The Harmful Effects of ADHD Medication in Children

Mellanie Cadwell

Abstract

The medications and treatments for children with Attention Deficit Hyperactivity Disorder (ADHD) were researched to expose the risks of pharmaceuticals and their side effects on young children. The medical risks of medications commonly used to treat children with ADHD were examined using published research and findings from pediatricians, physicians, scientists, and other health care professionals, as well as alternative treatments for the disorder. The research showed that the ADHD pharmaceutical treatment plans have serious short and long term side effects on young children, with no evidence of long term efficacy. Whereas, alternative treatment plans pose no harmful physical side effects and are still effective.

The Harmful Effects of ADHD Medication in Children

Abigail first started exhibiting signs of Attention-Deficit/Hyperactivity Disorder (ADHD) in preschool. Her preschool teachers complained to her parents that during story time she disturbed the other children with her fidgeting. Her parents took her to a developmental pediatrician who, after many tests, diagnosed her with ADHD. The pediatrician prescribed different medications that made her seriously ill and drastically altered her personality. After trying several different medications, her parents decided to abstain from pharmaceuticals as a means of treatment. The side effects of the medications that Abigail used as a treatment for her ADHD are not uncommon for many young children with the disorder. There are many drugs being used to treat ADHD that have short term side effects and long term health risks. Furthermore, the Multimodal Treatment Study (MTA) on ADHD showed that though there was no conclusive evidence of long term effectiveness of the ADHD medications, alternative treatments and behavior therapies are effective treatments for ADHD. Due to the harmful side effects and long term health risks of ADHD medication, as well as the findings of the MTA study, parents should reconsider the use of ADHD medication in the treatment plan for their children with ADHD.

One cannot understand the medications or therapies used to treat ADHD without understanding the disorder first. ADHD is the single most common medical disorder diagnosed in school age children today. According to Efron, Hazell, and Anderson (2011), “the core symptoms are developmentally inappropriate impulsiveness, inattention and often hyperactivity” (p. 682). It is estimated that one in twenty children are diagnosed with the disorder (Pellow, Solomon, & Bernard, 2011). There is much controversy over the pharmaceutical treatment of ADHD, as the disorder is not one that a child will simply outgrow. Thus, parents are becoming increasingly skeptical of the current medicinal treatment plans.

One reason why parents should reconsider ADHD medication is their harmful side effects. Currently, there are three main types of medications that treat ADHD in children: Stimulants, antidepressants and antihypertensive medications. All three classes of drugs carry the risks of serious side effects. According to Ryan, Kitsiyannis, and Hughes (2011) “one of the most common stimulants prescribed by physicians is methylphenidate, with approximately 85%-90% of all prescriptions for this drug being written for ADHD” (p. 53). Though they have successfully treated symptoms of ADHD, they also have serious side effects. Common side effects of methylphenidates include nausea, vomiting, fever, headache and insomnia (2011). More concerning is the fact that the more serious side effects range from irregular heartbeat, hallucinations, depression, tics, seizures, slurred speech, weakness on one side of the body, and even addiction (2011).

For an eight or nine year old child taking stimulant medication as an ADHD treatment, the side effects can be far more difficult to endure than the disorder itself. In acclimating to the drugs, children are expected to grin and bear it. However, one must question whether taking the medication and subjecting a young child to the risks of seizures or an irregular heartbeat is worth the risk. Is forcing a child to go weeks feeling nauseas, vomiting, unable to sleep or having blurred vision a healthy choice to make for one’s child? A parent would not encourage his or her child to eat brownies laced with marijuana as a means to calm or “mellow out” the child. Why then are drugs that have not only the same psychotropic side effects as marijuana, but more serious and dangerous side effects encouraged and prescribed?

Pellow, Solomon, and Bernard (2011) stated in the Alternative Medicine Review that “as many as 20-30 percent of children either do not respond to this class of drug or are unable to tolerate them due to the wide range of adverse effects they may produce” (p. 327). Therefore, 20-30 percent of all children on a stimulant regiment are unnecessarily subjected to serious health risks with no benefit to their disorder. Although Ryan, Kitsiyannis, and Hughes advocate the use of stimulant medication due to their short term efficacy, Barnett and Labellarte (2002) stated “the presence of psychosis and an unacceptable risk for stimulant abuse are the most compelling reasons to avoid stimulants” (p. 193).

