Approximately 8% of children have Attention Deficit Hyperactivity Disorder (ADHD). Symptoms of the condition include “difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity),” according to the National Institute of Mental Health. Children with ADHD may also have learning disabilities or behavior problems.

Kids with ADHD face other difficulties, too: They are more than 2.5 times as likely as other children to develop a substance abuse disorder, and they’re nearly 3 times more likely to report nicotine dependence as teenagers and as adults, according to the American Academy of Pediatrics (AAP)’s new report, published in Pediatrics. They also are 1.5 times more likely to have a marijuana use disorder.

Treating Young ADHD Patients: The Paradox and Promise of Stimulant Medications

Despite these scary stats, the news isn’t all bad: Behavioral treatment and stimulant medications (like dextroamphetamine and methylphenidate) can improve symptoms of ADHD. While it may seem counter-intuitive to treat an adolescent at risk of developing a substance abuse disorder with a medication that itself has potential for misuse and addiction, "One of the big points in the paper is that there is no evidence that stimulant treatment increases the risk of developing a substance use disorder for kids with ADHD," says Sharon Levy, MD, a lead author of the report and chair of the AAP’s Committee on Substance Abuse.

In fact, stimulant treatment may actually lower the risk of developing a substance abuse disorder in children with ADHD, according to the AAP.

Diagnosing and Treating Children with ADHD

ADHD is a well-known and not common disorder, but parents shouldn’t automatically assume that a child has ADHD if he is inattentive in the classroom. "Depression, an anxiety disorder, and a learning disorder can all make a child appear inattentive in the classroom, so you need to get a thorough evaluation," Levy explains. If you believe your child has ADHD, have her evaluated by an expert. Confirm the diagnosis or figure out what else might be going on before you start any treatment, Levy says.

Parents whose children have symptoms or have been diagnosed with ADHD should be educated and knowledgeable about the risks and benefits of stimulant medication, Levy adds. Here are some important points for parents of children with ADHD to keep in mind:

  • Stimulant medications can be very effective at treating ADHD symptoms. Additionally, stimulant treatment for patients with ADHD may reduce the risk of developing a substance abuse disorder, though the jury is still out. Large studies have found an association between stimulant medication use and lower rates of substance abuse disorders in teens with ADHD, though these finding were not confirmed in a "gold standard" randomized controlled trial (in which participants are randomly assigned to different treatment groups, and the outcomes compared), Levy explains.
  • Stimulant medications should not be prescribed for teens who don’t have ADHD. Any teen who presents with new symptoms that suggest ADHD should have a full evaluation to confirm the diagnosis before receiving a prescription. Some teens may report exaggerated symptoms just to get a prescription for stimulant medication, Levy points out. There is no evidence that stimulant medication improves academic performance in teens without ADHD.
  • Supplement the use of stimulants with behavioral therapy. "Behavioral treatment should always be part of any treatment plan," Levy says. Behavioral treatments, including meeting with an organizational coach at school, and being seated in a low-distraction area of the classroom (such as one that’s close to the teacher) can be helpful.
  • If your child takes stimulant medication, it’s important to discuss how he handles his medication. "By the time kids reach high school, they can be tempted to share their medication or borrow medication from another student," Levy says. Children as well as parents need to be aware of the potential for misuse and abuse of stimulant medications, and to know that trading or selling their stimulant medication is actually a crime.

Sharon Levy, MD, reviewed this article.


Harstad, Elizabeth, Sharon Levy, and Committee on Substance Abuse. "Attention-Deficit/Hyperactivity Disorder and Substance Abuse." 30 June 2014. Pediatrics. 134, no. 1 (2014): e293-e301. Doi: 10.1542/peds2014-0992

"Attention Deficit Hyperactivity Disorder (ADHD)." National Institute of Mental Health. Page accessed September 11, 2014.