Intended for healthcare professionals

Practice Therapeutics

Stimulant medication to treat attention-deficit/hyperactivity disorder

BMJ 2017; 358 doi: (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}
  • 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

What therapeutics are available?

Treatment for ADHD can include drugs, behavioural therapy, or a combination of these (fig 1, fig 2). Stimulant treatments such as methylphenidate and amphetamines are the key drug treatments. They are thought to work by restoring the imbalance in catecholamine levels at the synapse by inhibiting presynaptic dopamine re-uptake, hence increasing the availability of extracellular dopamine.3 Unlike methylphenidate, amphetamine can also reverse dopamine uptake and targets the vesicular monoamine transporter 2 to increase cytoplasmic dopamine levels.4

Fig 1 Treatment decision making in ADHD without co-existing disorders

Fig 2 Possible treatment decision making in ADHD with co-existing disorders

Stimulant medication is intended to reduce symptoms, boost academic achievement, and improve quality of life, but should be considered as first line treatment in severe …

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