One quick glance at the warning label adhered to a bottle of pills is enough for some parents to refuse the recommended treatment for their child’s Attention Deficit Hyperactivity Disorder. The Food and Drug Administration claims “Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided” (1). Despite this strong claim made by a nationally recognized organization, doctors continue to prescribe psycho-stimulant medications every day. The benefits of administering psycho-stimulant drugs to adolescents for the treatment of ADHD out-weigh the risks.
The common side effects of psycho-stimulants are not regarded as being a serious health hazard by its users. The shared side effects among popular psycho-stimulant medications such as methylphenidate, Lis dexamphetamine, and dextroamphetamine sulfate are loss of appetite, insomnia, and elevated blood pressure. For most users, these do not pose a serious health threat and are considered only somewhat bothersome. “A further study confirmed that over 95 percent of side effects occurrences for all doses of lisdexamfetamine are mild or moderate. But nine percent of the 272 children in the study discontinued treatment due to the drug’s side effects” (Collingwood). The long term effects of these drugs, when considering adolescents, are usually a lack of weight gain. It is important for parents to take into consideration a healthy diet for their children who are treated for ADHD because it can easily be managed and prevented. In a review article written by Jose Martinez- Raga and numerous co-authors on “Risk of Serious Cardiovascular Problems with Medications for Attention-Deficit Hyperactivity Disorder” it was mentioned that “medications used to treat ADHD are not linked to increased risk of heart attack or other serious cardiovascular problems” (Martinez-Raga 26). The empirical evidence found through extensive research leads to the conclusion that treating ADHD with psycho-stimulants does not pose any serious health threats and therefore is safe for practice with adolescents.
Increased academic performance from psycho-stimulant treatment for ADHD helps bolster one’s confidence and form high self- esteem. Due to the behavioral nature of ADHD symptoms, the disadvantages of this disorder are seen in the classroom and in a child’s social interactions. The inattentive subtype of ADHD hinders children from learning at the same rate as their peers and causes them to fall behind academically.
[C]hildren with the inattentive subtype have been described by teachers as exhibiting less disruptive behavior but higher degrees of social impairment, unhappiness, and anxiety or depression… these adolescents suffer significantly from problems such as disorganization, inability to follow through on academic tasks, and difficulty sustaining attention for extended academic projects (Wolraich).
Failure to succeed in the classroom leads to a lack of self-esteem and consequently a lowering of self-worth. Once treated, students with ADHD are able to perform alongside of their peers and compete with their classmates to rise to the top of the class. One particular study that was done revealed that the use of psycho-stimulants had a positive response rate of 66% in “quiz and test performance, observations of attention and behavior during lectures, and teacher ratings, as well as accuracy on assignments completed during study hall” (Evans). Although it is not guaranteed, students who score higher on tests and are able to follow their teacher’s directions more easily are likely to receive greater amounts of encouragement both at school and at home. By doing better in school students have a stronger feeling of accomplishment in their lives. Ultimately, this bolsters their confidence and builds higher self- esteem.
Teachers are better able to manage their classroom when students who have been diagnosed with ADHD are treated with psycho-stimulants. Studies have shown that children with ADHD are more likely to have a co-occurring learning disability that hinders them from doing well in the classroom. It is for that reason that teachers are, in some cases, affected by a child’s ADHD more than the parents of that child would be affected. Teachers have more observation time to use in their rating when assessing the severity of ADHD. The Corner’s Rating Scale was used in a study to determine the discrepancy between parents and teachers on the emotional and behavioral problems for children with diagnosed ADHD. Testing revealed that the teachers scored consistently higher than the parents did which could be a result of prolonged contact with the children outside of their home environment (Miranda). When the behavioral problems associated with ADHD begin to manifest, it usually has a direct effect on the teachers. Children with ADHD have a tendency to act out in class and disrupt the learning process for other student in the classroom.
This presents teachers with a time management problem since they are obligated to correct the behavior before continuing in a lesson. “Educators selecting evidence-based interventions for students with ADHD are often interested in interventions with known effectiveness for increasing academic performance” (Harrison, 742). The burden of teaching a student with ADHD is greater than that of a regular student because they are thirty percent more likely to drop out of school (Harrison). Once a student is treated for his or her ADHD, teachers are better able to manage the learning environment and help to increase that student’s academic performance. The most effective way to treat the core symptoms of ADHD remains to be psycho-stimulant medication. After lengthy studies on the combination of psycho-social and psycho-stimulant treatment, reports show that there is no significant added benefit in psycho-social treatment in terms of academic performance. The majority of teachers preferred that they were notified if one of their students was diagnosed with ADHD.
