Does Treatment of ADHD with Stimulants Pose a Risk to Brain Development?

What Is ADHD?

Attention Deficit/Hyperactivity Disorder (ADHD) is a common brain disorder estimated to affect up to 10% of children and 5% of adults worldwide. ADHD has core symptoms of inattentiveness, impulsivity and hyperactivity linked theoretically to specific malfunctioning circuits in various brain regions. Treatments with medication theoretically return patients to normal states of arousal by improving the efficiency of information processing in certain areas of the brain.

How Is ADHD Treated?

Stimulants like Ritalin (methylphenidate) and Adderall (amphetamine compound) continue to be the mainstay of treatment for ADHD because of how remarkably well they work.

Concerns About ADHD Treatment

Though stimulant treatment for ADHD is known to be effective, concerns about effects on the developing brain remain. Possibly this persistent concern is related to findings from animal studies (rodents) using up to 100Xs the therapeutic dose that is recommended for treatment of humans with ADHD. Those studies suggested a possible correlation with detrimental effects on rodent brain development. However, structural and functional neuroimaging studies of human brain regions thought relevant to ADHD find no evidence that stimulant treatment negatively impacts brain development or function. In contrast, studies suggest that stimulant treatment favorably attenuates the brain abnormalities that have been associated with ADHD.

What Are Functional Neuroimaging Studies?

Functional neuroimaging studies (fMRI) typically target three brain regions because they have been almost universally found to be involved in ADHD. These regions are the Striatum, Anterior Cingulate Cortex (ACC) and Prefrontal Cortex (PFC). Of the studies that show alterations in striatal function, most all find that medication favorably attenuates ADHD-related striatum dysfunction. Of the studies that show alterations in ACC activity, most find that medication favorably attenuates abnormal ACC function, and more studies than not show that medication favorably attenuates dysfunction in the region of the PFC.

Magnetic Resonance Imaging Studies

In fact Magnetic Resonance Imaging (MRI) studies on ADHD patients consistently suggest that treatment of ADHD with therapeutic oral doses of stimulants is associated with findings in persons with ADHD that are more similar to non-ADHD patients than were findings of un-medicated ADHD individuals. Structural MRI studies also support the use of stimulants in ADHD: That is, when any medication-associated effect was found, it was always in the direction of favorable attenuation of ADHD differences toward subjects without ADHD.

Clinical Implications

Results of all these studies have several clinical implications. For parents, patients, and clinicians who have been concerned that the use of stimulants could harm the developing brain, studies indicate that these concerns are unfounded and that treatment with stimulants should be considered if appropriate for the clinical presentation of the patient. Moreover, brain changes associated with stimulant treatment probably account for stimulant-associated improvements in attention and concentration.

A Favorable Attenuation

In Conclusion, therapeutic doses of stimulants are associated with favorable attenuation of abnormalities in brain structure and function in subjects with ADHD and do not support concern that such treatment negatively impacts brain development.

That said, the obvious question becomes: what is the risk associated with not treating ADHD with medication? Answer: Across the lifecycle, untreated ADHD is associated with high levels of disability and exerts an enormous negative toll in all areas of functioning, including academic, occupational, and interpersonal.

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