The Skinny on Psychostimulants,Part 2:Methylphenidate Stimulants

The Skinny on Psychostimulants, Part 2: Methylphenidate Stimulants

Last week I introduced a class of drugs called psychostimulants, or central nervous system (CNS) stimulants. As the name states, psychostimulants are “uppers” that stimulate the central nervous system when consumed in varying ways. This class includes the illicit drugs cocaine, ecstasy, and crystal meth, nicotine found in tobacco, and the most commonly consumed drug in the world, caffeine, which is a highly addictive compound that occurs naturally in more than 60 plant species, including the various beans brewed to make the most widely consumed beverage in the world, coffee. Other recognizable sources of caffeine include cocoa beans, tea leaves, and kola nuts. Caffeine is also chemically synthesized for handy inclusion in energy drinks, sodas, and various medications. This class also includes two types of stimulant medications, amphetamines and methylphenidate, which can be found as the bases in a myriad of pharmaceutical products.

In last week’s blog I introduced amphetamines; this week I’ll discuss methylphenidate stimulants. Like amphetamines, methylphenidate stimulants are tightly controlled Schedule II central nervous system (CNS) stimulants that work by stimulating the chemical messengers dopamine and norepinephrine, the neurotransmitters associated with control, attention, fight or flight response, and the pleasure/ reward system in the brain.

While these two types of drugs induce similar effects when taken, the way that they induce those responses, their mechanisms of action, are actually different. Both work to increase levels of dopamine and norepinephrine in the synapses between neurons, which helps messages move from one neuron to the next. Recall from last week that amphetamines have three mechanisms for increasing these levels: 1) they reverse the direction of the transporter pumps that would normally divert dopamine and norepinephrine away from the synaptic cleft, 2) they disrupt cellular vesicles, thereby preventing the storage of excess dopamine and norepinephrine, which frees them up for use in the cleft, and 3) they also promote the release of dopamine and norepinephrine at nerve cell terminals, making them more readily available in the synaptic cleft. Amphetamines’ three mechanisms combined ensure that there are very high concentrations of dopamine and norepinephrine in the synapses of the central nervous system and result in the very strong psychostimulant effects that amphetamines produce. 

In contrast, methylphenidate affects the levels of dopamine and norepinephrine in the synaptic cleft through a single mechanism: by shutting down the transporter pumps that would usually take up excess neurotransmitters. It does not reverse these pumps to cause a flood of neurotransmitters to be released, and does not work to increase neurotransmitter levels through any other actions the way that amphetamines do. As a result, amphetamines are slightly more stimulating than methylphenidate-based stimulants. For this reason, I typically use methylphenidate-based stimulants for children and adolescents and generally reserve amphetamines for use in adults. 

Both amphetamines and methylphenidate are used to treat and control symptoms of narcolepsy, obesity, binge eating disorders, and most commonly, attention deficit hyperactivity disorder (ADHD). Off-label indications, meaning potential uses that are not strictly approved by the FDA, include using either to treat major depressive disorder and in cancer patients to treat weakness, fatigue, and depression. There are also some relatively recent studies that indicate success in using psychostimulants off-label to decrease pain levels as part of a regimen in treating chronic pain patients. 

All stimulants can be prone to misuse, and may be used recreationally in certain populations via oral route, smoking, injecting, or snorting, to get high and/ or to stay awake for long periods of time. And their ability to improve concentration means some people use them to boost cognitive ability, to improve focus, and to study for and/ or take exams. This is a relatively common practice among some college students. 

The two types of medications are available as short-acting medications and in longer acting preparations. Both are essentially equally effective, and have the same benefits, risk(s), and side effect profiles, only varying mainly in their severity, with the profiles associated with amphetamines sometimes being slightly stronger than with methylphenidate. And while I’ve found that most patients respond equally well to either medication, adults to amphetamines and children to methylphenidate, some may respond better to one versus the other. But that’s certainly not a unique feature; that’s always the case with medications, as different bodies respond differently to varying formulations. 

