Stimulant Medications in Pediatric ADHD, Essay Example

Introduction

Attention-deficit or Hyperactivity Disorder (ADHD) is a “cognitive” and “behavioral” problem associated with different levels of expressing oneself or having a deficit in attention and dealing with problems together with being hyperactive or impulsive (Stevens et al., 2013) (Daley et al., 2014) (Hall et al., 2013). The problem is and has been prevailing in children (Catala-Lopez et al., 2017; Cortese et al., 2019; Hall et al., 2013 & Stevens et al., 2013). Studies done in the past have designated that “non-stimulants” are not limited from usage (Cortese et al., 2019) (Stevens et al., 2013). In the contrary, non-stimulants are still effective in their own way (Stevens et al., 2013).

In 2013, stevens and colleagues found that more than 12% of children have ADHD, while the hall and her colleagues indicated that about five percent of kids suffer from the same disorder in the United Kingdom alone. The authors also depicted that the disorder persists to adulthood at a chance of almost two-thirds, with over 2% of adults meeting the criterion of diagnosis. The disorder results in a problem for society, as the patients call for extra care from family and friends as well as society (Coghill et al., 2021). The patients are at risk of having negative results in what they do, for instance, school performance or any type of competition they take (Coghill et al., 2021). Coghill and colleagues also link the disorder with other health issues like neurodevelopmental disorder. Looking to statistics, the disorder has posed risks of hurting the medical budget due to its medication dilemma. Previous studies have tried to establish a safe and medically trusted mode of treatment, but there have been no tactics other than using stimulants. Non-stimulants are less effective compared to stimulants. The current paper will debate the controversy of ADHD treatment, especially using stimulants as the main treatment technique.

Use of Stimulants as medication for ADHD

The common stimulants applied in treating ADHD are “psychostimulants” (Cortese et al., 2019). As depicted, one of the vital elements are the “methylphenidate” and “amphetamine” are stimulants with fast-acting elements like “pharmacokinetic” and “pharmacodynamic” (Cortese et al., 2019). For effective treatment to occur, subsequent medication should be administered. The short-lived medication, methylphenidate, is administered in three different types; an oral liquid, a normal tablet, and a chewable one (Stevens et al., 2013). A slow and lengthy effective one is offered via the “osmotic release oral system” (OROS) (Stevens et al., 2013). “Amphetamine” is delivered in a type of an “extended-release” blend of “amphetamine salt formulation”. The tablet has both functions and can be delivered as a two-in-one medication, a fast and slow medication tablet (Stevens et al., 2013). The absorption is fast, and metabolism is done by the liver (Stevens et al., 2013). However, several clinicians have believed stimulants to be a cure for ADHD; well, is it?

The Effectiveness of Stimulants

Bailly (2018) argues and states that stimulant medication is not necessarily a cure for ADHD. The author points out a study to investigate the effectiveness of stimulants for ADHD patients. A controversy is observed when different children and grown-ups are subjected to stimulants as a treatment for ADHD. The reaction or outcome from children was different from adults’ as they reported different moods. “It is not clear whether this difference in effect on mood between adults and children was due to ‘differing experience with drugs, ability to report affect or age-related pharmacologic effects” (Under; Stimulants Medication is not a Specific Treatment for ADHD). The scenario depicts a huge doubt and mistrust of stimulants as an effective and reliable medication or treatment for ADHD. Although it is recommended and has greater positive effects, as identified before, it has shown a controversy in terms of results and mood changes.

In addition, Cortese (2018) indicates that the study carried out by the Cochrane group depicted poor evidence that stimulants can be reliable in treating ADHD. However, the author recommends further clinically accurate tests on the application of stimulants as an ADHD medication. The statement further pushes stimulants as an undertested and controversial medication for ADHD.