Antidepressants, like stimulants, also have very serious and harmful side effects. Antidepressants such as Atomoxetine, Wellbutrin, Strattera and Risperdal are often prescribed to children who did not respond well to stimulant medication (Ryan, Kitsiyannis, & Hughes, 2011). Unlike stimulants, antidepressants take longer to be effective (2011). Unfortunately, antidepressants subject children to the risky side effects for a longer period of time as well. These side effects included the same common side effects as stimulants, however they also increased the risks of depression and suicidal ideations. Hammad, Laughren, and Racoosin (2006) conducted a study highlighted in the June 2006 edition of The Journal of Family Practice that concluded “the use of antidepressant medications in children is associated with an increased risk of suicidal ideation and suicide-related behavior” (p. 488). In fact, Pellow, Solomon, and Bernard (2011) found that Strattera also generated “psychotic symptoms and suicidal tendencies in children” (p. 327).

Parents should weigh the value in antidepressant medication as a means to treat their child’s ADHD against the risk of suicide or other psychotic symptoms. Children with ADHD already struggled to focus. Adding mental and emotional symptoms would exacerbate the problem, rather than alleviate it. In fact, Barnett and Labellarte (2002) noted that “individuals with unstable personalities, depressive states, and anxiety states may potentially worsen” (p. 193). Ryan, Kitsiyannis, and Hughes (2011) also recognized the dangers in antidepressants, much like Barnett and Labellarte, and cautioned that parents should consider that the medications carry many adverse side effects, “ranging from physical symptoms…to behavioral changes…to severe reactions with the potential of death” (p. 57). These adverse side effects should not be discounted due to their uncommon nature. In doing so, parents are exchanging one disorder for the creation of another. This is not a viable solution in treating children with ADHD as the child would suffer emotionally and physically, though mentally they would be temporarily treated.

The third class of ADHD medication is hypertensive medications, such as Clonidine and Guanfacine. Usually prescribed for the treatment of high blood pressure, antihypertensive medications “have also been shown to help alleviate moderate ADHD-associated impulsive and oppositional behaviors commonly observed in children with ADHD” (Ryan, Kitsiyannis, & Hughes, 2011). However, Barnett and Labellarte (2002) found that “the largest double-blind, placebo-controlled studies of clonidine for ADHD…did not show efficacy” (p. 199). In other words, studies showed that the use of antihypertensive medications did not succeed in treating ADHD alone. These medications had to be used in conjunction with other ADHD medications, such as MPH stimulants.

Furthermore, though antihypertensive medications shared similar common side effects with stimulants and antidepressants, they also risked sudden unexplained death (SUD) in children with ADHD. “The use of clonidine plus MPH has generated concern due to reports of SUD in children with ADHD taking the combination” (p. 199). Additionally, Barnett and Labellarte pointed out that there was “the cardiovascular risk of significant bradycardia associated with clonidine alone” (p. 200). Due to the controversy of the safety of the hypertensive medications in children, parents should reconsider the use of these medications in their child’s ADHD treatment plans. The “serious cardiovascular AEs such as hypotension and bradycardia as well as rebound tachycardia and hypertension” caused the medications to be black-boxed by the Food and Drug Administration (FDA), which required manufactures list these side effects as a warning on the medication labels (p. 200).

Not only are the side effects of ADHD medications risky and harmful, but the long term consequences of the drugs are detrimental to a child’s health as well. There are serious physical ramifications of using certain ADHD medications for an extensive period of time. There were numerous reports of long term cardiovascular problems from pharmacological treatments of ADHD. Nissen (2006) reported that stimulants “substantially increase the heart rate and blood pressure” (p. 1446). Though Ryan, Kitsiyannis, and Hughes (2011) promoted the short term effectiveness of pharmacological ADHD treatments, Nissen argued that the harmful long term cardiovascular effects outweighed the short term benefits. The risk of heart disease in a developing child should never be overlooked regardless of the circumstance. By using ADHD medications, the child’s short term benefits would ultimately cost him or her a lifetime of cardiovascular health issues.

Long term use of ADHD antidepressant medications also increased the risk of long-term psychiatric disorders and brain impairments. Antidepressant medications used to treat ADHD in children work by “impairing brain functions” (Docksai, 2013, p.12). After an extended period of use, a child could “suffer biochemical disruptions and ‘chronic brain impairment’ long after he or she ceases taking it” (p. 13). In fact, any type of psychiatric medication impairs brain function as that is what it is designed to do. Huang and Tsai (2011) discussed a ten year study of children who took ADHD medication for over five years that found “both male and female young adults with a diagnosis of ADHD in childhood on the medications to be at higher risk of adverse psychiatric outcomes, including antisocial, addictive, mood and anxiety disorders” (p. 548). Though parents chose pharmacologic treatments for their child in the hope that it would have improved focus and performance in school, the same medications would actually impair brain function and possible long term brain development.

