Debate: Are Stimulant Medications for Attention-Deficit/Hyperactivity Disorder Effective in the Long Term? (Against)

Definition of terms is necessary to address the motion. First, “psychostimulants” are defined as methylphenidate and amphetamine, which inherently are short-acting drugs characterized by pharmacokinetic and pharmacodynamic properties of immediate-release formulations that act for a few hours. Sustained effects across the day can be achieved by controlled-release formulations, but positive carry-over to the next day is not significant, so on subsequent days these medications must be administered again to reinstate pharmacological effects. Second, “effective” refers to treatment-as-usual, whereas “efficacious” refers to enhanced or optimized treatment (that may set a maximum for effectiveness). Magnitude of effectiveness (eg, small, medium, or large effect size) depends on who is treated, how treatment is delivered, what outcome is evaluated, and other factors (including treatment adherence and study design). Third, “long term” refers to a given time frame (eg, 1 year), which can be applied to specify duration of treatment, length of follow-up, or both. Some studies evaluate long-term effectiveness of treatment while it is continued, whereas others evaluate long-term effectiveness of treatment during the follow-up after it is discontinued. Given these definitions, the following questions address long-term effectiveness of stimulant medication.