Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Pharmacological Treatment
Psychostimulants
Pharmacological treatment with psychostimulants is the most widely studied
treatment for ADHD. Stimulant treatment has been used for childhood behavioral
disorders since the 1930s (Bradley, 1937). Psychostimulants are highly effective
for 75 to 90 percent of children with ADHD. At least four separate
psychostimulant medications consistently reduce the core features of ADHD in
literally hundreds of randomized controlled trials: methylphenidate,
dextroamphetamine, pemoline, and a mixture of amphetamine salts (Spencer et al.,
1995; Greenhill, 1998a, 1998b; Greenhill et al., 1998).
These medications are metabolized, leave the body fairly quickly, and work for 1
to 4 hours. Administration is timed to meet the child’s school schedule, to help
the child pay attention and meet his or her academic demands, and to mitigate
side effects. These medications have their greatest effects on symptoms of
hyperactivity, impulsivity, and inattention and the associated features of
defiance, aggression, and oppositionality. They also improve classroom
performance and behavior and promote increased interaction with teachers,
parents, and peers. Small effects were found on learning and school achievement
(see reviews by Barkley, 1990; Pelham, 1993; Swanson et al.,1993, 1995b;
Greenhill et al., 1998; Cantwell, 1996a; Spencer et al., 1996.) However,
psychostimulants do not appear to achieve long-term changes in outcomes such as
peer relationships, social or academic skills, or school achievement (Pelham et
al., 1998).
Children who do not respond to one stimulant may respond to another (Elia et
al., 1991; Elia & Rapoport, 1991). Children should be reevaluated without the
medication to see if stimulant treatment is still indicated. Many families
choose to have their child take a“drug holiday” on weekends and vacations to
reduce overall exposure, but the utility of this strategy has not been
demonstrated (AACAP, 1991).
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