Methylphenidate is most commonly used for treating ADHD, and is FDA approved first line therapy for ADHD patients age 6 and up. While it may seem counterintuitive to treat hyperactivity with a stimulant, this class of drugs have been shown to be the most effective treatment for reducing the symptoms of ADHD. This is because CNS neurotransmitter concentrations are lower in the ADHD brain, sometimes markedly so, and the addition of a stimulant raises the neurotransmitter levels to equal those comparable to the “normal” levels found in the non-ADHD brain. 

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and is associated with impaired functioning and negative developmental outcomes. Children with ADHD find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. They generally have more difficulty focusing, controlling actions, and remaining still or quiet, as compared to classmates or other people the same age. The American Academy of Pediatrics (AAP) recommends behavior therapy and medication for children 6 years of age and older, preferably both together. The end result in up to 90 percent of cases is that methylphenidate-based stimulant medication helps children with ADHD become more focused, improve their approach to schoolwork, get better organized, think before acting, get along better with others, conform better to societal norms, and break fewer rules. They do better socially, academically, and in terms of self esteem. As a result, they, and their other family members, are happier. In my experience, as the chaos in the patient’s mind is decreased, the chaos that usually follows and surrounds them is also decreased, and that makes for better harmony in the home as well. To put the success of methylphenidate in treating ADHD into perspective, there is no other medication for a psychiatric condition that has such a high response rate. 

In contrast, children with untreated ADHD don’t do as well comparatively speaking. Generally, if the symptoms of ADHD are negatively impacting any area of their life, they are impacting every area of their life, because ADHD is not just an academic problem, it’s a neurobehavioral problem that permeates every aspect of life and affects them academically, emotionally, and socially. Studies have shown that unchecked ADHD symptoms hinder childhood progress, causing a tendency to suffer in school and in social relationships. This negatively affects self-esteem, which causes feelings of anxiety and depression, not only at the time, but as lifelong consequences. The long term implications of low self esteem are well documented and extensive, and nearly always include fairly pervasive anxiety and depression. Low self esteem and all of its many consequences is common in adults with undiagnosed childhood ADHD, as well as from other sources, and it’s a common source of issues that I treat on a daily basis. 

So the lesson is that when weighing risks of treating ADHD with methylphenidate stimulants, recognize that making the decision not to medicate a child with notable ADHD symptoms has its own risks that must be considered. When you take into account that childhood is meant to be a building block and a time to learn, not just math and grammar, but how to make friends and function in the world, what the decision encompasses is a whole person and a whole life, and all that entails. As a psychiatrist, my opinion might be biased, but I might never understand why the decision to treat disorders affecting mental health are made so differently from ones that affect physical health, as if good mental health isn’t as important, or as necessary, as good physical health. I wonder, if a child had diabetes that was negatively impacting their life, would you suggest that child be treated for it, or would you withhold medication from them? Why is mental health treated so differently?

While it has been used safely and effectively for decades, there’s still a great deal of angst and controversy surrounding using stimulants in children with ADHD, one that begs further discussion. I’ll start with some fast facts on ADHD.

ADHD: By the Numbers

Incidence and prevalence statistics always vary according to sources and sampling methods, but the following are the 2020 numbers quoted by the Centers for Disease Control and Prevention.

The number of children ever diagnosed with ADHD is 6.1 million, or 9.4 percent. 

This includes: 

388,000 (2.4 percent) young children, aged 2 to 5 

2.4 million (9.6 percent) of school-age children, aged 6 to 11

3.3 million (13.6 percent) of adolescents, aged 12 to 17

Symptoms of ADHD typically first appear between the ages of 3 and 6.

The average age of ADHD diagnosis is 7 years old.

Males are more than twice as likely to be diagnosed with ADHD than females (12.9% compared to 5.6%).

