Attention Deficit/Hyperactive Disorder (ADHD) is a prevalent and debilitating condition that affects up to 8% of the population. Fortunately, there are effective treatments that alleviate the symptoms and enable those who are diagnosed with it to live highly successful lives, minimizing any trace of the disorder. Typically, stimulants are the first line of treatment to promote optimal levels of functioning. As research continues to reveal the significant benefits of ADHD medication, patients and parents naturally become interested in the expected outcomes, the potential short-term and long-term side effects, and whether or not physical dependency should be of any concern.
Because of the prevalence of ADHD, stimulants are the most studied class of psychotropic medications among pediatric researchers. This means that we have considerable information and a clear understanding of their benefits and risks, and so we are in an ideal place to address some of these pressing questions.
The reason that stimulants are considered the most effective treatment for ADHD is because they promote normal dopamine functioning in the brain, which is the locus of the disorder. In neurobiological terms, stimulants target the frontal and prefrontal cortex of the central nervous system, where they block the reuptake of dopamine and norepinephrine, making more of it available in the synaptic cleft. Increased amounts of dopamine are associated with higher sociability, motivation, and a heightened capacity to focus, or pay attention. Because stimulants restore the brain to this normal baseline of dopamine production, the FDA has approved amphetamines (such as Adderall) for children over three-years old, and methylphenidate (such as Ritalin) for children over six.
These benefits are substantiated in real-world settings as well. For example, we see significant changes reflected in the Connors and Vanderbilt ratings scales, which are used by parents and teachers to evaluate the behavior of ADHD children in a variety of settings. Typically, a child’s rating will improve by one full standard deviation once a medication regimen is initiated. Also, academic performance generally improves by at least one full letter grade.
Over two hundred controlled studies on ADHD medication have proven the safety and efficacy of these drugs. Today, psychiatrists regard stimulants as the highest standard of care for ADHD. Yet because these studies are often published in scientific and medical journals, it can be difficult for parents to stay up-to-date, and therefore express concern regarding a few central issues.
For example, because stimulants, like many drugs, can be abused, parents worry that putting their children on ADHD medication may lead to dependency or higher risk of substance abuse later in life. The medical research, however, does not bear this out. To date, research indicates no greater risk of addiction, and actually shows that proper ADHD medication reduces the risk of substance abuse when patients adhere to the medication protocols prescribed by the psychiatrist. This may be due to the fact that children often experience greater success and higher overall self-esteem when their ADHD is treated correctly. Thus, in addition to decreased rates of substance abuse, they also face fewer legal problems.
Parents may also question whether or not stimulants negatively impact a child’s growth. Although some studies suggest that stimulants might be associated with mild growth suppression, no definitive link has been determined. And in those studies where it has been suggested, the possible growth suppression is considered to be so minimal (2cm) that the known benefits, which include significant improvement in school, friendships, and family relations, tend to far outweigh this potential risk. More often, stimulants are associated with decreased appetite. In cases where a patient experiences this side effect, we manage it by adjusting or increasing diet where necessary. In all cases, children and adolescents on ADHD stimulants should be monitored through regular visits to the psychiatrist, such that any potential side effect will be identified and addressed.
Finally, when parents hear that ADHD medication works as a “stimulant,” they may imagine that their children are at a greater risk for heart-related problems. Although stimulants can, on rare occasion, increase blood pressure and heart rate, when this is the case, it is almost always clinically insignificant and rarely merits a change in medication protocol. While there is no conclusive link to increased cardiovascular risk, if a patient has a preexisting cardiac condition or if there is a family history of specific cardiac disorders, certain precautions will be taken before starting a round of medication. This will include a thorough cardiac exam and a possible EKG. Regardless of preexisting risk factors, ongoing evaluation of all side effects ensures that the child maintains a healthy mind and body.
In general, the vast majority of patients that take ADHD medication respond very well to the treatment and tolerate it without any significant side effects. While there may always be a case in which stimulants are not indicated, this is something a psychiatrist routinely screens for during an initial psychiatric evaluation. But the great wealth of studies on ADHD stimulants over the last decade strongly weighs in favor of medication as the standard of care. Regardless, it is important that patients and parents feel comfortable enough to express their concerns, because staying informed is the best way to make appropriate treatment decisions.