Editor’s Note: Katie is a telephone triage nurse with a background in women’s and children’s health. She is also the mother of two neurodiverse teens with medical complexities. -Cara L. Coleman, JD, MPH
Many people know someone with attention deficit hyperactivity disorder (ADHD), a condition that can affect focus and impulse control. Recent research has raised concern that the standard treatment for this common condition—stimulant medications—may increase the risk of psychotic episodes.
This is a scary idea that could cause families and doctors to rethink using these medications, even if they are helping improve focus and impulse control. A study to figure out whether these medications are likely to cause such episodes is the focus of “Stimulant Medication Use and Risk of Psychotic Experiences,” by Hare et al., which is published in this month’s Pediatrics (10.1542/peds.2024-069142).
What are “psychotic episodes”?
The term psychotic episodes describes periods of seeing or hearing things, or having thoughts, that aren’t based in reality. Of note, the study did not include patients who already had the diagnosis of a psychotic disorder (a condition in which those experiences happen regularly).
Why suspect a link?
Previous research noticed what looked like a strong connection between stimulant use and psychotic episodes. However, a connection between two things doesn’t always mean that one causes the other. Sometimes further research shows no connection at all; other times, it’s found that a completely different factor (or factors) is the cause of both things being studied.
What did the study find?
The use of stimulants did not appear to cause an increased risk of psychotic episodes. Instead, some individuals seemed to have traits that appeared to raise the likelihood for both. Most notably, individuals with more severe ADHD symptoms were more likely to receive a stimulant prescription and were also more likely to have a psychotic episode.
What can you do with this article?
If your child has ADHD, you can be reassured that a stimulant is unlikely to cause psychotic episodes. You can be aware that ADHD symptoms, especially severe ones, do seem to raise the risk. Immediately report to your doctor if you notice that it seems like your child is having thoughts or experiences that aren’t reality based. If a provider is hesitant to prescribe stimulants out of concern for psychotic episodes, you can use this article to start a conversation.
