Intended for healthcare professionals

Education And Debate

Use of stimulants for attention deficit hyperactivity disorder: AGAINST

BMJ 2004; 329 doi: (Published 14 October 2004) Cite this as: BMJ 2004;329:908
  1. Harvey Marcovitch (, paediatrician1
  1. 1 Honeysuckle House, Balscote OX15 6JW

    Definitive diagnosis of attention deficit hyperactivity disorder is complex. David Coghill believes the condition is undertreated, but Harvey Markovitch argues that current uncertainties about diagnosis and treatment mean doctors should be cautious


    Doctors must take great care before prescribing psychoactive drugs for children. Relying on published trials and manufacturers' summaries of product characteristics (data sheets) has proved inadequate for selective serotonin reuptake inhibitors.1 Doctors should be just as cautious before prescribing central nervous system stimulants for attention deficit hyperactivity disorder (ADHD) and consider their response to the fact that despite decades of use, the first reasonably large medium term controlled trial (14 months' use) was not published until 1999.2

    Even though evidence of safety and efficacy is more qualitative than quantitative, overall prevalence of stimulant use may be as high as 6% in the United States. If we were to follow the American …

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