According to a recent study published by the Journal of the American Medical Association, the number of children diagnosed with attention-deficit hyperactivity disorder (ADHD) saw a startling increase between 1997 and 2016, revealing that on average 1 out of 10 children were being diagnosed with ADHD.

To make matters worse, another study indicates that certain ADHD medications may cause psychosis in patients.

Cohort Study

The latter study, published in the New England Journal of Medicine, targeted patients between the ages of 13 and 25 who were diagnosed with ADHD and began taking methylphenidate (e.g. Concerta or Ritalin) or amphetamine (e.g. Vyvanse or Adderall) medications between January 1, 2004 and September 30, 2015. In addition, the study evaluated new diagnoses of psychosis in patients for which antipsychotic medication was prescribed within 60 days following the onset of psychosis.

In order to definitively determine new-onset psychosis in patients, the study excluded patients with a history of mental health disorders, such as acute psychosis, schizophrenia and bipolar disorder. Also excluded were patients receiving antipsychotic medications, mood stabilizers or stimulants used for conditions other than ADHD within the 12 months before the date the study began. Patients who had been prescribed oral glucocorticoids within 60 days of the onset of the study were also excluded, as these medications can also cause psychosis.

Findings

Out of the 221,846 patients included in the study, 110,923 were taking amphetamines and were matched by 110,923 individuals receiving methylphenidate. Of the 343 episodes of psychosis reported, 237 episodes occurred in the amphetamine group and 106 in the methylphenidate group, making new-onset psychosis present in about 1 in 660 patients and doubling the risk of psychosis for those taking amphetamines.

Limitations to the study include a possible under-reporting of substance abuse—which can increase the risk of psychosis—and determining whether misuse or abuse of ADHD medications had occurred. However, due to a large number of patients and exclusion of individuals taking other medications that can cause psychosis, the study still reveals a strong causal connection between ADHD medications and psychosis.

Issues Raised

The findings of these studies shed light on the alarming increase of children diagnosed with ADHD, as well as types of treatment implemented and the results of those treatments—specifically the disturbing number of children experiencing psychosis after receiving ADHD medications.

Increase in ADHD Diagnosis

Such high prevalence of ADHD in children suggests that there is something peculiar occurring nationwide, raising questions regarding the true causes of the increase. A few factors may be at play, including changes in diagnostic criteria, social and environmental factors, pharmaceutical pressure or any combination of these possibilities.

Regardless of the determining factor(s) for an ADHD diagnosis, a distressing rise in prevalence suggests a high need for awareness concerning ways to reduce risk factors for developing ADHD. Possible approaches could include the implementation of actions to lower childhood poverty, to educating officials about the need for safe green space, and informing parents and teachers about the importance of replacing excessive technology time with nature-oriented experiences.

Treatment Options

According to an article written by Daniel R. Taylor, Director of Community Pediatrics and Child Advocacy at St. Christopher's Hospital for Children, "Writing a prescription for a stimulant medicine to treat the symptoms of ADHD takes me less than 30 seconds. Writing to local, state and federal officials to push for the necessary investments in children and families takes much longer. But if we do not take action . . . we will see a condition that so often should be preventable only continue to rise."

Sadly, what seems to be rampant over-prescribing of risky ADHD meds may be largely due to an unwillingness by physicians to look at the broader picture the way that Dr. Taylor does. Not only are there ways to prevent the occurrence of attention-deficits, but there are also forms of treatment that can likely reduce or eliminate the need for medication, including behavioral therapy. The American Academy of Pediatrics recommends implementing behavioral therapy in conjunction with ADHD medication, and there has been a promising decline in the number of children treated solely with ADHD medication since 2017.

Over-prescription of medications to treat ADHD has raised concerns for many years. However, recent findings that medications such as Adderall and Ritalin are causing psychosis in children are too alarming to ignore, especially when there are alternative methods of treatment available.

This tragic development in the treatment of ADHD demonstrates the need for more awareness about prevention and implementation of less harmful treatments, while posing the question of whether these drugs are worth the risk.