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Should Children with ADHD Be Medicated?

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

ADHD symptoms are typically treated with a group of powerful drugs called psychotropic medications. These medications are used to treat mental illnesses. The use of mind- or mood-altering drugs in children, whose brains continue to develop until their mid-twenties, raises concerns. In the United States, psychotropic medications are a widely accepted means of treatment for children with ADHD symptoms. General practitioners, rather than specialized psychiatrists, often prescribe medication for ADHD. Many times this occurs without the benefit of a formal evaluation by a qualified mental health professional. Some people refer to this practice as "Diagnosis by Medication." This refers to an approach to medicate first, and then see what happens. According to this approach, if improvement occurs, it indicates the patient has ADHD. However, this practice is fraught with problems. First, children without ADHD demonstrate improved attention and focus with the same drugs used to treat ADHD. Second, without a thorough evaluation, the prescribing professional cannot be certain the child has ADHD. This is particularly problematic because other disorders have similar symptoms. Utilizing the wrong medication to treat a disorder can cause serious complications, including a worsening of symptoms. These complications are discussed in the treatment section.

Several studies have examined the increasing rate of medication use in the United States. Some people find these trends disturbing.

Prescription use

Although the 6 to 12-year-old group had the highest overall rate, the 13 to 18-year-old group had the most dramatic increase. Castle, Aubert, Verbrugge, Khalid, & Epstein, R. (2007) speculate that this increase reflects the new understanding that ADHD symptoms can continue into adulthood. In addition, prescription use in the preschool ages remained low. This may indicate the societal tendency to avoid medication in the very young.

The study also found that boys are three times more likely than girls to be prescribed stimulant medication. There were also differences in rates of medication across racial groups.

Some studies suggest that rates of medication use in minority groups are increasing. This may reflect a reduced stigma associated with ADHD among these groups, and a growing acceptance of medication treatment. Both professionals, and non-professionals, are concerned about the ease and frequency of prescribing powerful drugs to children. Concerns center on the qualifications and expertise of the prescribing provider; the proper age to begin medication; and, the overall rise of ADHD diagnoses. It may also reflect a more global concern about the rapid growth and influence of pharmaceutical companies in today's healthcare industry (aka, 'Big Pharma').

The use of medication to treat ADHD in children is complex. On the one hand, medication can help a child lead a calmer and more successful life. Many children make dramatic improvements after they begin a medication regime. On the other hand, there is reasonable concern about the safety, side effects, and long-term risks of these medications. Usually the ADHD symptoms are quite severe before pre-school children are prescribed medication. Parenting a so-called 'wild child' can become so difficult that any help is welcomed: Even if that help is in the form of medication.

Initially, stimulant medication was thought to have few side effects. Research seemed to support this. However, more recent studies discuss the possibility that stimulants may not be good for children. One study provides a Black Box Warning (Nichols, 2004)) about antidepressants and a risk of suicide as the teen begins to feel a little better. Another study reported that stimulant use may be tied to cardiovascular risk (Tumolo, 2014). Other studies are not so dire. The National Institute of Mental Health (NIMH) reports that stimulant use does not raise hypertension, but may increase heart rate (Vitiello, 2011). Many caregivers of medicated children have long suspected there may be some risk associated with stimulant use. New studies are being conducted to evaluate risks. For more information about the risks and benefits of these medications, see the Treatment section.

Despite these valid concerns, medication is the single most effective treatment for children with ADHD. (Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. (2009). In 2009, NIMH reported that stimulant use was associated with higher academic performance. It also reported that stimulant use was not likely to improve long term outcomes. (Scheffler, 2009). Nevertheless, when medication is combined with behavioral treatment and parent education services, it is generally accepted as the treatment of choice.

As research continues, families must make some very difficult decisions. Parents must educate themselves about the pros and cons of medication use. They should become familiar with other treatment options. Every family is different. The risks and benefits of various treatment options must be thoughtfully considered for each child. Sometimes medication use is the best option.

There is no one-size-fits-all solution. For more information about treatment decisions please refer to the treatment section.


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