Doctors have relied on the prescription medications Adderall and Ritalin to treat attention deficit hyperactivity disorder for decades.
More than 15 million American adults and seven million children live with the lifelong condition, which is one of the most common neurodevelopmental disorders in childhood and leaves kids unable to focus or control impulsive behaviors. Approximately 3.5 million children ages three to 17 take an ADHD medication.
Now, researchers say the stimulants don’t work as previously believed.
Instead of affecting regions of the brain that control attention, the drugs primarily affect the brain’s reward and wakefulness centers, a recent study from Washington University School of Medicine in St. Louis researchers found.
“I prescribe a lot of stimulants as a child neurologist, and I’ve always been taught that they facilitate attention systems to give people more voluntary control over what they pay attention to,” Dr. Benjamin Kay, an assistant professor of neurology, explained in a statement. “But we’ve shown that’s not the case.”
“Rather, the improvement we observe in attention is a secondary effect of a child being more alert and finding a task more rewarding, which naturally helps them pay more attention to it,” he said.
Instead of improving patients’ ability to focus, the drugs make individuals with ADHD more alert and interested in subjects they wouldn’t normally enjoy, the study authors said.
The researchers also found that the drugs produced patterns of brain activity that mimicked the effect of good sleep — and negated the effects of sleep deprivation for kids with ADHD who did not get the recommended nine hours of sleep each night.
And, children on ADHD medication had better academic performance and performed better on cognitive tests.
Researchers used brain imaging data from nearly 6,000 children between the ages of eight and 11 that was collected as part of the Adolescent Brain Cognitive Development Study – the largest long-term study of brain development and child health in the country – comparing the scans and how the brain regions communicate in children who took the stimulants and children who did not not.
The researchers then looked at the brains of five healthy adults who didn’t have ADHD, who took the medication. The results of their observations were the same.
“These results also provide a potential explanation for how stimulants treat hyperactivity, which previously seemed paradoxical,” Dr. Nico Dosenbach, the David M. & Tracy S. Holtzman Professor of Neurology, added.
Both researchers said more work is needed to better understand the long-term effects of the drugs on brain function.
The medications could provide a corrective effect by clearing cellular debris in the brain. Or, they could cause lasting damage by covering up chronic sleep disorders.
Previous research has tied ADHD to a lack of proper sleep.
“Sleep disturbances are incredibly common in ADHD, impacting about three out of four children and adolescents with the disorder,” Jessica Lunsford-Avery, a professor of psychiatry and behavioral sciences at Duke University School of Medicine who was not involved in the study, told The Washington Post.
“It is increasingly clear that clinicians and families should view ADHD as a 24-hour disorder. Unfortunately, sleep problems are rarely recognized or adequately treated in children and adolescents with ADHD.”
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