Controversies and Misunderstandings About Stimulant Medication
Controversies around Stimulant Medication for Children
The prescription of stimulant medication for children with ADHD has been one of the most controversial issues in child psychiatry. Some sectors have demonized stimulant medication, charging that parents and physicians are being grossly negligent in prescribing such “dangerous” drugs. Other parents have unrealistic expectations that “taking a pill” will resolve all of the behavioral, social and academic challenges that their child faces.
Controversies around Stimulant Medication for Adults
Widespread recognition of adult ADHD began in the mid-1990’s. Those that were children in the mid ‘90’s are now college students and young adults. Unfortunately, alongside college students and young adults taking prescribed stimulants for carefully diagnosed ADHD are many students that simply want stimulant medication for performance enhancement and ability to stay up all night when facing deadlines. And worse, college students and young adults taking stimulants in order to remain more alert and functional while engaging in heavy alcohol consumption or grinding up stimulant pills to take them in large doses as recreational drugs.
Unfortunately, the mis-use of stimulants among adults has caused an increasing number of psychiatrists, particularly those that do not have a specialty in treating ADHD, to be increasingly hesitant to prescribe stimulants to adults that request them. As ADHD symptom lists are readily available on the internet, it is relatively easy to feign ADHD when seeking stimulants for performance enhancement.
Are stimulants effective for ADHD and “ADD”?
It is a misunderstanding that stimulant medication is only used to decrease hyperactivity. Stimulant medication increases the available supply of dopamine in the pre-frontal lobes of the brain – the area of the brain where executive functions such as impulse-control, self-monitoring, planning, organizing and time management.
What the Research Indicates
Children and adults respond very similarly to stimulant medication, although many specialists believe that therapeutic doses may be higher for adults. Approximately 80% of people with diagnosed ADHD benefit from stimulant medication. And some physicians believe that the percentage is even higher when adults are prescribed adequate doses. However, only a modest percentage experience such enormous benefit from stimulant medication that no other treatment is needed to manage ADHD challenges and function well on a daily basis. A large, carefully controlled multi-site study of children with ADHD suggests that the ideal treatment approach includes both medication and behavior management approaches.
Far less research exists on best practices in treatment approaches to treating adult ADHD, however much has been written and we now have extensive experience among specialists, such as those at the Chesapeake ADHD Center, that suggest similar conclusions. While some adults more mildly affected by ADHD may be satisfied with the benefits of stimulant medication, most find that they need to work with a coach, counselor or other ADHD specialist in order to build organizational and time management habits as well as daily brain-healthy habits that can enhance brain functioning to augment the effects of stimulant medication.