If the short term side effects and long term health risks were not enough to cause a parent to reconsider using ADHD medications, the Multimodal Treatment Study for ADHD (the MTA study) found that there was no conclusive evidence for the long term efficacy of pharmaceutical treatments in children with ADHD. In his review of the MTA study, Kean (2004) concluded that research over the past 30 years has shown that “treatment with medications does not change learning or behavior outcomes in the long term” (p. 199). It is much like using ADHD medications as a Band-Aid to temporarily cover a much more serious wound. Ingram, Hechtman and Morgenstern (1999) shared Kean’s view and concluded “to date, there is no evidence that stimulants alter the course of ADHD or improve long term outcomes” (p. 248). Therefore, parents medicated their children with ADHD with only short term success and without a long term solution. Children forced to take ADHD medications endured side effects and risked their emotional well-being and physical health for a treatment plan that did not cure their disorder, but essentially left them to deal with it later on.

Despite the lack of positive long term effects of ADHD medications, the MTA study recognized the positive outcomes of alternative treatments and behavior therapies for ADHD. The MTA study included a Summer Treatment Program in which participants were either in the behavior treatment group or the combined treatment group. The behavior treatment group received behavior therapy and the participants did not use ADHD medications. The combined treatment group used a combination of behavior therapy and ADHD medication as part of their treatment plan (Kean, 2004). Though Ingram, Hechtman, and Morgestern (1999) argued that “multimodal treatment is not a significant improvement over methylphenidate” (p. 248), the MTA study proved otherwise. At the end of the summer, “of the children in the behavioral group 75% were maintained without medication for 14 months and 64% no longer met the diagnostic criteria for ADHD” (p.179). Even Ryan, Katsiyannis, and Hughes (2011) conceded that “medications will not cure ADHD” (p.53). However, the MTA study showed that, though it may not work with all children with ADHD, behavior therapies and alternative treatment plans did have long term efficacy with no harmful side effects or health risks.

The alternative treatments the MTA study found effective included dietary management and complementary and alternative medicine (CAM). The goal of CAM therapies is “treating patients holistically and individually, and aim to treat underlying etiologies” (Pellow, Solomon, & Bernard, 2011, p. 328). In a study cited by Pellow, Solomon, and Bernard, 62% of the participants in the MTA study improved their behavior by 50% from dietary management, which proved the effectiveness of dietary management. Additionally, the children who followed the dietary intervention no longer met the DSM-IV criteria for ADHD” (p. 328). The dietary management consisted of organic fruits, vegetables proteins (2011). Foods that are high in sugars, additives, and are overly processed have the opposite effect in children in that they increase hyperactivity in young children. Therefore, the elimination of these products proved beneficial in the management of ADHD.

The use of stimulants, antidepressants, and antihypertensive medications to treat ADHD is a double edged sword. On one side they treat short term symptoms of the disorder, most of which have harmful adverse effects associated with the medication. One the other side, there is no conclusive evidence or research that shows that they have long term effectiveness, but they do have harmful long term health risks. If one had a leaky pipe in his walls, he would not put tape over it as a viable solution to the problem. Rather, he would take the necessary steps to repair or replace the pipe to circumvent more extensive damage later on. The same could be said of ADHD medication. They are simply tape on a leaky pipe. If the medications do not resolve the issue in the long run, one should not risk the child’s health as a short term solution. Nonetheless, pediatricians continue to prescribe medications for ADHD as a first line treatment. The MTA study proved that alternative treatments and behavior therapies have short term and long term success, but they are also not harmful to the child’s overall health. Parents should exercise scrutiny in selecting a viable treatment plan for their children with ADHD. CAMs have been proven effective and safe, whereas medicinal treatments have harsh side effects, long term health risks, with no long term efficacy. Considering the findings of the MTA study, parents should reconsider the use of ADHD medications in the treatment of their children with ADHD.

References

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Pellow, J., Solomon, E. M., & Barnard, C. N. (2011). Complementary and Alternative Medical Therapies for Children with Attention-Deficit/ Hyperactivity Disorder (ADHD). Alternative Medicine Review, 16(4), 323-337. Ryan, J. B., Katsiyannis, A., & Hughes, E. M. (2011). Medication treatment for attention deficit hyperactivity disorder. Theory Into Practice, 50(1), 52-60. doi:10.1080/00405841.2010.534939.