Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in children, yet many parents are resistant to giving their kids certain prescription medications designed to treat it. One of the most prevalent fears is that prescribing stimulant medications could lay the groundwork for substance use in the future, including illicit drug use.
However, such medication is often a firstline treatment as ADHD symptoms start in childhood before the age of 12. For some children, methylphenidate, commonly known by the brand name Ritalin, is the best option. It can relieve ADHD symptoms that impair a child's functioning in school, in addition to interfering with forming and keeping friendships. Stimulant drugs are used to help children focus and pay attention better.
The Drug Enforcement Administration classifies some stimulant medications as schedule two substances, meaning they may induce euphoria and can be addictive. Naturally, many parents may be concerned how this plays out as a child gets older. Nonetheless, despite its classification, taking stimulant medications as a child is not associated with substance abuse issues later in life, according to a new study published in JAMA Psychiatry.
"I hope that parents and providers will be able to use this to have a bit of a sense of relief," co-author Dr. Brooke Molina, a professor at the University of Pittsburgh School of Medicine, told Salon. "That if they feel for the circumstances of the child that they're treating or parenting, that stimulant medication is indicated, that they can have some sense of relief that they're not adding to the existing risk that children with ADHD already have for substance use disorder by giving them stimulant medication."
Molina and her colleagues analyzed 579 patients with ADHD over a 16-year period between childhood, adolescence and adulthood to see if there was any connection between taking stimulant medication and subsequent substance use. During the time period, Molina and her colleagues interviewed the children and parents, and collected data and questionnaires from their teachers and schools.
"The data that we have for these children is extensive, that is what created a really helpful opportunity for us to address this particular question: which is, 'Are children with ADHD who are treated with stimulant medication being put at risk for having an elevated likelihood of substance use or substance use disorder?'" Molina said. "And one of the things that was particularly useful about this data set is that we had very detailed records on their substance use."
Molina and her colleagues found there was no association between stimulant treatment and substance use. In Molina's study, she and her colleagues looked at the data multiple ways to confidently land on their conclusion. Despite looking at the data from multiple angles, they found no association.
"Our study not only accounted for age, but also used a statistical method that adjusted over time for the many characteristics that may distinguish treated from non-treated individuals," said study co-author Traci Kennedy, Ph.D., assistant professor of psychiatry at the University of Pittsburgh School of Medicine, in a press statement. "Considering these factors allowed us to more accurately test the relationship between stimulants and substance use."
As Molina alluded, children with ADHD have an elevated risk for substance abuse. But Molina compared it to being the child of a parent who struggles with alcoholism.
"Just because you have a mother or a father who has or had alcohol use disorder, by no means does that mean that you are going to have it," Molina said. "But you have an elevated risk."
Notably, Molina's study didn't find there are "protective effects" of stimulant medication, either.
"There are a lot of strong beliefs out there that taking medication, starting it early and taking it for longer and taking it consistently will lead to better long term outcomes," Molina said, adding that would generate the hypothesis that children treated that way would have a lower likelihood of substance use disorder as adults. "So we didn't find that and that's something that will surprise some of the readership."
ADHD diagnoses have consistently increased since the 1990s. Roughly one out of every 10 children and adolescents between the ages of 3 and 17 living in the U.S. have a current ADHD diagnosis. As a follow-up, Molina will be exploring one big limitation of the study.
"We followed individuals from childhood being treated in childhood to older ages, but we don't have children in this study whose treatments started in adolescence or in adulthood," Molina said. "And that may be a different kettle of fish."
