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      Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects

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          Abstract

          Prescription stimulants are often used to treat attention deficit hyperactivity disorder (ADHD). Drugs like methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) help people with ADHD feel more focused. However, misuse of stimulants by ADHD and nonaffected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks. In this review, we discuss recent advances in the use and increasing misuse of prescription stimulants among high school and college students and athletes. Given the widespread belief that stimulants enhance performance, there are in fact only a few studies reporting the cognitive enhancing effects of stimulants in ADHD and nonaffected individuals. Student athletes should be apprised of the very serious consequences that can emerge when stimulants are used to improve sports performance. Moreover, misuse of stimulants is associated with dangers including psychosis, myocardial infarction, cardiomyopathy, and even sudden death. As ADHD medications are prescribed for long-term treatment, there is a need for long-term safety studies and education on the health risks associated with misuse is imperative.

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          The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study.

          Brooke S G Molina, Stephen P. Hinshaw, James M. Swanson … (2009)
          To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers (local normative comparison group; N = 261). Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report. In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested. Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.
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            The worldwide prevalence of ADHD: is it an American condition?

            Stephen Faraone, Joseph Sergeant, Christopher Gillberg … (2003)
            Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder that affects up to 1 in 20 children in the USA. The predominance of American research into this disorder over the past 40 years has led to the impression that ADHD is largely an American disorder and is much less prevalent elsewhere. This impression was reinforced by the perception that ADHD may stem from social and cultural factors that are most common in American society. However, another school of thought suggested that ADHD is a behavioral disorder common to children of many different races and societies worldwide, but that is not recognized by the medical community, perhaps due to confusion regarding its diagnosis and/or misconceptions regarding its adverse impact on children, their families, and society as a whole. In this article we present the available data, with a view to determining the worldwide prevalence of ADHD. A total of 50 studies were identified from a MEDLINE search for the terms ADHD, ADD, HKD, or attention-deficit/hyperactivity disorder and prevalence combined, for the years 1982 to 2001. 20 were studies in US populations and 30 were in non-US populations. Analysis of these studies suggests that the prevalence of ADHD is at least as high in many non-US children as in US children, with the highest prevalence rates being seen when using DSM-IV diagnoses. Recognition that ADHD is not purely an American disorder and that the prevalence of this behavioral disorder in many countries is in the same range as that in the USA will have important implications for the psychiatric care of children.
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              Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey.

              Sean Esteban McCabe, John Knight, Christian J Teter … (2005)
              To examine the prevalence rates and correlates of non-medical use of prescription stimulants (Ritalin, Dexedrine or Adderall) among US college students in terms of student and college characteristics. A self-administered mail survey. One hundred and nineteen nationally representative 4-year colleges in the United States. A representative sample of 10 904 randomly selected college students in 2001. Self-reports of non-medical use of prescription stimulants and other substance use behaviors. The life-time prevalence of non-medical prescription stimulant use was 6.9%, past year prevalence was 4.1% and past month prevalence was 2.1%. Past year rates of non-medical use ranged from zero to 25% at individual colleges. Multivariate regression analyses indicated non-medical use was higher among college students who were male, white, members of fraternities and sororities and earned lower grade point averages. Rates were higher at colleges located in the north-eastern region of the US and colleges with more competitive admission standards. Non-medical prescription stimulant users were more likely to report use of alcohol, cigarettes, marijuana, ecstasy, cocaine and other risky behaviors. The findings of the present study provide evidence that non-medical use of prescription stimulants is more prevalent among particular subgroups of US college students and types of colleges. The non-medical use of prescription stimulants represents a high-risk behavior that should be monitored further and intervention efforts are needed to curb this form of drug use.
              Article 0 comments Cited 150 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Brain Behav
                Journal ID (iso-abbrev): Brain Behav
                Journal ID (publisher-id): brb3
                Title: Brain and Behavior
                Publisher: Blackwell Publishing Inc
                ISSN (Print): 2162-3279
                ISSN (Electronic): 2162-3279
                Publication date (Print): September 2012
                Publication date (Electronic): 23 July 2012
                Volume: 2
                Issue: 5
                Pages: 661-677
                Affiliations
                Global Neuroscience Initiative Foundation Los Angeles, California
                Author notes
                Shaheen E. Lakhan, Global Neuroscience Initiative Foundation Los Angeles, California. Tel/Fax: 206-339-8274; E-mail: slakhan@ 123456gnif.org

                Funding Information No funding information provided.

                Article
                DOI: 10.1002/brb3.78
                PMC ID: 3489818
                PubMed ID: 23139911
                SO-VID: d52fb611-5209-4b9c-bbc8-1aad5506e6e3
                Copyright © Copyright © 2012 Wiley Periodicals, Inc.
                License:

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                History
                Date received : 10 April 2012
                Date revision received : 30 May 2012
                Date accepted : 15 June 2012
                Categories
                Subject: Reviews

                ScienceOpen disciplines: Neurosciences
                Keywords: amphetamine,performance,athletes,students,attention deficit hyperactivity disorder,methylphenidate,misuse,cognition
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: amphetamine, performance, athletes, students, attention deficit hyperactivity disorder, methylphenidate, misuse, cognition

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