Despite that fact, the incidence of ADHD diagnosis in girls has increased in recent years. Historically, diagnosis and incidence reporting had been low in girls, but new research indicates how ADHD symptoms manifest differently in boys and girls, leading to better recognition in girls.

ADHD isn’t just a childhood disorder. About 60 percent of children with ADHD in the United States become adults with ADHD, which is about 4 percent of the adult population. 

ADHD severity is generally based on the age at diagnosis:

Mild: Average age of diagnosis is 8

Moderate: Average age of diagnosis is 7

Severe: Average age of diagnosis is 5

Roughly two-thirds of children with ADHD diagnosis have/ have had/ will have at least one other mental, emotional, or learning disorder: most common are depression and/ or anxiety and other behavioral or conduct disorders, but other conditions such as autism spectrum disorder and Tourette syndrome/ tic disorder may also affect children with ADHD.

ADHD On the Rise

Cases and diagnoses of ADHD have been increasing dramatically in the past few years. The American Psychiatric Association (APA) says that roughly 8.4 percent of American children have ADHD, which differs significantly from the statistic quoted by the Centers for Disease Control and Prevention. The numbers vary depending on sampling methods and reference, but they all do indicate one thing: that ADHD diagnoses are on the rise. 

To account for the differences in statistics, there may be an implication that ADHD is being commonly mis-diagnosed, that children are being diagnosed with ADHD when they don’t actually have it. In reality, while ADHD isn’t a fast, easy diagnosis to make, there are strict and clear cut guidelines for diagnosis that make mis-diagnosis fairly rare. There must be a comprehensive evaluation using multiple collaborative sources (including interviews with the child, the parent(s), and typically the teacher), established symptom rating scales, observation by a physician, and cognitive and/ or academic assessments. A valid diagnostic appraisal takes time, so while mis-diagnosis certainly occurs in a very small percentage, it is certainly not responsible for the rise in numbers. 

What is responsible? The answer is multi-faceted, and includes: the increase in research and development in making the diagnosis, the decrease in the stigma associated with seeking help and/ or being evaluated for and/ or potentially having the diagnosis, and the increase in public awareness of ADHD. Many of today’s ADHD patients would have been yesterday’s “problem children.” In other words, we simply know better now, so we do better. Physicians are better trained in how ADHD manifests itself, especially in girls, since it’s stereotypically been a “boy disorder,” and everyone involved, including physicians, parents, and teachers, are more alert and pay closer attention to the disruption that behavioral issues cause in the classroom to everyone, not just the student with ADHD. 

The question then may be asked if more kids are actually experiencing ADHD today than they were before, and if so, why? We now know that ADHD is caused by a mix of genetic and environmental factors, and current best estimates indicate that about 70 to 80 percent of the risk for ADHD is genetic. But it’s not very clear cut or simple, where you either have an “ADHD gene” or you don’t, and there’s no single marker to look for or confirm a diagnosis. Instead, each gene involved in the condition contributes a certain amount of risk for developing it. The genetic component is complicated, but we really know even less about the environmental component, which makes up the other 20 to 30 percent of the risk of developing ADHD. The environmental risk factors we are fairly sure of- the ones we have the strongest and clearest evidence for- appear to be preterm birth and low birth weight. We also know that it is likely that if in fact we are seeing a true rise in ADHD cases over the last 20 years or so, as we believe we are, environmental factors must play an important role in it, simply because genetics don’t change that quickly. Some studies have suggested that exposure to toxins (ie lead exposure, smoking during pregnancy) may play a role, and that traumatic brain injuries may also play a role in increasing risk of developing ADHD. In the end, the rise in the number of cases is most likely to be a combination or interaction of all of the above factors, and that some environmental factors interact with certain genetics to increase a child’s risk of developing ADHD. What else do we know about increasing numbers of ADHD cases? That we always need and want to know more. 