Long Term Effects

Stimulants applied as medication to ADHD patients have been observed to be short-lived, and no evidence has been provided to depict a long-term effect. As Cortese et al. (2019) indicates in their debate, long-term effect has been tested and shown no effect on this type of medication. The authors identify the long treatment results as insignificant, and no significant change was observed. That indicates that taking stimulants for as long as one may take will make no difference to the condition being questioned, thus, meaning one will have to either stop or take them their whole life. There might be short-term effects of stimulants, but they do not guarantee to be effective for longer periods. Taking stimulants for so long can trigger other problems, which will be discussed.

Assessing the Side Effects

Short or long usage of stimulants might have mild side effects. Prolonged and overdosing can result in severe side effects like loss of appetite, lack of sleep, and loneliness or self-isolation (Healthy Children). In some patients, stunted growth and tics (sounds or muscle movements) might be experienced (Healthy Children). Ahmed & Virani (2017) suggests that severe side effects occur due to misdiagnosis and relying on parental descriptions. If doctors have a hard time determining whether a child is suffering from ADHD or which is the right dose, then who should people trust? In matters of health, this is a controversial matter which requires a deeper analysis. For instance, the authors identify that almost 10% of children were prescribed ADHD medication based on evidence from parents and guardians. By 2017, the number had risen to almost 12 %, indicating unseriousness in dealing with the situation at hand. The facts and figures concerning misdiagnosis and wrong prescriptions are dangerous and scary. The disorder is controversial to the doctors and making a clear description of the behavior might coincide with other behavioral disorders or a substance abuse disorder. The misunderstanding or underestimation by the parents and doctors poses a threat, thus arousing controversy concerning the disorder and the attributes mentioned to be the key identifiers.

In addition, another problem arising from the medication of ADHD by the use of stimulants is that most manufacturing companies are in business and are only worried about selling their products rather than caring for other people’s health (Bailly, 2005). The manufacturing companies are worsening the already delicate situation of confused parents and physicians. As healthy Children indicate, finding a proper dosage for a child with ADHD is a headache. However, it happens that is not the only problem. Physicians find it hard to diagnose a patient with ADHD and differentiate them from other related disorders. The disorder seems like a mystery, and that makes it more controversial.

Stimulants as Drugs?

Previous studies have found evidence connecting stimulants to abusing them as drugs. Bailly (2005) indicates that some students from Durham were abusing Ritalin. In Boston and Baltimore, the abuse of methylphenidate has been reported (Bailly, 2005). The tablets are abused orally, smashed, and consumed intranasally (Bailly, 2005). A study indicated that a child treated with stimulants has a higher chance of using or might have used cocaine and nicotine (Humphreys et al., 2013). Substance abuse and stimulant medication seem to be interlocking issues that are becoming problematic in determining the right and most effective medication for ADHD. Another study showed that dealing with ADHD situation using certain stimulants set a baseline for a foreseen drug abuse habit among youth and teenagers (Jordan et al., 2014).

Habitual use of stimulants as treatment factors has depicted increasing drug abuse habits in children but less in adults. The risk is how to control future possibilities of drug abuse propelled by stimulant intake due to ADHD. The scenario stirs up a dilemma on the tactic of treating the disorder. The controversy is, are the doctors treating a patient or making them vulnerable to hard drugs in the future? The tactic seems to arouse a different and difficult issue of drug abuse and addiction.

Although there is poor evidence connecting marijuana, alcohol abuse, and stimulant medication, there is still no assurance that it can prevent or not affect their abuse. That indicates that there is still a chance of one to develop an addiction to both drugs and try to blend them for more effect, and the effects of substance abuse might even worsen the disorder.

Unexpected Severe Effects

There are studies linking stimulant treatments and abnormalities in body growth (Stevens et al., 2023). However, the problem has stirred a controversial conclusion on what causes the diversion of the body cell growth. The contradictions are depicted by studies colliding on the conclusion side. Different studies have indicated delayed growth while others have not. Other studies have concluded that it is not the stimulants but the ADHD itself causing growth delays in body tissues (Stevens et al., 2013). The issues bring another problem to the table. It means that ADHD treatment requires more scrutiny and observations to assess the effectiveness of the stimulant, side effects, or other long-term effects like the one mentioned.

