Practice Therapeutics

Stimulant medication to treat attention-deficit/hyperactivity disorder

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j2945 (Published 14 July 2017) Cite this as: BMJ 2017;358:j2945
  1. Paramala Santosh, consultant child and adolescent psychiatrist1 2
  1. 1Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
  2. 2Honorary Reader, Department of child psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  3. 3Director, HealthTracker Ltd, Gillingham, UK
  1. Correspondence to P Santosh paramala.1.santosh{at}kcl.ac.uk
  • Accepted 15 June 2017

What you need to know

  • In children and young people, stimulants should be the first choice in those with severe attention-deficit/hyperactivity disorder (ADHD), or when non-pharmacological approaches have failed

  • Stimulants are effective in managing ADHD symptoms in adults and should be continued as long as ADHD symptoms have an adverse effect on quality of life

  • Stimulants can be used in ADHD with most co-existing disorders such as anxiety, oppositional defiant disorder, conduct disorder, tic disorder, and autistic spectrum disorder

A 10 year old boy is restless at school and often disturbs the rest of the class. His mother is concerned that his restlessness interferes with his activities outside school. He is diagnosed with attention deficit/hyperactivity disorder (ADHD) by a paediatrician and starts treatment with methylphenidate. The boy’s mother is worried because the drug is a stimulant and she fears her son might become addicted to it.

People with ADHD display developmentally inappropriate levels of inattentiveness and impulse control, and can have difficulty moderating activity.1 Some 5% of people are thought to be affected by the disorder.2

ADHD facts

  • The core symptoms of ADHD are inattention, hyperactivity, and impulsivity

  • ADHD can present with one or more co-existing conditions, such as conduct disorder, oppositional defiant disorder, anxiety, and/or depressive disorder36

  • The cause of ADHD is unknown

    • o Genetic heritability of ADHD symptoms is about 75%37 in children and adolescents, (meaning that genetic factors can explain 75% of the variance in ADHD symptoms in the general child and adolescent population) and 30% in adults38

    • o Non-genetic risk factors include smoking during pregnancy and alcohol abuse, prematurity/low birth weight, intrauterine exposure to certain medication, and maternal postnatal depression39

  • Genes involved in neurite outgrowth37 can lead to subtle changes in the frontal-striatal system40 and the dorsal, ventral, motor, and visual networks of the brain, …

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