Treatment

Ritalin and Other Psychostimulants for ADHD: Pros and Cons

Arguments For Medications

Arguments Against Medications

Effect on ADHD Symptoms

The effectiveness of Ritalin in improving ADHD symptoms has been established by more than 160 controlled studies, the largest amount of evidence on any subject involved with childhood behavioral disorders. They are equally effective in boys and girls with ADHD.

Positive results in many studies are most evident in children with severe symptoms, particularly those who suffer from aggression. The benefits with less severe conditions tend not to be as pronounced.

Effect on Intelligence and Academic Achievement

Some studies suggest that medications raise intelligence test scores, even in children who have accompanying disorders, such as autism, pervasive developmental disorder, and mental retardation.

There is no definite proof that drugs improve academic achievement. Psychostimulants, for example, do not improve a child's ability to memorize facts by rote. In fact, in a major study there was no difference in academic achievement between children taking medications and those being given behavioral therapies. A 2001 study reported that only low doses improved academic functioning in adolescents. In some young people higher doses was associated with worse performance.

Effect on Social Functioning

A 2000 study reported that medications had some positive effect on self-esteem, which was greatest in highest doses. (Presumably, children with the most severe symptoms felt the greatest improvement in self-confidence.)

One of the few long-term studies on ADHD children reported that patients who were effectively treated and responded well were more likely to be living independently as adults, to be either married or to be engaged. They had higher IQs and were less likely to have substance abuse problems or have attempted suicide. (Patients who were closely monitored for treatments as children, however, may also have had more positive parenting, which could also account for the better outcome.)

A child may still have social problems after taking psychostimulants. Medication alone rarely helps aggressive children with ADHD. A major study found no difference in oppositional behavior or relationships with peers between children taking psychostimulants and those being given behavioral therapies.

Side Effects

Most young people report mild side effects, most often loss of appetite.

Some children report distressing side effects that include a "zombie" like effect, tics, and moodiness. Weight loss may be a problem for some children. Even in young people who abuse Ritalin, however, less than 1% experience severe side effects (rapid heart rate, hypertension).

Effect on Bone Loss and Growth

The drugs do not cause bone loss, as some people have feared.

These drugs may affect growth, although most studies suggest the impact is not significant and that children catch up later on.

Effect on the Brain

Some evidence suggests that medication may enhance growth of brain white matter -- which consists of insulated nerve fibers that make up the core of the cerebral hemispheres.

No major studies have been conducted on the long-term effects of stimulant use in preschool children. Studies on animals being given such drugs during equivalent developmental periods report negative effects on memory, on important neurotransmitters, and other adverse effects.

Risk for Addiction

Studies on both animals and humans suggest that Ritalin lacks the properties that create addiction, particularly in doses used for treating ADHD. Furthermore, a major 2003 analysis of six studies suggested that the use of stimulants may protect against drug abuse in ADHD young people.

An emerging and serious problem is the sale of stimulants to non-ADHD peers, who are in danger of over-use and severe side effects. Crushing the pills and inhaling them nasally can also provide a euphoric state.

Choosing Candidates for Drug Treatment

When used correctly, questionnaires and other screening tests for ADHD symptoms are proving to be very accurate for determining the best candidates for drug treatments.

There are no objective tests for diagnosing ADHD, so it is unclear if the appropriate people are being treated or not treated.