Although, stimulant medication is considered relatively safe, children and young people need to be monitored for side effects. Some of the reported and publically known adverse side-effects of stimulant medication include:
- Slowing of linear growth
- Sleep issues
- Abdominal pain
- Emergence of tics
- Rebound effect (when the dose wears off) and subsequent heightened effect of ADHD symptoms, e.g., emotional lability and depressed affect [17, 18]
The use of non-stimulants such as Atomoxetine, particularly during the initial months of treatment have been linked to increased irritability and agitation, self-harming and suicidal behaviour, reduced appetite, resulting in weight loss and increased blood pressure and heart rate. There is also the rare potentiality for liver damage which usually presents as unexplained nausea, darkening of urine or jaundice along with abdominal pain (NICE, 2008).
However, despite the apparent efficacy of psycho-stimulant medication it should be noted that circa 25% to 35% of young people with ADHD may not respond to treatment [9, 19]. Furthermore, some very efficient, short-term, longitudinal studies have reported long-term effects of MPH to be modest [20, 21] and not helpful . One main concern, is that MPH does not alter the underlying disease process . Long-term adverse effects of MPH have been documented including reduced growth, tremor, sleep and vegetative disturbances and irritability [24, 25].
During the past decade prescriptions for stimulant medication for ADHD in the United Kingdom has escalated with a net drug cost to the National Health Service of circa £25, 000, 0003 and approximately £30, 000, 000 for health care professionals including educational and social time. In the United States, the prescribing of stimulant medication is a multi-billion dollar industry. Recent data presented by an official at the Centers for Disease Control and Prevention suggested that 10,000 American toddlers aged 2 or 3 years old are being medicated for ADHD outside established pediatric guidelines.
So, the administration of MPH is not without controversy. Several concerns have been raised about the currently unknown effects of psychostimulant treatment in the developing brain. In animal studies only, alterations in the dopaminergic system with long-term effects such as dysfunction of the reward system, to depression-like symptoms have been reported following the use of psychostimulants [27-29]. There is evidence also for long-term brain sensitisation to psychostimulants which is particularly pronounced in participants with novelty seeking traits . In light of these concerns, some parents are reluctant to consent to their administration and seek instead alternative treatment options. Another extremely concerning consideration is the over-prescription of these psycho-stimulant drugs in young children especially toddlers who naturally present with hyperactive-impulsive behaviours. There have been reports also of the illegal abuse of these drugs in individuals without ADHD because of their alleged cognitive enhancing properties. Ultimately, in the same way, a plaster (band aid) does not heal a wound – these medications are in no way a cure for ADHD and should only be used in the assistance of symptom management in chronic cases and when other options have been exhausted.