Methylphenidate Medications

There are several methylphenidate product formulations, including oral tablets and capsules in immediate release/ short-acting, extended release/ long acting, chewables, liquid, and patches to be applied to the skin. There’s even a formulation called Jornay PM, which is taken at night, but only becomes active in the morning. All are derived from essentially the same basic methylphenidate compound. Immediate release or short-acting formulations typically begin to work about 30-45 minutes after ingestion and last about 3-4 hours, while extended release generally last about 6-8 hours, though there are of course exceptions that may release even more slowly and last longer.

Ritalin is a short-acting formulation of methylphenidate that lasts about 3-4 hours. Focalin is another form of methylphenidate that also lasts about 4 hours. Both of these medications begin to work about 30-45 minutes after taking them. For children who have trouble swallowing pills, this medication can be crushed and mixed with foods. There is also a liquid and a chewable tablet form of the short-acting methylphenidate.

Other preparations of methylphenidate have been created to release the medication over a greater period of time, extending the duration of the effect of the medication. This is of great benefit when trying to provide a response that lasts through a school day, typically 6-8 hours. Some of these compounds take effect as quickly as the short-acting forms of these medications. 

Concerta is one of the longest-acting methylphenidate medications on the market, lasting 8-12 hours. Concerta can’t be chewed or opened. It has to be swallowed whole in order for it to work the way it was designed. This can be a problem for some kids.

Ritalin-LA and Metadate CD are capsules that are filled with medication. These medications are very similar in that they both last about 6-8 hours. These are better for kids who can’t swallow pills, because you can open up the capsule and sprinkle it on foods like yogurt, applesauce, peanut butter, etc.

Aptensio XR and Focalin XR are also capsules filled with medication that can be opened and mixed with food. They typically work longer than Ritalin LA or Metadate CD.

Quillivant XR is a long-acting formulation of methylphenidate in liquid form, which makes it a good alternative for kids who have trouble swallowing capsules and can’t tolerate beads on food items either.

Quillichew ER is a chewable long–acting formulation of methylphenidate that can last up to 8 hours.

Daytrana is a methylphenidate patch. It’s another good option for kids who can’t swallow pills. You can wear the patch for up to 9 hours, and often get another hour’s worth of response after the patch is removed. But if using the patch, understand that it can often take 1-2 hours from application to the skin to start working.

Potential Benefits of Methylphenidate

In truth, the benefits of treating ADHD with stimulants are too vast to really list when you consider long term implications, but for our purposes, I’m only dealing with direct observed benefits when treating ADHD with methylphenidate stimulants here. 

Methylphenidate based medications have been proven to reduce the disruptive and troublesome symptoms of ADHD, making kids less hyperactive, less impulsive, more focused, and less distractible, with few side effects, if any, when the medications work properly. However, it’s important to note that these medications cannot treat or correct learned behaviors or other types of learning disorders.

The Benefits of Methylphenidate on ADHD Brains: What Science Says

Much of the controversy that surrounds treating childhood ADHD with  methylphenidate stimulants has to do with concerns about long term implications, mainly regarding brain development. Recent research on the neurobiological and anatomical underpinnings of ADHD has shed some light on this subject. 

Several years ago, neuroimaging work confirmed that there are neuroanatomic, or structural differences, in the brains of people with ADHD versus those without ADHD, especially in the frontal cortex, which is involved with attention, organization, abstract thinking, and keeping track of things. It was also confirmed that total brain volume, made up of gray and white matter, also differs.

Regarding anatomical brain differences, specifically, children with ADHD had overall smaller brain volumes, by about 3 percent, than children without ADHD, though it is important to note that intelligence is not linked to or affected by brain size. In addition, five of the regional areas in the deep brain that pertain to regulating emotion, motivation, and emotional problems- the caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus- were smaller in people with ADHD; and some showed structural deformations as well. The brains of children with ADHD showed decreased cortical thickness in the prefrontal cortex, and less white and gray matter. 