The scariest part is the cardiac issues and impromptu deaths among ADHD patients under stimulant medication. The issues have been a key worry among the sector globally, with the cases happening in a relatedness situation. Studies have tried to build the evidence, but it has been a hard road to trail along since sudden deaths, and cardiac arrests do not happen during the test or medication (Stevens et al., 2013). They happen after but happen to be connected to the stimulant application. There was also a connection, though a small one, between stimulants and blood pressure (Stevens et al., 2013). That indicates the possibility of heart problems or cardiac arrest, which causes sudden deaths.

The Controversy Summary

The medication for ADHD via stimulants has proven to be more effective than non-stimulants. However, controversy surrounds this type of treatment. Association with drug addiction, sudden deaths, cardiac arrests, invariable effects, and effectiveness with no evident long-term effectiveness make it mistrusted. The tactic has shown several dilemmas, making it the most controversial medication to be conducted.

References

Ahmed, S., & Virani, S. (2017). Stimulant overprescribing, abuse, and diversion. American Journal of Psychiatry Residents’ Journal, 12(09), 11-12. https://doi.org/10.1176/appi.ajp-rj.2017.120905

Bailly, L. (2005). Stimulant medication for the treatment of attention-deficit hyperactivity disorder: Evidence-b(i)ased practice? Psychiatric Bulletin, 29(8), 284-287. doi:10.1192/pb.29.8.284

Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., … & Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: a systematic review with network meta-analyses of randomized trials. PloS one, 12(7), e0180355.https://doi.org/10.1371/journal.pone.0180355

Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., … & Simonoff, E. (2021). The management of ADHD in children and adolescents: bringing evidence to the clinic: a perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry, 1-25.https://link.springer.com/article/10.1007/s00787-021-01871-x

Common ADHD Medications & Treatments for Children (n.d). HealthyChildren.Org. Accessed on 20 June 2022, from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Determining-ADHD-Medication-Treatments.aspx

Cortese, S. (2018). Are the effects of methylphenidate uncertain? Irish Journal of Psychological Medicine, 35(3), 163-167. doi:10.1017/ipm.2018.16

Cortese, Samuele; Swanson, James M.; Coghill, David (2019). Debate: Are Stimulant Medications for Attention-Deficit/Hyperactivity Disorder Effective in the Long-Term?. Journal of the American Academy of Child & Adolescent Psychiatry, (), S0890856719304186–. DOI: 10.1016/j.jaac.2019.04.029

Hall, C. L., Newell, K., Taylor, J., Sayal, K., Swift, K. D., & Hollis, C. (2013). ‘Mind the gap’-mapping services for young people with ADHD transitioning from child to adult mental health services. BMC psychiatry, 13(1), 1-8.https://doi.org/10.1186/1471-244X-13-186

Humphreys KL, Eng T, Lee SS. (2013). Stimulant Medication and Substance Use Outcomes: A Meta-analysis. JAMA Psychiatry. ;70(7):740–749. doi:10.1001/jamapsychiatry.2013.1273

Jordan, C. J., Harvey, R. C., Baskin, B. B., Dwoskin, L. P., & Kantak, K. M. (2014). Cocaine-seeking behavior in a genetic model of attention-deficit/hyperactivity disorder following adolescent methylphenidate or atomoxetine treatments. Drug and alcohol dependence, 140, 25-32. https://doi.org/10.1016/j.drugalcdep.2014.04.020

Stevens, J. R., Wilens, T. E., & Stern, T. A. (2013). Using stimulants for attention-deficit/hyperactivity disorder: clinical approaches and challenges. The primary care companion for CNS disorders, 15(2), PCC.12f01472. https://doi.org/10.4088/PCC.12f01472