise concern for this conclusion as a possible biased finding since the researchers have included patients exposed to stimulants intermittently or for short durations along with those exposed continuously (n = 358), which may have falsely led to the results. Possibly, analysis of the combined no-stimulant treatment group (stimulant-naive and those with short or inconsistent stimulant use) against the stimulant treatment group for age variable (as had been done in the correlation analysis) may have validated the statement.

In what appears to be a printing mistake, Table 1 incorrectly shows the percentage of males in the no-stimulant group as being 9.0%, which must be higher given the n in this group (36/61).

Meta-analysis also concludes that treating ADHD during childhood reduces the incidence of substance use disorder by half, whereas failure to treat doubles the risk for substance use disorder. Reference Verma, Balhara and Mathur2 We concur with the authors that stimulant treatment impact on nicotine dependence should be interpreted with caution, warranting future larger-sample, longer-term prospective studies inspecting the role of non-stimulant medications in modulating substance use disorder in ADHD.

References

1 Groenman, AP, Oosterlaan, J, Rommelse, NNJ, Franke, B, Greven, CU, Hoekstra, PJ, et al. Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. Br J Psychiatry 2013; 203: 112–9.CrossRefGoogle ScholarPubMed
2 Verma, R, Balhara, YP, Mathur, S. Management of attention-deficit hyperactivity disorder. J Pediatr Neurosci 2011; 6: 13–8.Google Scholar
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