White matter affects learning and brain functions, and acts as a relay to coordinate communication between different brain regions. White matter consists of axons, or nerve fibers, which have a myelin sheath whose color gives the area its name. Think of these myelinated nerve fibers of the white matter as the wiring of the brain- where information is carried from one point to the next- and these are insulated, so that the information is conserved, ie doesn’t “leak out” as it’s carried. Grey matter is the more outward layer of the brain that serves to process information in the brain and directs sensory stimuli to nerve cells in the central nervous system where the synapses induce the response to that stimuli. The grey matter has more connections than white matter, but isn’t as insulated as myelinated white matter; so this area relates more to memories and facts which are used every day to help a person function optimally.

In fact, further studies have shown that the structural differences in ADHD brains tended to be most observed in the brains of children with ADHD and not as much in ADHD adult brains. This is likely an indication that childhood is an important time to treat ADHD, which seems to be confirmed by further research. All in all, the findings led researchers to state that ADHD is a function of atypical brain structure and atypical chemical development. A few years ago, a research group took these findings a step further. Given the success of methylphenidate in treating the symptoms of ADHD, which is basically correcting the atypical chemical differences in neurotransmitter levels, they looked at the effects of methylphenidate on brain structure. 

The study found that childhood psychostimulant medication (methylphenidate) led to volume normalizations in several areas where volume levels were known to be reduced in the ADHD brain. Normalization means that where they were previously reduced prior to treatment with methylphenidate psychostimulant medication, they were increased to the point of reaching levels found in “normal” non-ADHD brains after being treated with the psychostimulant methylphenidate.

These studies found that specifically, overall white matter volume and grey matter volume normalized, or “resolved” after childhood treatment with psychostimulant, as did anterior cingulate cortex (ACC) volume, which is implicated in several complex cognitive functions, such as empathy, impulse control, emotion, and decision-making. When they looked at the largest part of the brain, the cerebral cortex, which is the ultimate control and information processing center, responsible for higher-order brain functions of sensation, perception, memory, association, thought, and voluntary physical action, they found that the ADHD-related thinning that had been present, was moderated by childhood psychostimulant treatment. The ADHD-related size reduction of the deep brain structures, which are key to learning, memory, reward, motivation, and emotion, normalized after psychostimulant treatment, as did deformations of the caudate nuclei, when present. 

One hypothesis that they had looked to prove or disprove was that methylphenidate treatment of ADHD during childhood and adolescence, but not during adulthood, would stimulate white matter, striatal, and frontal cortical development, resulting in more adult-like values. And in fact, their findings did prove this. This is important, because it is an age-related treatment response. It essentially means that when you treat childhood ADHD with methylphenidate in childhood, the methylphenidate stimulates a response that normalizes most of the abnormalities found in the brain of the child with ADHD such that they are comparable to normal adult values later. That’s a good thing.

Another study looked at behavioral changes associated with using methylphenidate, and found that, relative to periods off medication, ADHD patients on medication have fewer motor vehicle accidents, have a lower risk of traumatic brain injury, are less likely to engage in criminal activity, have lower rates of suicidal behavior, and have lower rates of substance abuse. Why? Because it seems that when neurotransmitter levels are normalized, behavior is normalized as well, which makes behavior when on medication safer, more risk averse, ie less risky. The authors end the report of their findings with this: “Thus the answer to the question ‘Is there long-term benefit from stimulant treatment for ADHD” is a definite “Yes!'”

Potential Negative Side Effects of ADHD Stimulant Medications/ Methylphenidate

Most side effects associated with methylphenidate are very mild and temporary, but if they exist, are likely to be dose or formulation related, as it can take some time to find the appropriate medication and dose. If you find that any side effects are intolerable or persist, it’s important that you inform the prescribing physician. In addition, the dose should be re-evaluated each year, even if there are no issues, as the medication needs can change over time, especially in growing children. 

