Moms Columns & Blogs

Substance abuse and ADHD

Written collaboratively by Rebecca Brenner and Paul Smolen, MD



If your a child is diagnosed with ADHD, Attention Deficit Hyperactive Disorder, you have a difficult decision to make. Do you treat your child with stimulant medications or not? This is a bad spot for parents to find themselves in. The child’s problem is a big one and the treatment seems very drastic. Before deciding on a treatment plan with your doctor, you might want to read a new clinical report from the American Academy of Pediatrics addressing the benefits and risks of treating ADHD with stimulant medications. We have known for a long time that, without treatment, children with ADHD are two and a half times more likely to have an “Substance Use Disorder” or SUD, than non-ADHD children when they become adults, even after accounting for other factors such as family history, gender, age, race, cognitive impairment, and family environment. The good news is that treating children with ADHD at a school-age, as they set their academic course, with stimulant medications reduces their risk of becoming using and becoming addicted to cigarettes, alcohol and other illicit drugs as adults by a whopping 85% according to Pediatrics, the official journal of the American Academy of Pediatrics. The timing of treatment is important however– children who are treated early, at school-age, have a much lower risk of developing SUD than the children who initiate medication treatment in adolescence.

Why might this be the case? We know that stimulant medications themselves have abuse potential. It’s counter intuitive tho think that using a powerful medicine like Ritalin would lower a child’s chance of having SUD in their adult years. How does treatment with these medications reduce the risk of a child growing up to have a substance abuse problem? Let’s take a closer look at the link between ADHD, stimulant medication treatment, and substance abuse to figure it out. Children with ADHD are more impulsive- impulsiveness being a core feature of the diagnosis. Additionally, many of these children have difficulty managing social situations- often having difficulties making and keeping friends during their childhood. Stimulant medications can help some children with both of these difficulties. On a biological level, Adderall and Ritalin increase communication between neurons in a child’s brain, that has the effect of lowering impulsivity and improving judgment. When medicated, they are literally using more of their brain. Children with ADHD who are medicated frequently have better attention spans, better impulse control, follow directions better, and perform much better at school. The improvement in the core features of ADHD has the effect of taking a great deal of stress off the child. Less stress, more academic success, better social functioning and less negativity from the teachers and administrators at school, can be a winning formula for many children who suffer from ADHD. Rather than dreading school, a child with ADHD can often begin to build on their successes and actually enjoy school. It is great to watch when it happens for both the child’s family, the child’s teacher, and for his or her pediatrician.

If you or a friend find yourself in the situation of having to decide about medication for a child with ADHD, I am sure you will find the article in Pediatrics helpful. Take a few minutes and check it out. If you have any comments about this article, ADHD, or related topics, feel free to leave your feedback on my blog, www.docsmo.com. Until next time.

Smo Notes:

1. http://pediatrics.aappublications.org/content/134/1/e293.full.pdf

DocSmo is a member of the Charlotte News Alliance and can be found at www.docsmo.com

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