It is estimated that in 1995, doctors treating children and adolescents wrote six million prescriptions for stimulant medications-methylphenidate (Ritalin�) and dextroamphetamine (Dexedrine�). Of all the drugs used to treat psychiatric disorders in children, stimulant medications are the most thoroughly studied.
Stimulant use for ADHD in the United States has increased greatly over the last 25 years. A recent study saw a 2.5-fold increase in methylphenidate between 1990 and 1995. This increase appears to be mostly related to an increased length of treatment, and more girls, adolescents, adults, and inattentive persons (in addition to those persons with both hyperactivity and inattentiveness/attention deficit) receiving treatment.
One theory suggests that ADHD is related to problems in controlling responses to internal and external stimuli. Evidence suggests that the areas of the brain involved in planning, foresight, considering consequences, and inhibiting actions, are underaroused in persons with ADHD. Stimulant medication may work on these same areas of the brain to increase brain activity to more normal levels, allowing the patient to focus better. More research is needed, however, to firmly establish how these stimulants work.
Stimulant drugs, when used with medical supervision, are usually quite safe. Although they can be addictive when abused by teenagers and adults, when taken as prescribed for ADHD these medications have not shown to be addictive nor to lead to substance abuse problems. They seldom make children "high" or jittery, nor do they sedate the child. If these side effects occur, doctors usually will try a different dosage of medication. Although there is little information about the long-term effects of psychostimulants, there is no evidence that careful use for treating ADHD is harmful. People taking moderate doses sometimes have a decreased appetite or are unable to sleep. These effects occur early in treatment and may decrease with time. Some medications might slow a child's growth, but ultimate height does not appear to be affected.
Actually, it appears to be just the opposite. Although an increased risk of drug abuse and cigarette smoking is linked with childhood ADHD, this risk appears mostly due to the ADHD condition itself, rather than its treatment. In a study jointly funded by the NIMH and the National Institute on Drug Abuse (NIDA), boys with ADHD who were treated with stimulants were much less likely to abuse drugs and alcohol when they got older. Caution is warranted, though, as the overall evidence suggests that persons with ADHD (especially untreated ADHD) are at greater risk for later alcohol or substance abuse. Because some studies have conflicting results, more research is needed to understand this. At any rate, parents should not avoid seeking effective treatments because of inflated claims about substance abuse risks. There are many, proven findings of the harmful effects from too little or no treatment for a child with ADHD.
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