The immediate family of children treated for ADHD benefit from the effects of psycho-stimulants. The most common symptoms of ADHD that manifest in children and young adults include: “hyperactivity, impulsivity, and inattention”, which present parents with a difficulty in raising and controlling the behavioral tendencies in their children (Treuer). Through psycho-stimulant treatment, patients will experience a diminishing of their symptoms, which is felt by not only the patient but the patient’s immediate family as well. Improvement in behavioral problems leads to less family conflict which in turn allows for a better quality of life. “Evidence from the more definitive randomized controlled trials indicates that stimulants are more effective in ameliorating the core behavioral symptoms of ADHD (restlessness, inattentiveness, impulsiveness) than placebos, nonpharmacological therapies, or no treatment” (Schachar). Because of the high rate of comorbidities of other psychological problems in children with ADHD it is important to treat the core symptoms of ADHD that occur alongside of the behavioral ones that are harder to treat. By treating the core symptoms of ADHD parents of children suffering from ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) are able to redirect focus on managing the behavioral problems associated with raising their child. For children with ODD/CD diminishing the aggressive behavior is not an easy task. Furthermore, parents and siblings who only have to deal with behavioral problems when the cognitive problems are being treated with psycho-stimulants will have less stresses in their lives.
Adolescents with ADHD have been found to have co-morbid/ co-occurring conditions such as depression and anxiety that are found not to be associated side effects of the medication. Parents debating whether or not to treat their child with psycho-stimulants often times believe that these drugs are the direct cause as to why users to develop other psychological problems. The concern is such that: if a child takes this medicine and becomes depressed, then he or she is at a higher risk of becoming mentally ill. There is not a direct correlation between psycho-stimulant treatment and developing psychological problems. It is very common for children with ADHD to have pre-existing psychological problems because of the chemical imbalances thought to cause ADHD.
Between 25% and 75% of adolescents with ADHD also meet diagnostic criteria for oppositional defiant disorder or conduct disorder… 48% had comorbid depression/dysthymic disorder, 36% had comorbid oppositional defiant disorder/conduct disorder, and 36% had comorbid anxiety disorder (Wolraich).
The manifestation of additional psychological problems for children with ADHD shows that they are at a higher risk of developing mental illnesses that would be the cause of certain life threatening actions. The likelihood that a child with ADHD will have suicidal thoughts or tendencies is higher than that of a child without this disorder. In a review written by Dr. W. Burleson Daviss he notes that “[y]ouths with ADHD and depression together have a more severe course of psychopathology and a higher risk of long-term impairment and suicide than youths with either disorder alone”. The use of psycho-stimulants for the treatment of ADHD is not the direct cause of these mental illnesses and therefore cannot be to blame as associated side effects of the psycho-stimulants alone.
Psycho-stimulants are designed in such a way that does not allow users to become addicted to the substance when ingested as prescribed . The substance methylphenidate, although it is pharmacologically similar to cocaine, does not have the propensity to be abused in the same way that cocaine is unless it is administered intravenously . The chemical similarities between methylphenidate and cocaine are that both substances were correlated with the amount of dopamine D^2 receptors that were produced when the glucose metabolism was increased in specific areas of the brain (Volkow, “Association of Methylphenidate” 22). Studies in which positron emission tomography scans were performed on the brains of subjects who were cocaine addicts revealed that there is an increase in metabolic activity in the certain areas of the brain when there is repeated use of a substance. There is activation in the cingulate gyrus and right thalamus for cocaine users when administering the addictive drug. It has been hypothesized that increased glucose metabolism in this region of the brain is “linked with motivation and goal-directed behaviors” (Volkow, “Association of Methylphenidate” 22). In psychology, it is studied that the underlying cause of addictions is developing a habit from goal-directed behaviors. A behavior that results in elevated dopamine levels is thought to be susceptible to addiction. “Cocaine stimulates the reward, or ‘pleasure,’ pathways in the brain which use the neurotransmitter dopamine” (Wood). Drugs like cocaine, when administered intravenously, causes a rapid spike in dopamine and that stimulus is what drug addicts often seek.
