CNS Drugs

, Volume 7, Issue 4, pp 264–272 | Cite as

Central Stimulant Treatment of Childhood Attention Deficit Hyperactivity Disorder

Issues and Recommendations from a US Perspective
  • Daniel J. Safer
Disease Management


The use of CNS stimulants for the treatment of attention deficit hyperactivity disorder (ADHD) in children has steadily increased in most areas of the world over the last 30 years. In mid-1995, at least 1.5 million US children were receiving methylphenidate or dexamphetamine (dextroamphetamine). However, in other countries these agents are not used as widely.

Specific stimulant-induced benefits for children with ADHD include: improved school grades, more completed classroom work, fewer reprimands for disruptive behaviour, improved handwriting, and improved behaviour at home and in social situtions. Stimulants benefit at least 75% of children with ADHD and are remarkably well tolerated, having few (for the most part minor and temporary) adverse effects.

However, the benefits of stimulants that are obvious in most patients with ADHD during a brief clinical trial are primarily symptomatic. Although the behavioural benefits of stimulants are generally present during each period of treatment for as long as the ADHD condition exists (and children with ADHD are now often staying on stimulant medication into their mid-teens), the treatment has not been shown to change the long term outcome of the disorder.

Before prescribing stimulants, paediatric physicians need to perform a careful diagnostic assessment for ADHD using multiple sources of information, including detailed ratings of the child’s behaviour from his/her teachers and from a parent. If at baseline, the child’s academic and behavioural adjustment in the classroom is good, stimulant medication would be inappropriate. However, if the child’s pattern of ADHD has consistently and seriously interfered with his/her classroom and home adjustment, stimulant treatment should be actively considered. Should stimulant therapy be initiated, knowledgeable medical follow-up is required.


