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Common ADHD Medication May Affect White Matter in Boys’ Brains

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Experts say a combination of medication and behavioral therapy is usually the best way to treat children with ADHD. Getty Images
  • Researchers say ADHD medications such as Ritalin and Concerta can affect the development on white matter in the brains of boys.
  • The researchers said the same effects were not seen in adult men who took the drugs.
  • They add that more research needs to be done to see if there are serious health issues from the white matter changes.
  • Experts say professionals always weigh the balance between medications and behavioral therapy when treating children with ADHD.

A drug often used to treat attention deficit hyperactivity disorder (ADHD) affects the development of white matter in the brains of boys, according to new research.

The study, which was published today in the journal Radiology, reports that the same effect was not seen in adult males with ADHD.

However, researchers said methylphenidate (MPH), sold under the brand names Ritalin and Concerta, was found to impact a boy’s white matter, the part of the brain that is needed for learning, brain function, and communication between different areas of the brain.

“Methylphenidate is the largest class of psychotropic medications prescribed to children for the treatment of ADHD. It effectively reduces symptoms of inattention, hyperactivity, and impulsivity in up to 80 percent (of cases). Its short-term safety has been documented in many studies and efficacy is among the highest of psychiatric medications. However, surprisingly little is known on long-term safety of MPH on the human brain,” Dr. Liesbeth Reneman, senior study author and professor in the Department of Radiology and Nuclear Medicine at the Academic Medical Center at the University of Amsterdam in the Netherlands, told Healthline.

In undertaking the study, Dr. Reneman and her colleagues studied 50 boys and 49 young adult men who were diagnosed with ADHD and had never taken MPH.

The study participants were given either MPH or a placebo for 16 weeks.

One week before they began taking their treatment, they had an MRI to assess their white matter. They also had an MRI one week after stopping treatment.

During the MRI, diffusion tensor imaging was used to measure important aspects of white matter such as size and nerve fiber density.

The researchers said that boys in the study who were given MPH medication rather than placebo had changes to the white matter that weren’t observed in adults or in the placebo group of boys.

But Reneman says more research is needed to determine if there are serious health issues associated with the change in white matter. She noted that the study was small and only focused on boys.

“We still need to establish the long-term implications of our findings… we are currently conducting a four-year follow-up study. As we also do not yet know whether these effects are reversible or not, and whether they are related to functional or behavioral changes over a longer period of time, our study highlights the importance for further research on this topic in children and adolescents treated with methylphenidate,” she said.

“But we expect to find that these findings may be positive, based upon an older retrospective observational, cross-sectional study which reported an increase, or apparent normalization, of white matter volume in children with medicated ADHD compared with children who were not receiving medication,” Reneman noted.

According to the U.S. Centers for Disease Control and Prevention (CDC), more than Disease Control and Prevention (CDC)” rationale=”Governmental authority”>6 million children in the United States have been diagnosed with ADHD. That’s about 9 percent of all children aged 2 to 17.

There is no definitive data on rates of ADHD treatment, but a 2016 study based on parent-reported data stated that 62 percent of children with ADHD were taking ADHD medication.

Treatment options for ADHD vary by age. The American Academy of Pediatrics (AAP) advises that for children under age 6, first-line treatment should be behavior therapy. If this is ineffective MPH may then be prescribed.

In school-age children, ages 6 or above, the AAP advises a combination of MPH and behavior therapy.

Steven Korner, PhD, a psychologist in private practice in Cresskill, New Jersey, and coordinator of special education in the Harrington Park School District in New Jersey, says the decision to use medicine is one not taken lightly by practitioners.

“It is always a dilemma as to whether to try medicine first because if it works, it may save the child and family some pain,” he told Healthline.

“A conservative approach is to try behavioral methods first before going to medicine. Of course, these must be implemented with consistency or they have a lower probability of working,” Korner added. “Simple sticker charts used in an inconsistent manner is a waste of time. Medicine can be a ‘go to’ when all else fails and the disorder is severe. If it is used, it needs to be monitored closely, particularly at the outset to get the right medication and dose.”

Dr. Rolanda Gott is a developmental-behavioral pediatrician at the University of California Los Angeles Mattel Children’s Hospital.

She says MPH is both safe and effective, but it must be accompanied by a comprehensive intervention plan.

“Based on our long clinical data for many years there is no current knowledge that there are significant negative effects on the brain development of children with ADHD treated with methylphenidate,” Gott told Healthline.

“It is safe as long as a clinician gets a comprehensive picture from parents, school, child, evaluates for comorbidity, provides a comprehensive intervention plan, educates and follows the family for potential side effects,” she added.

MPH medications such as Ritalin work by decreasing hyperactivity and impulsivity and improving focus and motivation.

Side effects can include sleep problems, loss of appetite, and weight loss.

Dr. Steve Lauer, a pediatrician at The University of Kansas Health System and associate chair of pediatrics at the University of Kansas Medical Center, said clinicians and parents alike should weigh the benefits and risks of MPH.

“In pediatrics, we are always concerned about using a psychoactive medication in a patient whose brain is still growing and maturing. Parents and the physicians who care for kids should always consider the risks and benefits of starting a psychiatric medication,” Lauer told Healthline.

“We always have to balance the effects of treatment with the effects of not treating. No medication is without risk. However, many patients thrive with the addition of this medication and many have taken it for years. The goal is always to use the minimal amount of medication that benefits the patient,” he said.


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