Wednesday, February 13, 2013

Stimulant Treatment of ADHD in Children

There are many ethical concerns that are raised by the treatment of children with psychotropic drugs. This is especially relevant with the use of stimulants to treat ADHD because of the large number of children receiving stimulant medication. In 2008, 3.5% of children under 18 in the United States received stimulant medication. This was even higher in school age children and adolescents, with 5.1% of 6-12 year olds and 4.9% of 13-18 year olds receiving stimulant treatment. This data indicates that an estimated 2.8 million children received stimulant medication for the treatment of ADHD in 20081.

Are stimulants overused? (Source)

The safety of stimulant medications in children is a large concern because there have not been many longitudinal studies on the effects of stimulant usage, especially for children beginning stimulant usage at a young age. There has been some evidence of serious side effects, including cardiovascular risk, growth suppression, and development or early onset of other psychiatric diseases2,3. Since 2007, the FDA has made stimulant medication provide warnings for these potential side effects2.

Even less well studied are the potential emotional side effects that could accompany the diagnosis of ADHD and treatment of children with stimulant drugs. One such concern is the possibility of stigma. Mental disorders are plagued with public perception problems. This is exacerbated by the diagnostic variances seen with disorders such as ADHD. These diseases can only be diagnosed through behavioral components because, with our current understanding, we do not have conclusive biomarkers or other laboratory tests to diagnose the disease, as we do in normal illnesses. This leads to multiple problems in the diagnosis of these diseases, especially in children where the symptoms are just exacerbations of normal childhood behavior2. Because of the variance and problems involved in the diagnosing of these disorders, it is easy for the public to misunderstand these diseases. ADHD is often thought of as over diagnosed, and there are some who are skeptical ADHD is even a disease. How does this view affect the children who grow up with this diagnosis and who are taking psychotropic drugs for its treatment?

Children diagnosed and treated for ADHD also have to cope with another potential component of stigma, because children with ADHD are thought to be at higher risk for social dysfunction, including drug abuse and criminality2. Thus, being diagnosed and visibly treated for ADHD could lead to changes in social perception by peers and teachers. This stigma could fall unevenly on different gender, social, and racial groups. There is evidence that girls with ADHD are treated differently than boys, with girls being less likely to receive stimulant medications, even though they receive equal benefits from stimulant treatment4,5. Differential effects of perception, stereotypes, and stigma on female children could mediate this difference in medication treatment.

Further studies are needed to understand how the diagnoses of ADHD and treatment with stimulants affect children, both physically and emotionally. It will be important to weigh this information against the positive benefits of stimulant treatment on a person-to-person basis when deciding which treatment regimen will be best.

--Elizabeth Pitts


Want to cite this post?

Pitts, E. (2012). Stimulant Treatment of ADHD in Children. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/02/stimulant-treatment-of-adhd-in-children.html



Works Cited

1) Zuvekas, S.H. & Vitiello, B. Stimulant medication use in children: a 12-year perspective. American Journal of Psychiatry 169, 160-166 (2012).

2) Singh, I. Beyond polemic: science and ethics of ADHD. Nature Reviews Neuroscience 9, 957-964 (2008).

3) DelBello, M. P., Soutullo, C. A., & Hendricks, W. et. al. Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset. Bipolar Disorders 3, 53-57 (2001).

4) Angold, A., Erkanli, A., Egger, H. L., & Costello, E. J. Stimulant treatment for children: a community perspective. Journal of the American Academy of Child & Adolescent Psychiatry 39, 975-984 (2000).

5) Barbaresi, W. J., Katusic, S. K., & Colligan, R. C et. al. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. Journal of Developmental & Behavioral Pediatrics 27, 1-10 (2006).

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