ADHD medication for kids: Is it safe? Does it help?

Ellen Braaten, Ph.D.
Ellen Braaten, Ph.D., Contributor

Follow me at @ellenbraaten, the MGH Clay Center

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders, with prevalence rates around 3%-4%. Medication is frequently used to treat the symptoms of inattention, impulsivity, and hyperactivity that are associated with the disorder. It’s a developmental disorder, meaning that the symptoms start in childhood, before the age of 12. The symptoms can impair functioning in school and at home, and interfere with forming and keeping friendships.

I’m a psychologist and I don’t prescribe medication, but despite that fact, parents often ask me, “Should my child with ADHD be on medication?” followed by, “What are the downsides of medication?” and then frequently follow up with, “Aren’t there too many kids on medication anyway?” A study published last fall in BMJ can help parents and professionals with answers to these questions in terms of the drug methylphenidate, in particular.

Methylphenidate is the most commonly prescribed drug for ADHD worldwide. It’s known by a number of brand names, including Ritalin, Concerta, Metadate, Daytrana, and Quillivant. Although it has been used for over 50 years to treat ADHD — and studies have found it to be effective in decreasing the symptoms of inattention, impulsivity, and hyperactivity — there had been no comprehensive, systematic reviews of the benefits and risks of this drug until this study.

What we’ve learned about methylphenidate

For the study, the investigators reviewed hundreds of papers that had examined the effects of methylphenidate for ADHD. Their analysis found that methylphenidate did improve children’s performance in the classroom. In other words, teachers reported fewer symptoms of ADHD and better general behavior when kids with ADHD were taking the medication. In addition, parents reported a better quality of life for the family when their children were taking medication.

On the other hand, there was some evidence that methylphenidate comes with the risk of side effects, including sleep problems and decreased appetite. These side effects are considered “non-serious adverse effects.” However, if you’re a parent of a child who isn’t sleeping or eating, these may seem quite serious. The good news is that there was no evidence that methylphenidate increases serious side effects, which would include life-threatening problems — that is, something that would require a hospital stay or result in a life-long condition.

What should parents do?

So what does this mean for parents trying to decide whether their child should take ADHD medication? First, they don’t need to worry about whether taking the most widely prescribed medication — methylphenidate — will cause serious, long-term problems. It most likely will not. Second, because a fairly large percentage of kids who take methylphenidate (about 25%, based on this study) may experience minor and short-lived problems such as difficulty with appetite and sleep, parents should be prepared to see these effects in their children. Knowing that issues such as these might be a problem, and that these issues may improve as a child adjusts to the medication, can help parents anticipate possible solutions — which can include, for example, having a big breakfast before taking the medication or lowering the dose if sleep is an issue. These are all things that can be discussed with a child’s pediatrician, and there are ways to cope with these issues once they are identified. Finally, parents can be comforted by the fact that these medications can improve a family’s quality of life at home, a child’s general behavior at school, and result in fewer problems with attention, impulsivity, and hyperactivity.

ADHD medication: The bigger picture

This study doesn’t answer the question of whether there are too many children on medication. Interestingly (and often surprisingly, for many people), other studies have shown that at least one-third and up to one-half of children with significant developmental and psychological problems go untreated. That’s a lot of kids who need help, either through some sort of therapy, educational support, or (for some) medication. This study also only addresses one medication, although it is the one that is most popularly prescribed.

Deciding what treatment option to use when you have a child with ADHD isn’t easy. Medication isn’t the only option, as there are data that show some behavioral treatments that can help children with ADHD learn different skills are also effective. In fact, recent studies indicate that a combination approach might be best. In other words, medication can help kids to get more out of non-medication treatments such as therapy and school supports. When prescribed correctly by a medical doctor who understands and commonly treats these issues, the downsides of medication with methylphenidate probably do not outweigh the positives in most cases.

Comments:

  1. BonsaiTreeGardener.net

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  2. Beverley Calvert

    Isn’t the ADHD problem in the cerabellum? May have this spelt wrong.

