ADHD Alert — Prescribed Stimulants Linked To Psychosis Risk In Some Children

New research into stimulants, often prescribed for children with ADHD, has established that they might increase the risk of psychosis among certain kids. Children who have parents with mental illness are at a greater risk of this possible adverse effect from prescription stimulants like Ritalin. The latest research into an association between stimulants and psychosis was funded by the Canadian Institutes of Health Research, the Nova Scotia Health Research Foundation, the Canada Research Chairs Program, and the Department of Psychiatry of Dalhousie University.

The authors of the paper published in Pediatrics found that, among individuals enrolled in a study of developmental psychopathology in the sons and daughters of parents with severe mental illness, 62 percent of the children and young adults experienced psychotic symptoms while on stimulant medications, compared to only 27 percent of those who were not taking stimulant medications. The children and young adults had been prescribed stimulants for attention-deficit/hyperactivity disorder. It is now believed that children and young adults that have parents with a mental illness could be at an increased risk of psychotic symptoms, such as delusions and hallucinations, when they are given stimulants to treat ADHD symptoms.

The researchers issued a warning in the paper.

“Psychotic symptoms should be monitored during the use of stimulants in children and adolescents. Family history of mood and psychotic disorders may need to be taken into account when considering the prescription of stimulants.”

Additional information published on the AAP Blog, which is a forum for the American Academy of Pediatrics, stated that research indicates that “individuals with psychotic disorders who were exposed to stimulants in their youth appear to have a significantly earlier age of onset of psychosis than those who are unexposed, even after correcting for intelligence, marijuana use, educational attainment and family history.” Researchers suspect that long term increases in dopamine release might be the mechanism that causes what they call a “disturbing finding.”

Lynn E. MacKenzie and fellow coauthors used what has been described by Clinical Psychiatry News as a “comprehensive testing battery,” built on previous work that shows a genetic overlap between stimulant-induced psychosis and risk for schizophrenia. MacKenzie, a PhD candidate in clinical psychology at Dalhousie University, and her coauthors, wrote that all of the participants who experienced psychotic symptoms in her study had parents with major depressive disorder or bipolar disorder. MacKenzie found that hallucinations were the most common psychotic symptoms that kids experienced while taking stimulants. Methylphenidate (the ingredient in prescriptions like Ritalin and Concerta) was the most common stimulant assessed.

“Stimulant medications can be very beneficial for children, including children with family history of mental illness,” MacKenzie said. “Our findings indicate that prescribing physicians should inquire about psychotic symptoms in children and adolescents taking stimulant medication.”

“Our experience suggests that stimulants are a double-edged sword – we see a lot of benefits, but we have also found that the psychotic side effects may be much more common than previously thought – at least in kids who have mental illness in the family,” senior author Dr. Rudolf Uher, associate professor of psychiatry and Canada Research Chair in early intervention at Dalhousie University, explained.

“Stimulants are effective medications for ADHD, but they may not be suitable for every child with attention problems,” Uher said, according to Parenting. The researchers are surprised by how common psychotic side effects from stimulant medications seem to be, but stress that the medications can be extremely helpful, so it should not be taken as a suggestion that we should stop using stimulants to treat ADHD.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center, agrees with the ADHD findings.

“It seems that stimulant-related psychotic symptoms associated with stimulant treatment are more common, more complex and more extensive among children of parents with mood disorders compared to children whose parents do not have active mental illness.”

Dr. Uher said that it is important for teachers and school officials to understand that “prescription of stimulant medication is a complex decision.” Uher said that given this complexity, it is imperative that teachers and school staff members stop pressuring parents to have their children medicated for ADHD behavior.

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