Decreased Appetite

This is the most common side effect of stimulant medications. The loss of appetite may happen just while the medication is effective, and then wear off, as the benefits of the medication do. Children may be very hungry once the medication wears off, and if they haven’t eaten, they may also be irritable, aka hangry. This is typically a manageable problem, but the issue should be discussed with the physician who prescribes the medication if it persists or is intolerable.

Insomnia/ Sleep Problems

There may be issues with falling asleep associated with methylphenidate. This is usually fairly mild, and it tends to occur more in younger children who might have already had issues with falling asleep before they started the medication. There are many things that can interfere with falling asleep or manifest as sleep issues, so it’s important to determine if any external causes (other than medication) may be present. These can include poor or irregular sleep schedule, excess screen time/ blue light exposure right before bed, academic concerns/ worrying about school tests, or social issues with friends. Again, problems falling asleep are likely to improve over time, but may also be overcome by changing either the time or type of the medication that is given. For example, if a second or third dose of a short-acting formula is taken too late in the day, it may not have worn off by bedtime, which could cause the issue. This can be addressed by the physician with formula or dosing changes.

Mood Changes

There is a small subset of children with ADHD who may seem moody and irritable when they take stimulant medications, even if they are taking the best possible dose. If this is going to happen, it usually happens right away, as soon as they start taking the medication, and goes away immediately when they stop taking it. If this happens, it may help to switch to a different formulation or dose, so inform the prescribing physician right away to discuss potential alterations. Sometimes when a stimulant dose is too high, especially in children, they may begin to look tired or experience irritation. If this happens, the prescribing physician may opt to adjust the dose until the right dose is found: one in which the child gets the most benefit from the medication with the least possible side effects.

“Wear-Off” Effects

While this isn’t technically a side effect, a very small minority of children experience behavioral changes as their ADHD medication wears off, which typically occurs at the end of the school day. Some parents call it “rebound” but that term can be a bit misleading. They can seem more irritable or emotional, but it is usually a mild transient finding. Sometimes it’s related to being hangry or overtired, but it can be connected to the medication level dropping, and strategies that create a more gradual decrease in the medication level may help relieve it. Obviously, discuss with the prescribing physician if you notice it and believe it’s due to the medication levels. 

Tics

About 10% of kids with ADHD will have concomitant tics, whether or not they take methylphenidate, so that translates to a fair number of children. Tics usually start between 6 and 8 years of age, which is often when kids also first start taking a medication for ADHD. Tics may also be transient, and may come and go over time. The best we know from a series of studies, is that stimulants don’t cause tics, but if tics are present, sometimes methylphenidate can aggravate them. Despite this, methylphenidate may possibly still be used, but treatment should be more closely monitored if this is the case. If tics increase significantly during treatment, there may be an option to use a non-stimulant medication that affects the brain in a different way. 

Non-Stimulant Medications for ADHD

There are two types of non-stimulant medications that can help to alleviate some symptoms of ADHD. While they don’t have the efficacy that stimulants do, and they have very different side effect profiles, they may be an option worth trying if stimulants aren’t a viable option due to concomitant disorders like tics. Just as with stimulants, it may take several attempts to find the right medication and dosage, with the least side effects.

Clonidine (Catapres, Kapvay) and guanfacine (Tenex, Intuniv) are called alpha-adrenergic agonists, and these medications were developed to lower high blood pressure in patients with hypertension. But they are also prescribed in adjusted doses for children with ADHD who don’t tolerate stimulants well, and are sometimes also used to treat tics. These medications can cause fatigue related to low blood pressure, so blood pressure and heart rate must be regularly monitored while taking these medications. These are typically short-acting medications that require several doses each day, but they come in longer acting versions, Kapvay and Intuniv.

Atomoxetine (Strattera) is in a class of drugs called norepinephrine reuptake inhibitors. Norepinephrine is one of the CNS neurotransmitters needed to control behavior.

