Stimulants

Who’s Afraid of ADHD Stimulants?

First-line medications used to treat ADHD are among the most rigorously studied, with decades of supporting evidence. So why do fears about their use persist?

William Dodson, M.D.
By William Dodson, M.D., LF-APA Verified Updated on August 19, 2024
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“To deplore the use of a tool that can not only relieve suffering, but actually turn it into success, health, and joy, well, that’s just plain ignorant, as well as cruel to the people who it scares away from ever trying medication.”

This quote perfectly sums up the pervasive fear among adults and caregivers of children diagnosed with ADHD. And it remains as detrimental now as it was when authors Edward Hallowell, M.D., and John Ratey, M.D., first published it in their book ADHD 2.0 (#CommissionsEarned).

The first-line medications for ADHD are some of the most effective, best studied, most scrutinized, longest known, and safest drugs in all of medicine. They have been safely prescribed to children for decades. Nonetheless, no other class of medications in virtually all of medicine inspires more baseless fears, intentional disinformation, and wild beliefs as do the stimulants used to treat ADHD. Interestingly, these fears are almost entirely an American phenomenon that hardly exists elsewhere in the world.

ADHD and Stimulants: A Disinformation Campaign Begins

In the late 1970s, a public backlash against treating ADHD with stimulant medication began after groups launched nationally organized, and extraordinarily effective, disinformation campaigns. This instilled a climate of fear among physicians, parents, and educators, and sowed anxiety and confusion among the public. Moreover, it planted in the minds of Americans the otherwise nonsensical idea that it was the treatment of ADHD that was dangerous — not the untreated medical condition itself.

It is also important to make a distinction between side effects due to stimulant medications and those unpleasant experiences caused by poor clinician training and experience. Finding a good clinician is much more difficult than it should be. Establishment medical education has failed miserably to prepare clinicians to diagnose and treat ADHD at all ages.

[Free Download: The Caregiver’s Guide to ADHD Treatment]

The goals of medication treatment include:

  • Rule #1: The right medication and dosage matched to the right person should be dramatically beneficial and have virtually no side effects.
  • Rule #2: Finely tuned ADHD medication should help you be “the best version of you.”

The Dangers of Untreated ADHD

Clinical neuropsychologist Russell Barkley, Ph.D., has demonstrated that untreated ADHD is not just highly impairing, it can be deadly. In fact, having ADHD lowers a person’s estimated life expectancy by 12.7 years.1 Barkley has noted that most of the contributors to this mortality are lifestyle-related and can be reversed with treatment.

Research shows that untreated ADHD, with its impulsivity and inattention, raises the risks for serious traffic accidents, addiction, unsafe sexual practices, and self-harm, as well as challenges with academic performance, relationship difficulties, financial struggles, and chronic stress for children, teens, and adults.

ADHD and Stimulants: Facts Over Fears

Baseless fears about stimulant medication have scared caregivers away from seeking proper treatment for their children diagnosed with ADHD. The benefits of ADHD medication, based on decades of research and medical practice, used in conjunction with cognitive behavioral therapy, are profound for many people. The risks stemming from untreated ADHD are equally profound.

[Read: What Are the Long-Term Effects of ADHD Medication on the Brain?]

These are the fears I hear most from caregivers about ADHD medication, and my responses:

Fear #1: Will medication change my child’s personality?

The first-line stimulant medications affect a person with ADHD differently than they do a neurotypical person. Stimulant medications calm and soothe the hyperarousal and loss of emotional control associated with ADHD. A neurotypical person on an ADHD stimulant, by contrast, becomes more agitated, jittery, irritable, and unable to slow down.

Fear #2: Are stimulants addictive?

Having ADHD increases a person’s risk of substance use disorder, regardless of whether they take medication. However, one large study of adolescents found that “current pharmacotherapy for ADHD is associated with lower risk for substance use problems as long as medication treatment is maintained, indicating that pharmacotherapy is likely to be a key part of efforts to reduce substance use risk in those with ADHD.2

Fear #3: What if my child loses weight on a stimulant and doesn’t grow?

Appetite suppression is a common side effect of stimulant medications that goes away when the medicine is taken consistently enough to develop a tolerance to it. Most children ultimately gain weight and grow just as they did before taking medication.

For a small portion of elementary school-age children, most of whom were already picky eaters, the side effect of appetite suppression does create a problem. If a child is losing weight, or just not gaining weight for more than one month, the protocol for reversing this is to:

  • Lower the dose of stimulant.
  • If that does not work, switch stimulant molecules
  • If this is ineffective, use the lowest dose of a gentle antihistamine that is FDA-approved for children 3 years of age and older. While this is an off-label use, it often helps to maintain a very beneficial ADHD treatment until the child becomes tolerant of the medication. Antihistamines like cyproheptadine, for example, return appetite to previous levels for about six hours. They are usually taken 30 minutes before lunch and dinner.

Fear #4: What if a stimulant worsens my child’s anxiety?

ADHD shares a high comorbidity with anxiety disorder. Researchers conducted a meta-analysis of 23 studies of children diagnosed with anxiety who had started on ADHD stimulants and found that anxiety decreased significantly in almost all cases.3

Arm yourself with knowledge. Read about the findings from research studies that have investigated ADHD medication. Then you can make a rational, informed decision about what is best for your child and/or yourself.

ADHD and Stimulants: Next Steps

William W. Dodson, M.D., is a board-certified adult psychiatrist. He was named a Life Fellow of the American Psychiatric Association in 2012 in recognition of his contributions to the field of adult ADHD.

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Sources

1 Barkley, R. A., & Fischer, M. (2019). Hyperactive child syndrome and estimated life expectancy at young adult follow-up: the role of ADHD persistence and other potential predictors. Journal of Attention Disorders, 23(9), 907–923. https://doi.org/10.1177/1087054718816164

2 Schepis, T. S., Werner, K. S., Figueroa, O., McCabe, V. V., Schulenberg, J. E., Veliz, P. T., Wilens, T. E., & McCabe, S. E. (2023). Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine, 58, 101902. https://doi.org/10.1016/j.eclinm.2023.101902

3 Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075