Research Raises Questions over ADHD Drugs

ADHD Drug Use

Story at-a-glance -

  • The ADHD drug methylphenidate (Ritalin) led to modest improvements in symptoms, but this finding was based on poor-quality studies
  • Ritalin is associated with an increased risk of sleep problems and appetite loss
  • The sleep troubles caused by ADHD drugs “could undermine the benefits of stimulant medications in some cases”

By Dr. Mercola

Nearly 10 percent of U.S. children have been diagnosed with attention deficit hyperactivity disorder (ADHD).1 The condition is described as "one of the most common childhood disorders" by the National Institute of Mental Health, but its symptoms can be ambiguous.2

For instance, a child who has difficulty staying focused and paying attention, difficulty controlling behavior, and who is hyperactive may be diagnosed with this condition. The problem is that all children may display these symptoms, albeit some more than others.

Only those whose behaviors are "more severe" or occur "more often" for six months or more are supposed to be diagnosed with ADHD, but even these are subjective criteria.

There is no test or other objective way to detect children with ADHD, so often they're diagnosed based on the observations of parents, teachers, and, sometimes, a mental health professional.

While psychotherapy is sometimes offered to children with ADHD, the most common treatment for ADHD are stimulant drugs.3 ADHD drugs are the most common psychotropic drugs used by children (tied for first place with antidepressants).4

The use of such drugs is controversial for a number of reasons, which were recently highlighted by the first comprehensive systematic review of their benefits and harms.

ADHD Drugs Offer Only Moderate Benefits, Increase Risk of Sleep Problems, and Appetite Loss

Anyone considering the use of ADHD drugs must carefully consider whether the benefits outweigh the risks. In the case of methylphenidate (brand names Ritalin, Concerta, Medikinet, and Equasym), this is highly questionable.

Research published in The Cochrane Database of Systematic Reviews found the drug may lead to modest improvements in symptoms, general behavior, and quality of life.5

However, the modest benefit was based on poor-quality studies, leading the researchers to caution against using the drug without careful consideration. Study author Dr. Morris Zwi, consultant child and adolescent psychiatrist, said:6

"Our expectations of this treatment are probably greater than they should be … Whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence.

What we still need are large, well-conducted trials to clarify the risks versus the benefits."

The systematic review also found the drug is associated with an increased risk of sleep problems and appetite loss. Overall, those taking methylphenidate had a 29 percent increased risk of experiencing a non-serious adverse event, the most common of which were sleep problems and decreased appetite.

Among children taking the drug, the risks were especially pronounced. Compared to the control group, children taking methylphenidate had a 60 percent greater risk for trouble sleeping/sleep problems and a 266 percent greater risk for decreased appetite.

Stimulant Drugs May Harm Sleep for Kids with ADHD

A separate study published in Pediatrics also found that stimulant medications such as Ritalin may harm children's sleep.7

Although the drugs have stimulant effects, they may have a calming effect on children with ADHD, and some have suggested the drugs may improve sleep by reducing bedtime-resistant behaviors.

However, this research, which reviewed nine individual studies, found that in general children taking stimulant drugs:

  • Took longer to fall asleep than others (with the time lengthening as the dose increased)
  • Had shorter sleep duration
  • Had worse sleep efficiency, which is the ratio of time spent asleep to the time spent in bed

The effect is particularly troublesome because lack of sleep makes ADHD symptoms worse, with researchers noting, "sleep adverse effects could undermine the benefits of stimulant medications in some cases."8

Lead author Katherine M. Kidwell, a psychology doctoral candidate at the University of Nebraska, told Reuters:9

"In some of the studies, children received stimulants only once a day in the morning, and in some studies they received medications at two or three times throughout the day...

We think that when stimulants are in children's bodies close to bedtime, the stimulant keeps them from being able to fall asleep and reduces the quality of their sleep.

… Poor sleep actually exacerbates ADHD symptoms, particularly inattention ... In addition to making ADHD symptoms worse, poor sleep leads to a host of other physical, cognitive, and emotional problems."

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ADHD Drugs Send 23,000 Kids to the ER Every Year

It's estimated that 3.5 million U.S. children are prescribed ADHD medication,10 but this is not a decision to take lightly.

