Drug treatments for attention-deficit hyperactivity disorder in young people

The discovery of an effective drug treatment for attention-deficit hyperactivity disorder (ADHD) is conventionally attributed to Charles Bradley, a North American child psychiatrist who ran the family nursing home for delinquents in Rhode Island (Bradley1937). He described a case series of 30 children who received dexamphetamine, initially introduced as part of his idiosyncratic treatment for the headache that followed pneumoencephalography (Brown 1998). He believed that the newly discovered stimulant would promote the secretion of cerebrospinal fluid by the choroid plexus, which would prevent the headache. Dr Bradley was interested in organic causes for delinquent behaviour and routinely performed what was then state-of-theart brain imaging and electroencephalograms on his patients. Although he did not identify any structural abnormalities, he did see an unexpected side-effect of dexamphetamine. He found ‘a spectacular change in behaviour’ and ‘remarkably improved school performance’ in 14 of the 30 children. He noted that the children started to refer to their ‘arithmetic pills’ and outlined the side-effects they encountered. History does not record the efficacy of the dexamphetamine for the headache. As for many medications, the discovery was ser endipitous, but over 70 years later, psychostimulants continue to be the most widely prescribed agents for ADHD. In many ways, our conception of ADHD is defined by the effect of low-dose stimulants on behaviour and cognition. Such is the link between the two that although ADHD does have all the features required for a diagnostic construct, including biological markers and predictive validity, cynics have described ADHD as a drug response masquerading as a diagnosis.