Q. Why are stimulants used when the problem is overactivity?
A. The answer to this question is not well established, but one theory suggests that ADHD is related to difficulties in inhibiting responses to internal and external stimuli. Evidence to date suggests that those areas of the brain thought to be involved in planning, foresight, weighing of alternative responses, and inhibiting actions when alternative solutions might be considered, are underaroused in persons with ADHD. Stimulant medication may work on these same areas of the brain, increasing neural activity to more normal levels. More research is needed, however, to firmly establish the mechanisms of action of the stimulants.
Q. What are the risks of the use of stimulant medication and other treatments?
A. Stimulant drugs, when used with medical supervision, are usually considered quite safe. Although they can be addictive when abused by teenagers and adults, when taken as prescribed for ADHD these medications have not been shown to be addictive nor to lead to substance abuse problems. They seldom make children “high” or jittery, nor do they sedate the child. Although little information exists concerning the long-term effects of psychostimulants, there is no evidence that careful therapeutic use is harmful. When adverse drug reactions do occur, they are usually related to dosage and are always reversible. Effects associated with moderate doses are decreased appetite and insomnia. These effects occur early in treatment and may decrease with time. There may be negative effects on growth rate, but ultimate height appears not to be affected.
Q. Will children taking these medications for ADHD become drug addicts?
A. Actually, it appears to be just the opposite. Although an increased risk of drug abuse and cigarette smoking is associated with childhood ADHD, this risk appears mostly due to the ADHD condition itself, rather than its treatment. In a study jointly funded by the NIMH and the National Institute on Drug Abuse, boys with ADHD who were treated with stimulants were significantly less likely to abuse drugs and alcohol when they got older. Caution is warranted, nonetheless, as the overall evidence suggests that persons with ADHD (particularly untreated ADHD) are indeed at greater risk for later alcohol or substance abuse. Because some studies have come to conflicting conclusions, more research is needed to understand these phenomena. Regardless, in view of the substantial, well-established findings of the harmful effects of inadequate or no treatment for a child with ADHD, parents should not be dissuaded from seeking effective treatments because of misconstrued or exaggerated claims about substance abuse risks.
A. Comorbidity occurs in most children clinically treated for ADHD. ADHD can co-occur with learning disabilities (15-25%), language disorders (30-35%), conduct disorder (15-20%), oppositional defiant disorder (up to 40%), mood disorders (15-20%), and anxiety disorders (20-25%). Up to 60 percent of children with tic disorders also have ADHD. Impairments in memory, cognitive processing, sequencing, motor skills, social skills, modulation of emotional response, and response to discipline are common. Sleep disorders are also more prevalent.
Q. What is the history of ADHD? How is it related to ADD?
A. ADHD has assumed many aliases over time from hyperkinesis (the Latin derivative for “superactive”) to hyperactivity in the early 1970s. In the 1980s, DSM-III dubbed the syndrome Attention Deficit Disorder, or ADD, which could be diagnosed with or without hyperactivity. This definition was created to underline the importance of the inattentiveness or attention deficit that is often but not always accompanied by hyperactivity. The revised edition of DSM-III, the DSM-III-R, published in 1987, returned the emphasis back to the inclusion of hyperactivity within the diagnosis, with the official name of ADHD.
With the publication of DSM-IV, the name ADHD still stands, but there are varying types within this classification, to include symptoms of both inattention and hyperactivity-impulsivity, signifying that there are some individuals in whom one or another pattern is predominant (for at least the past 6 months). In the International Classification of Diseases (used predominantly in other Western countries), the term “Hyperkinetic Disorder” is used, but the criteria are the same as for ADHD/combined type.
Q. What are the future research directions for ADHD?
A. Continued research on ADHD is needed from many perspectives. The societal impact of ADHD needs to be determined. Studies in this regard include (1) strategies for implementing effective medication management or combination therapies in different schools and pediatric healthcare systems; (2) the nature and severity of the impact on adults with ADHD beyond the age of 20, as well as their families; and (3) determination of the use of mental health services related to diagnosis and care of persons with ADHD. Additional studies are needed to improve communication across educational and health care settings to ensure more systematized treatment strategies. Basic research is also needed to better define the behavioral and cognitive components that underpin ADHD, not just in children with ADHD, but also in unaffected individuals. This research should include (1) studies on cognitive development, cognitive and attentional processing, impulse control, and attention/inattention; (2) studies of prevention/early intervention strategies that target known risk factors that may lead to later ADHD; and (3) brain imaging studies before the initiation of medication and following the individual through young adulthood and middle age. Finally, further research should be conducted on the comorbid (coexisting) conditions present in both childhood and adult ADHD, and treatment implications.