Methylphenidate causes that same reaction when the drug is administered in two sequential doses, intravenously or through the nasal passage way (snorting). Moreover, the metabolic activity in the frontal region of the brain is increased with these drugs because they form a bond with the dopamine transporters; by doing this they either speed up or slow down the glucose metabolism rate in the brain, which can be seen on the PET scan. While testing the effects of methylphenidate in regards to its chemical capacity to be addictive, results showed that the slowly releasing capsules did not affect the dopamine levels in the same way that cocaine did. Results indicated “that elevation of dopamine is not sufficient per se to activate these frontal brain regions” (Volkow, “Association of Methylphenidate” 23). It is not likely for a user to develop a chemical dependency with methylphenidate when administering it the way it is designed to be administered. The dopamine levels are not high enough to cause the same reward seeking behavior that is exhibited in someone with an addiction. “[I]t is possible that oral methylphenidate at the doses used clinically would not achieve the threshold of dopamine transporter blockade considered necessary for reinforcement” (Volkow, “Variables That Affect” 1910).
Adolescents who are treated for ADHD with psycho- stimulants are at a lower risk of developing a substance use disorder because of the “protective effect” that the medications have been discovered to have. Methylphenidate (Concerta) is a stimulant drug that is prescribed for the treatment of ADHD in patients that are not hyper-active. Drugs such as lisdexamfetamine (Vyvanse) and dextroamphetamine (Adderall) are prescribed in the same way that methylphenidate is, and they are also confused to be gateway drugs for substances like alcohol and tobacco. Recent studies have shown that “the long-established clinical practice of the use of stimulant medication to treat young children with ADHD does not affect—neither increasing nor decreasing—the risk for substance abuse in adulthood” (Volkow, “Does Childhood Treatment”). According to the clinical studies there were three factors that influence the possibility of a “protective effect” of the stimulants. Characteristics of methylphenidate treatment, characteristics of patients and other variables possibly related to substance use disorders were taken into account. The findings were conclusive in that the age of initiation to stimulant drugs appeared to have a relationship with the propensity to develop a substance use disorder. “Unexpectedly, the development of antisocial personality disorder accounted for the association between age at first treatment with methylphenidate and substance abuse” (Mannuzza 608). These studies have indicated that the treatment of ADHD using psycho-stimulants has a potential protective effect on its users. The meta-analysis of such studies proposes that patients who were treated with psycho-stimulants were far less likely to develop a substance use disorder in adulthood than those who were not treated in the same manner. In addition, the time in which patients began treatment for their ADHD was closely related to their propensity to develop a substance use disorder.
Behavioral and cognitive therapies are not sufficient in adjusting the chemical imbalances that are thought to be the cause of ADHD in order to treat the core symptoms in adolescents. Although therapy sessions, clinics and summer camps have been known to improve the social skills and behavioral issues in children diagnosed with ADHD, they do not provide a lasting solution to their symptoms. They straighten out the child’s actions on a superficial level and help alleviate the social tension with their peers. The best course of action would be a combined treatment of psycho-stimulants alongside of behavioral and/or cognitive therapies. For some adolescents “randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms”(Ferguson). The most effective course of action for treating ADHD in adolescents is administering psycho-stimulants. Its efficiency is observed in the chemical changes that take place in the brain when the medication has its effect. The purpose of the medication Adderall, in this particular study, is to correct the level of catecholamine in the brain which is thought to be the cause of ADHD. “Due to the known effects of stimulants in blocking reuptake of catecholamines and (in the case of d-amphetamine) facilitating their release, it has traditionally been believed that the stimulants compensate for catecholamine deficiency in ADHD” (Solanto). By adjusting the chemical imbalances in the brain of children with ADHD, doctors are able to control the symptoms more efficiently and effectively.
Due to a high diagnostic rate of ADHD in adolescents and the possibility of a misdiagnosis, it is beneficial to withhold from psycho-stimulant treatment and chose behavioral and cognitive therapy instead. The number of adolescents diagnosed with ADHD has grown enormously over recent years. In fact, this number “more than doubled” in just five years (1990-1995). In the next five years after that, it doubled again to nearly 4.6 million cases diagnosed (Neufeld). Given the rapid increases in the diagnostic rate of this disorder it is inherent that the pharmaceutical companies are receiving proportional increases in the amount of money made off their medication. For Americans in particular, stimulants seem to be the preferred treatment as prescribed by practitioners. Shockingly, “the proportion of children receiving psychostimulants is 100 times greater in the USA than in the UK… and more Ritalin is consumed in the United States than all the rest of the world combined” (Neufeld 450). The statistics are infallible particularly when it comes to figuring out the problem with such a high diagnostic rate.
