Methylphenidate (MPH) is the most commonly used drug to treat attention deficit/hyperactivity disorder (ADHD) in children effectively and safely. However, in spite of its widespread application throughout what is considered one of the most plastic and sensitive phases of brain development in children, very little is known to date about its long-term effects on brain structure and function leading well into later adolescence and adulthood. Additionally, there is scant information available to parents, clinicians, and clients with ADD/ADHD about the influence of MPH on brain development. More importantly, recent human and animal studies suggest that MPH alters the dopaminergic system with long-term effects beyond the termination of treatment. As such, a multimodal treatment with psychodynamic therapies can assist the treatment team to support the development of the client's pro-social skills in addition to medication treatment, thus reducing full reliance on MPH as the primary treatment for ADD/ADHD.
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Beiderman et al. (1995) maintains that the co-occurrence of attention deficit hyperactivity disorder (ADHD) and psychoactive substance use disorder has been reported in a variety of clinical and research settings and continues to be a focus of attention and controversy. Accordingly, studies have documented a higher than normal risk for psychoactive substance use disorders in adults who had ADHD as children (Hesson & Fowler, 2018; Kessler et al., 2006; Kooij, 2012; Mao & Findling, 2014; Moore, Sunjic, Kaye, Archer, & Indig, 2016; Newcorn, Weiss, & Stein, 2007; Rucklidge, Downs-Woolley, Taylor, Brown, & Harrow, 2016). Similarly, studies of referred and non-referred adults with ADHD of childhood onset have documented the high risk for substance use disorders in these children becoming adults. Whether ADHD on comorbid disorders are risk factors for substance use disorders raises important clinical and scientific questions awaiting clarification given the use of one strong drug used to treat ADHD known as Methylphenidate (MPH). Another concern is raised in that MPH has been identified as the preferred treatment for youth and young adults with an ADHD, but more importantly impacts youth from culturally and linguistically diverse (CLD) backgrounds such African American and Latino males (DuPaul, Barklay & McMurray, 1994) who are already often over-identified in special education with this disability under the Individual Disability Education Act (IDEA, 2004). The use of MPH as the primary treatment for ADHD in children has also led to a concern about its impact on brain development in adolescents during this very critical stage of development (Breggin, 2001; Fitzgerald, 2009; Madhiraju, 2001).
This chapter examines various arguments around the use of MPH as these empirical based accounts provide both pros and cons that can assist the consumer (parent, therapist, teacher, medical doctor) in making informed decisions about the use of MPH in children, particularly adolescents during one of the most critical developmental periods of brain development which occurs between the ages of 12-21 years of age (Gaviria & Smith, 2001). Next, a comparative summary of the primary research utilized in this analysis is laid out so as provide an internal polemical argument. Following the summary, the author critiques the primary arguments provided by the authors of the studies with a conclusive summary based on the overall analysis.