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05 June 2024

New study finds that both stimulant and non-stimulant medications improve cognition in ADHD

A systematic review and meta-analysis study by King’s researchers tested the long-term effects of Methylphenidate and Atomoxetine on attention, reaction time, inhibition, and working memory in people with ADHD.

Someone stacking pencils whilst sat at a desk with a computer in front of them.

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders and can persist into adulthood in the majority of cases. ADHD is associated with deficits in cognitive functions, in particular executive functions such as motor and interference inhibition, sustained attention, working memory, timing, psychomotor speed, reaction time variability and switching. This is the first meta-analysis paper of chronic medication effects on cognition in ADHD, looking at attention, inhibition, reaction time and working memory. All of these aspects can affect academic performance in school, and occupational performance in adults.

The findings of this meta-analysis offer opportunities to further explore the use of stimulant and non-stimulants in the treatment of ADHD. Finding that cognitive function was comparatively improved in long term stimulant and non-stimulant treatment has implications for school and work performance for children and adults. This is an important aspect of ADHD treatment, alongside behaviour, as children particularly tend to exhibit problems with working memory and attention which can result in poor academic performance. Focus can be on behavioural improvements, but cognitive function is an important part of understanding and treating ADHD.

Professor Katya Rubia, Department of Child & Adolescent Psychiatry, King’s IoPPN

The meta-analysis shows for the first time that chronic Methylphenidate and Atomoxetine have comparable effects of improving executive functions in people with ADHD when taken over a longer period of time. For both drugs the best effect was on improving attention. Previous meta-analysis has looked at single dose effects, but this is not quite as clinically significant as looking over a longer period, which reflects more typical administration of the drugs. Previously, stimulants were considered to be the more effective treatment for cognition improvement, but this shows that non-stimulant treatment is comparable over longer term.

Isfandnia, F., El Masri, S., Radua, J., & Rubia, K. (2024). The effects of chronic administration of stimulant and non-stimulant medications on executive functions in ADHD: A systematic review and meta-analysis. Neuroscience and biobehavioral reviews, 162, 105703. Advance online publication.

For more information contact the IoPPN Communications Team.

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Katya Rubia

Professor of Cognitive Neuroscience