Attention Deficit Hyperactivity Disorder Methylphenidate Teacher Rating Stimulant Medication Acad Child Adolesc Psychiatry 
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  1. 1.
    Jensen PS, Vitiello B, Laughren TP. Design and methodology issues for clinical treatment trials in children and adolescents. Psychopharmacol Bull 1994; 30: 3–8PubMedGoogle Scholar
  2. 2.
    Williams L, Lerner M, Swanson J. Prevalence of office visits for ADD. NIMH Conference on Gender Differences in ADHD: 1994 Nov 11; Bethesda (MD)Google Scholar
  3. 3.
    Zito JM, Riddle MA, Safer DJ, et al. Pharmacoepidemiology of youth with treatments for mental disorders [abstract]. Psychopharmacol Bull 1995; 31: 540Google Scholar
  4. 4.
    Safer DJ, Zito JM, Fine EM. Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics 1996; 98: 1084–8PubMedGoogle Scholar
  5. 5.
    Wolraich ML, Hannah JN, Pinnock TY, et al. Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry 1996; 35: 319–24PubMedCrossRefGoogle Scholar
  6. 6.
    Taylor E. Cultural differences in hyperactivity. Adv Develop Behav Pediatr 1987; 8: 125–50Google Scholar
  7. 7.
    Chiarello RJ, Cole JO. The use of psychostimulants in general psychiatry. Arch Gen Psychiatry 1987; 44: 286–95PubMedCrossRefGoogle Scholar
  8. 8.
    Holmes VF. Medical use of psychostimulants. Int J Psychiatry Med 1995; 25: 1–19PubMedCrossRefGoogle Scholar
  9. 9.
    Conners CK. Rating scales for use in drug studies with children. Psychopharmacol Bull (Spec Issue: Psychopharmacology in Children) 1973: 60Google Scholar
  10. 10.
    Loney J, Milich R. Hyperactivity, inattentiveness and aggression in clinical practice. In: Wolraich M, Routh DK, editors. Advances in behavioral pediatrics, vol. 3. Greenwich (CT): JAI Press, 1981: 123Google Scholar
  11. 11.
    Ullman RK, Sleator EK, Sprague RL. Introduction to the use of ACTeRS. Psychopharmacol Bull 1985; 21: 915–20Google Scholar
  12. 12.
    Sleator EK, Ullman RK. Can the physician diagnose hyperactivity in the office? Pediatrics 1981; 67: 13–7PubMedGoogle Scholar
  13. 13.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press, 1994Google Scholar
  14. 14.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization, 1993: 155–7Google Scholar
  15. 15.
    Barkley RA. Hyperactive children: a handbook for diagnosis and treatment. New York: Guilford Press, 1990Google Scholar
  16. 16.
    Jacobvitz D, Sroufe A, Stewart M, et al. Treatment of attentional and hyperactivity problems in children with sympathomimetic drugs. J Am Acad Child Adolesc Psychiatry 1990; 29: 677–88PubMedCrossRefGoogle Scholar
  17. 17.
    Elia J. Drug treatment for hyperactive children. Drugs 1993; 46: 863–71PubMedCrossRefGoogle Scholar
  18. 18.
    Cantwell D, Wender P. ADD throughout life: new clinical insights. 1994 Oct 17; Montifiore Medical Center, New York CityGoogle Scholar
  19. 19.
    Barkley R. A review of stimulant drug research with hyperactive children. J Child Psychol Psychiatry 1977; 18: 137–65PubMedCrossRefGoogle Scholar
  20. 20.
    Safer DJ, Allen RP. Absence of tolerance to the behavioral effects of methylphenidate in hyperactive/inattentive children. J Pediatr 1989; 115: 1003–8PubMedCrossRefGoogle Scholar
  21. 21.
    Fischer M, Barkley RA, Edelbrock CS. The adolescent outcome of hyperactive children diagnosed by research criteria. J Consult Clin Psychol 1990; 58: 580–8PubMedCrossRefGoogle Scholar
  22. 22.
    Elia J, Borcherding BG, Rapoport JL, et al. Methylphenidate and dextroamphetamine treatments of hyperactivity: are there true non-responders? Psychiatry Res 1991; 36: 141–55PubMedCrossRefGoogle Scholar
  23. 23.
    Riddle MA, Geller B, Ryan N. Another sudden death in a child treated with desipramine. J Am Acad Child Adoles Psychiatry 1993; 32: 792–7CrossRefGoogle Scholar
  24. 24.
    Weiss G, Hechtman LT. Hyperactive children grown up. 2nd ed. New York: Guilford Press, 1993: 31–4, 136-41Google Scholar
  25. 25.
    Aman MG, Marks RE, Turbott SH. Clinical effects of methylphenidate and thioridazine in intellectually subaverage children. J Am Acad Child Adolesc Psychiatry 1991; 30: 246–56PubMedCrossRefGoogle Scholar
  26. 26.
    Kaplan SL, Busner J, Kupiez S, et al. Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH. J Am Acad Child Adolesc Psychiatry 1990; 29: 719–23PubMedCrossRefGoogle Scholar
  27. 27.
    Tannock R, Ickowicz A, Schachar R. Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 1995; 34: 886–96PubMedCrossRefGoogle Scholar
  28. 28.
    Gadow KD, Sverd J, Sporafkin J, et al. Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. Arch Gen Psychiatry 1995; 52: 444–55PubMedCrossRefGoogle Scholar
  29. 29.
    Hagerman RJ, Murphy MA, Wittenberg MD. A controlled trial of stimulant medication with fragile x syndrome. Am J Med Genet 1988; 30: 377–92PubMedCrossRefGoogle Scholar
  30. 30.
    Dequiros GB, Kinsbourne M, Palmer RL, et al. Attention deficit disorder in children: three clinical variants. J Dev Behav Pediatr 1994; 15: 311–9Google Scholar
  31. 31.
    Taylor E, Schachar R, Thorley G, et al. Which boys respond to stimulant medication? Psychol Med 1987; 17: 121–43PubMedCrossRefGoogle Scholar
  32. 32.
    Ahmann PA, Waltonen SJ, Olson KA, et al. Placebo-controlled evaluations of Ritalin side effects. Pediatrics 1993; 91: 1101–6PubMedGoogle Scholar
  33. 33.
    Lucas AR, Weiss M. Methylphenidate hallucinosis. JAMA 1971; 217: 1979–81CrossRefGoogle Scholar
  34. 34.
    Rapoport JL, Buchsbaum MS, Weingartner H. Dextroamphetamine: cognitive and behavioral effects in normal and hyperactive boys and normal men. Arch Gen Psychiatry 1980; 37: 933–43PubMedCrossRefGoogle Scholar
  35. 35.
    Pratt DS, Dubois RS. Hepatotoxicity due to pemoline (Cylert). J Pediatr Gastroenterol Nutr 1990; 10: 239–41PubMedCrossRefGoogle Scholar
  36. 36.
    Nehra A, Mullick F, Ishak KG, et al. Pemoline-associated hepatic injury. Gastroenterology 1990; 99: 1517–9PubMedGoogle Scholar
  37. 37.
    Gittelman R, Mannuzza S. Hyperactive boys almost grown up: III. Methylphenidate effects on ultimate height. Arch Gen Psychiatry 1988; 45: 1131–4CrossRefGoogle Scholar
  38. 38.
    Greenhill LL. Attention-deficit hyperactivity disorder: the stimulants. Child Adolesc Clin N Am 1995; 4: 123–68Google Scholar
  39. 39.
    Physician’s Desk Reference. 50th ed. Ornadell (NJ): Medical Economics Co., 1996: 848Google Scholar
  40. 40.
    Gadow KD. Pharmacology of behavior disorders. Clin Pediatr (Phila) 1983; 22: 48–53CrossRefGoogle Scholar
  41. 41.
    Virginia Departments of Education, Health Professions, Mental Health, Mental Retardation and Substance Abuse Services. Final report on effects of the use of methylphenidate. House document no. 28. Richmond (VA), 1991: B3Google Scholar
  42. 42.
    Safer DJ, Krager JM. Effect of a media blitz and a threatened law suit on stimulant treatment. JAMA 1991; 268: 1004–7CrossRefGoogle Scholar
  43. 43.
    Sleator E, von Neumann A, Sprague R. Hyperactive children: a continuous long-term, follow-up. JAMA 1974; 229: 316–7PubMedCrossRefGoogle Scholar
  44. 44.
    Safer DJ, Krager JM. Hyperactivity and inattentiveness: school assessment of stimulant treatment. Clin Pediatr (Phila) 1989; 28: 216–21CrossRefGoogle Scholar
  45. 45.
    Werry JS, Aman MG, editors. Practitioner’s guide to psychotropic drugs for children and adolescents. New York: Plenum, 1993Google Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Daniel J. Safer
    • 1
  1. 1.Departments of Psychiatry and Pediatrics, School of MedicineJohns Hopkins UniversityBaltimoreUSA

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