The diagnostic criteria for ADHD is “based on the failure of a child to function appropriately in the classroom”, but the problem with this is that “the line between acceptable and unacceptable classroom behavior and performance is extremely blurred” (Purdie 65). If doctors are using diagnostic criteria with any amount of discrepancy, then it is possible for them to misdiagnose patients more often than one would think. Since no physical harm is posed when undergoing behavioral therapy, it would seem fit that psycho-stimulant therapy should not be the preferred prioritized treatment for ADHD. Given the likelihood that a child may be experiencing ADHD-like symptoms without actually having ADHD, it would be beneficial to take a more holistic approach in treating certain children to avoid the obvious health risks of taking psycho-stimulants.
There have not been sufficient amounts of long-term clinical studies done to determine whether or not psycho-stimulant treatment causes any detrimental health conditions that the parents of children with ADHD ought to be aware of. Some scientists have found there has not been a sufficient amount of long-tern clinical studies done in order to have a complete understanding of all the risks associated with taking psycho-stimulants. Robert L Finding mentions that “the amount of long-term effectiveness and safety data relating to these compounds is relatively small”. It is highly concerning that doctors are prescribing medication to young children with the intention of keeping them on the medication for extended periods of time, especially if they do not fully understand what long term effects the medication may have on their patients. In a journal article written by van de Loo- Neus she explains “There is limited and inconsistent evidence for the long-term advantage of medication treatment beyond symptom control”. Furthermore, it cannot be known for certain that there are any long-term benefits of treating ADHD with psycho-stimulant medications.
Being informed of the various subtypes, comorbidities, and statistical occurrences of Attention Deficit Hyperactivity Disorder one can easily misunderstand the implications of psycho-stimulant treatment in adolescents. Although the Food and Drug Administration of America stands by its strict guidelines for administration of these drugs, practitioners continue to prescribe stimulants in order to treat adolescents. The severity of risks associated with these drugs is relatively low. Meanwhile, the risks which do have a greater severity have been proved unrelated to the medication itself. A comprehensive review indicates that the benefits do indeed outweigh the risks of using psycho-stimulant medication for the treatment of ADHD in adolescents.
*Although this was not the final (FINAL!) draft of my research paper from ENG102, this was all I had left in my google docs for some reason… Please forgive me if certain paragraphs do not effortlessly flow together or a typographical error jumps out of the screen at you in 3D.
Collingwood, Jane. “Side Effects of ADHD Medications | Psych Central.” Psych Central.com. N.p., 2010. Web. 09 Apr. 2014.
Daviss, W. Burleson. “Journal of Child and Adolescent Psychopharmacology.” A Review of Co-Morbid Depression in Pediatric ADHD: Etiologies, Phenomenology, and Treatment. Mary Ann Liebert, 2012. Web. 23 Apr. 2014.
Evans, Steven W., and William E. Pelham. “Psychostimulant Effects on Academic and Behavioral Measures for ADHD Junior High School Students in a Lecture Format Classroom.” Journal of Abnormal Child Psychology 19.5 (1991): 537-52. Springer Link. Web. 24 Mar. 2104.
7 Ferguson, John H. “National Institutes of Health Consensus Development Conference Statement: Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD).” Journal of the American Academy of Child & Adolescent Psychiatry39.2 (2000): 182-93. Science Direct. Web. 24 Mar. 2014.
7 Finding, Robert L. “Expert Opinion on Drug Safety.” Evaluation of Risks Associated with Short- and Long-term Psychostimulant Therapy for Treatment of ADHD in Children, , Informa Healthcare. Information Healthcare, n.d. Web. 23 Apr. 2014.
Fone, Kevin Cf, and David J. Nutt. “Stimulants: Use and Abuse in the Treatment of Attention Deficit Hyperactivity Disorder.” Current Opinion in Pharmacology 5.1 (2005): 87-93. Science Direct. Web. 16 Apr. 2014.
Food and Drug Administration. “Dextrine.”
Fda.gov. Food and Drug Administration,
June 2006. PDF File. 23 April, 2014.
