Using stimulants in children with ADHD.

WE READ WITH GREAT INTEREST JENNIFER Couzin’s article “Pediatric study of ADHD drug draws high-level public review” (News of the Week, 20 Aug., p. 1088), which describes “heated debate among pediatricians and bioethicists” over the ethics of a study proposing to evaluate the effects of stimulant medication in typically developing children. As one pediatrician and bioethicist stated in the article, “I can see why people are struggling... you’re actually giving [children] a psychoactive drug.” This cautious approach toward use of stimulant medication in typically developing children is dramatically different from the relatively uninhibited use of stimulant medication for children with attention deficit hyperactivity disorder (ADHD). Many pediatricians, psychologists, and psychiatrists now believe that stimulant medication should be the first and often only treatment for ADHD (1), and, as a result, use of stimulant medication to treat children with ADHD has increased substantially in the past few decades (2), with recent estimates indicating that more than 7% of elementary school children are medicated daily (3). Shouldn’t there be at least as much concern about giving a psychoactive drug to children with ADHD—typically for years— as there is about giving a single dose of the same substance to children without ADHD? After all, Rapoport’s studies in the 1980s, mentioned in Couzin’s article, demonstrated that stimulants have equivalent effects in ADHD and normal children, suggesting that stimulant medication should only be administered when absolutely necessary and after other treatment approaches have been tried. We do not believe that stimulant medication for ADHD should never be used. Rather, it should be used cautiously and only after other, less invasive treatments have been tried. DANIEL A.WASCHBUSCH1 AND WILLIAM E. PELHAM JR.2 1Department of Psychology, Dalhousie University, Halifax, NS B3H 4J1, Canada. 2Center for Children & Families, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY 14214–3093, USA. References 1. MTA Cooperative Group, Arch. Gen. Psychiatry 56, 1073 (1999). 2. M. Olfson, S. C. Marcus, M. M. Weissman, P. S. Jensen, J. Am. Acad. Child Adolesc. Psychiatry 41, 514 (2003). 3. A. S. Rowland et al., Am. J. Publ. Health 92, 231 (2002).