  3. Carol

    Its high time that people should get aware of the environmental factors which are contributing to the higher rates of neurological disorders. We all know that the whole world is polluted with toxins….but the most important thing which everyone should be aware off is that there are a category of toxins called neurotoxins which can damage the brain and nervous system which are present in the air we breathe, water we drink and the food we eat…..So, all the beings on earth are neurotoxic. And neurotoxicity is the hidden cause of various health conditions including various neurological disorders like ADHD, Autism…….Everyone should be aware that they are neurotoxic and take appropriate measures to avoid the exposure to these neurotoxins to minimize their consumption, they should try to detox these neurotoxins on daily basis which can help with the prevailing health conditions……. As all are neurotoxic….each person struggling with neurological disorders should understand the importance of considering the treatment of neurotoxicity as a part of treatment protocol for neurological disorders like ADHD, Autism.

    • John R williams

      Give me an example of a neurotoxin and a scientific paper where its levels have been measured . Then follow it up with a scientific paper reference that shows the compound is a neurotoxin in animals and in humans. I think your comments are unproven. I want original scientific papers not something that someone says in the secondary unrefereed literature. As a professor of organic chemistry I can understand the chemical reactions between molecules.

  4. Justin Ferrell

    I have ADHD. I take meds for it. It doesn’t always work. I may end up paying attention to all the wrong things. I take it while I’m doing my homework and it may not always help and then won’t be able to get any sleep because it keeps me up at night. I may go a couple days without sleep. because I also do my homework at the last minute too. It sucks a lot.

  5. Melinda

    Lynn Gimpel…. All due respect, but most people do not “outgrow” ADHD. Up to 35% of those diagnosed in childhood may no longer qualify for the diagnosis upon reaching adulthood, but this could be due to medications, educational supports they have benefited from, coping skills they have learned, and a myriad of other things. That leaves 65% of adults who still qualify for the diagnosis of ADHD. That doesn’t sound like most outgrow it to me.
    Source: Milwaukee Longitudinal Study, Barkley & Fischer. 2008

  6. GadoGadoMen.com

    With over 50 things that mimic ADHD (including lead exposure in tap water) we must rule out many other things 1st. Always. I’m working hard to raise global awareness on this fact.

  7. Jeff Emmerson

    With over 50 things that mimic ADHD (including lead exposure in tap water) we must rule out many other things 1st. Always. I’m working hard to raise global awareness on this fact.

    – Jeff Emmerson

  8. Lynn Gimpel

    ADHD is a case of delayed development of the frontal lobe. Executive function is delayed; an 8 year old has the attention span, consideration of consequences, impulse control, concentration, etc.
    of a 5 year old. Social skills, school performance,
    family interactions are emotionally 3-5 years delayed.
    Yes most will “outgrow” ADHD but if not treated early in life they will
    have a weak academic record, low self esteem,
    lack of confidence that will handicap them into adult
    Life.

    • Terri

      The frontal lobe – executive function does not complete its task until the early 20’s. Teachers do not like to teach boys because they are naturally fidgety. Parents are to busy these days to spend time on executing behavioral issues. Also, what is adding another drug going to do with the development of the frontal lobe? Alcohol and drugs seem to affect proper formation of this important function.

  9. john west

    With all due respect Ms. Patel, if, like us, you have a wonderful child who suffers from significant ADHD symptoms, you will have none of these concerns. While yes, changing schools can help a lot, meds are warranted in cases like ours — if just to learn how to take care of his household responsibilities.

    re:side effects: loss of appetite in adolescent boys who are growing taller by leaps and bounds is definitely a major concern among us parents! Chronic abdominal pain is also a side effect that forced us to switch meds.

  10. Lily Patel

    One problem I have seen with this diagnosis is the reservations parents have with putting their child on this type of medicine. I am not entirely convinced that attention deficits are the crux of the child’s health problems. It could be the education curriculum and that the child is just not interested in the learning environment that they are in. Furthermore, the schooling environment may not be structured that it is effective for the child’s learning abilities. It might not be providing adequate social supports. Some children may be interested in just math and science or just art and to receive such a specialized education could very well mean moving the child out of the present school and placing him or her in a private school or a boarding school where the attention and focus is geared towards the child’s interests.