Unlike stimulants, Atomoxetine can take 4-6 weeks to take effect and has to be taken daily.

Busting Myth-information

There’s a great deal of false information out there on ADHD and stimulants. 

Does using stimulants stunt growth?

In spite of concerns that have been voiced regarding growth and stimulants, a recent well-validated clinical study showed that neither ADHD, nor treatment with stimulants, was associated with a decrease in growth rate during the maximum growth period in childhood, or a change in final adult height. Combined with other studies, it is clear that treatment with stimulants has no impact on growth rate or final adult height.

Are psychostimulants addicting?

Provided they are taken via the prescribed route, at the level they are prescribed for ADHD, methylphenidate medications do not raise the dopamine level high enough to produce euphoria, and they are not considered addictive.

Does using stimulants make children prone to addiction later in life?

Observational studies conclude that stimulant medication to treat young children with ADHD does not affect- neither in an increasing nor decreasing way- the risk for substance abuse in adulthood.

Does using stimulants change a child’s personality?

ADHD medications should not change a child’s personality. If a child taking a stimulant seems sedated or zombie-like, or tearful and irritable, it usually means that the dose is too high and the clinician needs to adjust the prescription to find the right dose.

Does using stimulants have negative long term effects?

In over 50 years of using stimulant medications to counteract the symptoms of ADHD, and hundreds of studies, no negative effects of taking the medication over a period of years have been observed. On the contrary, using methylphenidate to treat childhood ADHD especially, is associated with the positive effects and benefits of normalization of neurotransmitter levels and structural brain differences.

Using Methylphenidate for ADHD in Children:

Parental Considerations

As a parent, making a decision to place a child on a stimulant for ADHD isn’t to be taken lightly. As a physician, it’s certainly one I take very seriously. The following are things to keep in mind when weighing the decision.

All research studies indicate that stimulants are the most effective treatment for symptom reduction in ADHD. 

Methylphenidate has been used for decades, and is considered safe and generally well tolerated by most people, including children and adolescents, with low side effect profiles. 

Do a risk/ benefit analysis. You have to weigh the risks associated with treating ADHD with a safe and effective stimulant with a good track record versus not treating the ADHD, and all of the areas of the person’s life that decision impacts, including the well documented academic and social implications. In the total analysis, the risks associated with living with untreated ADHD are generally greater than treating with a methylphenidate stimulant that has an excellent safety profile and actually has the benefits of normalization of neurobiological and structural brain anomalies associated with ADHD. 

When the symptoms of ADHD are negatively affecting every aspect of a child’s life, medication is a better and safer alternative than allowing that negative impact to persist throughout school age years and beyond.

Methylphenidate, like all medications, may cause some side effects, but most are mild, temporary, and/ or can be relieved by a change in formulation or dosing. It may take some trial and error to find the prescription and dosage that works well with the least side effects. While this may take time and patience, it’s time well spent. 

Deficiencies in neurotransmitters such as those in ADHD also underlie many common disorders, including anxiety, mood disorders, anger-control problems, and OCD, obsessive-compulsive disorder. As a result, ADHD often occurs concomitantly with other disorders. In other words, ADHD may not be the only thing going on with an ADHD brain. At least two-thirds of people diagnosed with ADHD are also diagnosed with at least one other mental health or learning disorder in their lifetime, according to the American Academy of Child and Adolescent Psychiatry. Some of the more common accompaniments, especially in children, include anxiety disorders, depression, and learning and language disorders. As a parent, you may find you’re looking for the right mix of medications or treatments for multiple issues.

Granted, there are a lot of issues to consider, but hopefully I’ve managed to cover most of them here. My opinion is clear, and it is that overall, given the high efficacy, the track record, the safety, and the many well proven benefits of its use, methylphenidate treatment for ADHD far outweigh the risks associated with not treating it. 

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MGA