According to data released by the Substance Abuse and Mental Health Services Administration (SAMHSA), ADHD drugs such as Ritalin, Vyvanse, Strattera, and Adderall (and their generic equivalents) were responsible for nearly 23,000 emergency room visits in 2011.11

Despite their commonality, drugs prescribed for ADHD are not "mild" by any means. These are hard-core, "class 2" narcotics, regulated by the Drug Enforcement Agency as a controlled substance because they can lead to dependence.

Yet, the majority of kids diagnosed with ADHD will be prescribed these potentially dangerous drugs, the most common being Ritalin. By definition, Ritalin stimulates your central nervous system and may certainly interfere with the delicate and complex workings of your brain and personality.

Not to mention, in children the long-term effects of drugs are typically largely unknown. That being said, the side effects we do know about include not only sleep problems and decreased appetite but also:

Sudden death in people who have heart problems or heart defects Stroke and heart attack Increased blood pressure
New or worse behavior and thought problems New or worse bipolar illness New or worse aggressive behavior or hostility
New psychotic symptoms (such as hearing voices, believing things that are not true, and are suspicious) New manic symptoms Increased heart rate
Slowing of growth (height and weight) in children Seizures Eyesight changes or blurred vision

One in Five Children with ADHD May Be Misdiagnosed – Brain SPECT Imaging May Help

Before giving your child drugs like Ritalin, it's important to be certain that they have a true need for them. At present, diagnosing ADHD comes down to a matter of opinion, as there is no physical test that can pinpoint the condition.

According to a 2010 study, an estimated 20 percent of children are misdiagnosed with ADHD.12 In other words, some children's acting out may still be within the confines of "normal" childhood behavior, or may be the result of lifestyle factors or toxic exposures, and not a "disease" that requires powerful mind-altering medications.

Brain SPECT imaging may prove to be an invaluable tool for psychiatric disorders like ADHD. Brain SPECT imaging is different from the anatomical MRI or CT scans. SPECT measures blood flow and activity patterns. It looks at how your brain works. It's similar to positron emission tomography (PET) scans, which look at glucose metabolism. When using SPECT imaging, physicians look for three things:

  1. Areas of your brain that work well
  2. Areas of your brain that are low in activity
  3. Areas of your brain that are high in activity

The job then becomes balancing the different areas of your brain. In his work with SPECT imaging, Dr. Daniel Amen, a physician and board-certified psychiatrist, has identified seven types of anxiety and depressions, six types of ADHD, five types of overeaters, and six types of addicts. For instance, SPECT imaging can reveal low prefrontal cortex activity, which is generally associated with poor impulse control. It's also associated with ADHD.

Another one of the major benefits of SPECT imaging is the ability to identify damage caused by toxic exposures. Dr. Amen explained just how significant such findings can be for the proper treatment:

"I had a patient … who is diagnosed with ADD [attention-deficit disorder]. He saw the best ADD doctor in the country. He made the diagnosis basically after 10 minutes of listening to his story. When we scanned him, he had a totally toxic-looking brain. Of course, you have ADD symptoms if you know there's damage to the front part of your brain. It turned out he had arsenic poisoning. He needed a detoxification program, not more Adderall."

Exercise Should Be 'Prescribed' for Children with ADHD

Research published in the journal Pediatrics found that kids who engaged in a regular physical activity program had an improvement in executive control, which includes inhibition (the ability to maintain focus), working memory, and cognitive flexibility (or switching between tasks).13

Executive functioning is often impaired in children with ADHD, which means exercise may directly help to improve symptoms. School performance often suffers in children with ADHD as well, and is a key reason why many parents consent to medications.

Yet, exercise is well known to boost test scores and academic performance in children, and this association is particularly strong among kids with ADHD.

One study found, for instance, that a before- and after-school physical activity program reduced inattention and moodiness among young children at risk of ADHD, as well as improved math and reading test scores.14 Other research revealed that 26 minutes of physical activity each day helped to significantly reduce ADHD symptoms in grade-schoolers.15

In a TED talk from 2012, John Ratey, an associate professor of psychiatry at Harvard suggested that exercise be viewed as medication for ADHD, as it triggers your brain to release dopamine and serotonin, which improve mood and boost cognitive performance. You can view that talk below.