6 Harrison, Judith, Bruce Thompson, and Kimberly J. Vannest. “Interpreting the Evidence for Effective Interventions to Increase the Academic Performance of Students With ADHD: Relevance of the Statistical Significance Controversy.” Review of Educational Research 79.2 (2009): 740-75.JSTOR. American Educational Research Association. Web. 17 Apr. 2014.
Mannuzza, S., et al. “Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood.” American Journal of Psychiatry 165.5 (2008): 604-09. PubMed. National Center for Biotechnology Information. PDF File. 24 Mar. 2014.
Martinez-Raga, Jose, et al. “Risk of Serious Cardiovascular Problems with Medications for Attention-Deficit Hyperactivity Disorder.” CNS Drugs 27.1 (2013): 15-30. Print.
Miranda, Ana, et al. “Emotional and Behavioral Problems in Children with Attention Deficit-Hyperactivity Disorder: Impact of Age and Learning Disabilities.” Learning Disability Quarterly 31.4 (2008): 171-85. Sage Publications Inc., Fall 2008. Web. 16 Apr. 2014.
8 Neufeld, Paul, and Michael Foy. “HISTORICAL REFLECTIONS ON THE ASCENDANCY OF ADHD IN NORTH AMERICA, C. 1980 – C. 2005.” British Journal of Educational Studies 54.4 (2006): 449-70.JSTOR. Taylor & Francis, Ltd. Society for Educational Studies. Web. 23 Apr. 2014.
8 Purdie, Nola, John Hattie, and Annemaree Carroll. “A Review of the Research on Interventions for Attention Deficit Hyperactivity Disorder: What Works Best?” Review of Educational Research 72.1 (2002): 61-99. JSTOR. American Educational Research Association. Web. 23 Apr. 2014.
8 Schachar, Russell, and Rosemary Tannock. “Childhood Hyperactivity and Psychostimulants: A Review of Extended Treatment Studies.” Journal of Child and Adolescent Psychopharmacology 3.2 (1993): 81-97. Journal of Child and Adolescent Psychopharmacology. Mary Ann Liebert. Web. 24 Mar. 2014.
Solanto, Mary V. “Dopamine Dysfunction in AD/HD: Integrating Clinical and Basic Neuroscience Research.” Dopamine Dysfunction in AD/HD: Integrating Clinical and Basic Neuroscience Research 130.1-2 (2002): 65-71. Dopamine Dysfunction in AD/HD: Integrating Clinical and Basic Neuroscience Research. Science Direct. Web. 24 Mar. 2014.
Treuer, Tamás, et al. “A Systematic Review of Combination Therapy with Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder, Including Patient Characteristics, Treatment Strategies, Effectiveness, and Tolerability.” Journal of Child and Adolescent Psychopharmacology 23.3 (2013): 179-93. Web. 24 Mar. 2014.
6 Van De Loo-Neus, Gigi H.H. “To Stop or Not to Stop? How Long Should Medication Treatment of Attention-deficit Hyperactivity Disorder Be Extended?” Science Direct. European Neuropsychopharmacology, n.d. Web. 23 Apr. 2014.
10 Volkow, Nora. D., and James M. Swanson. “Does Childhood Treatment of ADHD With Stimulant Medication Affect Substance Abuse in Adulthood?” American Journal of Psychiatry165.5 (2008): 553-55. Web. 24 Mar. 2014.
10 Volkow, Nora D., and James M. Swanson. “Association of Methylphenidate-Induced Craving With Changes in Right Striato-orbitofrontal Metabolism in Cocaine Abusers: Implications in Addiction” American Journal of Psychiatry 156 (1999): 19-26. PubMed. Web. 8 April 2014.
10 Volkow, Nora D., and James M. Swanson. “Variables That Affect the Clinical Use and Abuse of Methylphenidate in the Treatment of ADHD” American Journal of Psychiatry 160 (2003): 1909-1918. Psychiatry Online. Web. 8 April 2014.
Wolraich, M. L., et al. “Attention-Deficit/Hyperactivity Disorder Among Adolescents: A Review of the Diagnosis, Treatment, and Clinical Implications.” Pediatrics 115.6 (2005): 1734-746. Pediatrics. Web. 24 Mar. 2014.
Wood, Samuel E., Ellen Green Wood, Denise Boyd. Mastering the World of Psychology. Upper Saddle River, New Jersey: Allyn & Bacon, 2011. Print.