Natural Methods to Help Overcome ADHD-Like Symptoms

If your child struggles with behavioral difficulties or other ADHD-like symptoms, whether he or she has been diagnosed with ADHD or not, I strongly recommend addressing the following factors:

  • Too much sugar. High-sugar foods and starchy carbohydrates lead to excessive insulin release, which can cause falling blood sugar levels, or hypoglycemia. Hypoglycemia, in turn, causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety, and panic attacks.
  • Besides that, sugar promotes chronic inflammation in your body, and many studies have demonstrated the connection between a high-sugar diet and worsened mental health.

  • Gluten sensitivity. The evidence suggesting that gluten sensitivity may be at the root of a number of neurological and psychiatric conditions, including ADHD, is quite compelling. According to a 2011 study, celiac disease is "markedly overrepresented among patients presenting with ADHD,"16 and a gluten-free diet has been shown to significantly improve behavior in kids.
  • The study went so far as to suggest celiac disease should be added to the ADHD symptom checklist.

  • An unhealthy gut. As explained by Dr. Natasha Campbell-McBride, a medical doctor with a postgraduate degree in neurology, toxicity in your gut can flow throughout your body and into your brain, where it can cause symptoms of autism, ADHD, dyslexia, dyspraxia, depression, schizophrenia, and other mental disorders. Reducing gut inflammation is imperative when addressing mental health issues, so optimizing your child's gut flora is a critical step.
  • This includes not only avoiding processed, refined foods but also eating traditionally fermented foods. Fermented vegetables are perhaps among the most palatable fermented foods, although many kids enjoy fermented dairy products like kefir, especially if you blend them into healthy smoothies.

    If you cannot get your child to eat fermented foods on a regular basis, a high-quality probiotic supplement may be highly beneficial in correcting abnormal gut flora that may contribute to brain dysfunction.

  • Animal-sourced omega-3 deficiency. Research has shown that kids low in omega-3 fats are significantly more likely to be hyperactive, struggle with learning disorders, and display behavioral problems. Omega-3 deficiencies have also been tied to dyslexia, violence, and depression. A clinical study published in 2007 examined the effects of krill oil on adults diagnosed with ADHD.17
  • In that study, patients improved their ability to concentrate by an average of over 60 percent after taking a daily 500-milligram (mg) dose of krill oil for six months. They also reported a 50 percent improvement in planning skills and a close to 49 percent improvement in social skills.

  • Food additives and GMO ingredients. A number of food additives are thought to worsen ADHD, and many have subsequently been banned in Europe. Potential culprits to avoid include Blue #1 and #2 food coloring; Green #3; Orange B; Red #3 and #40; Yellow #5 and #6; and sodium benzoate, a preservative.
  • Research also shows that glyphosate, the active ingredient in Monsanto's Roundup herbicide, used in large quantities on genetically engineered Roundup Ready crops, limits your body's ability to detoxify foreign chemical compounds. As a result, the damaging effects of those chemicals and environmental toxins are magnified, and may result in a wide variety of diseases, including brain disorders that can affect behavior.

Additional Factors to Help Relieve ADHD Symptoms

Along with addressing your child's nutrition and activity levels, I also recommend implementing the following strategies:

  • Clear your house of dangerous pesticides and other synthetic chemicals.
  • EMF. Limit exposure to radiofrequency microwave radiation, cell and portable phones, and electro-pollution. This is especially true for the sleeping environment where rest and repair occurs. It should be as electrically neutral as possible.
  • Avoid commercial washing detergents and cleaning products used on clothes and around your home and replace them with naturally derived cleaning products free of added perfumes, softeners, etc.
  • Spend more time in nature. Researchers have found that exposing ADHD children to nature is an affordable, healthy way of controlling symptoms.
  • Investigate sensory therapy and emotional wellness tools. Energy psychology tools such as the Emotional Freedom Techniques (EFT) may help improve emotional coping and healing.
  • Other toxic exposures. Avoid all known toxins, like monosodium glutamate (MSG) and artificial sweeteners, including aspartame, mercury from "silver" amalgam fillings, and fluoride in the water supply.