ADHD: Child Neurodevelopmental Disorder
ADHD, or attention deficit hyperactivity disorder, is among the most common yet multifaceted neurodevelopmental disorders in children. It is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that severely interferes with daily functioning and subsequent development (Nevid, 2018). Following typical progression, symptoms of ADHD begin to manifest before the age of 12 and are present in two or more settings for 6 months. However, one key component for individuals diagnosed with this disorder is that no two children are alike in the presentation of their behaviors, introducing a continuum or spectrum of ADHD rather than the typical rigid categories that are often portrayed. Based on this idea of an ADHD spectrum, treatment approaches to alleviate the debilitating symptoms are individualized and change based on the severity level of each child.
When discussing treatment approaches, the most commonly implemented drugs for alleviating ADHD symptoms are psychostimulants, such as methylphenidate and amphetamine, which aim to increase the low levels of dopamine in the brain. Although there are significant benefits, there is abundant backlash from the community around the implementation of drug regimens in children. Due to the rapid spread of misinformation, many parents believe that with psychostimulants, their children are at greater risk of future substance abuse and addiction driven behaviors (Wolpert, 2022). Therefore, many children are not placed on drug therapy, despite the scientific evidence advocating for its benefits in improving cognitive functioning skills and attenuation to relevant stimuli.
Addiction Potential: Ritalin
Drugs of abuse, including psychostimulants, share a common theme of addiction potential and are marked by drug seeking behaviors. In the research article, “Opioid-induced rewards, locomotion, and dopamine activation: A proposed model for control by mesopontine and rostromedial tegmental neurons”, Stephan Steidl et al. introduces how opioid drugs interact and stimulate several brain regions and pathways important for substance abuse. Dopamine is a key player in drug reward activation in the brain, since dopamine receptors are activated by aversive events, salient external cues, and rewards. Dr. Steidl explains that all drugs of abuse share an ability to elevate nucleus accumbens levels of dopamine, forming addictive habits with its activation. There is also a characterizable sensitization of dopamine receptors, in which sensitization inducing pre-exposure enhances motivation to engage in drug self administration.
When discussing medications for the treatment of ADHD, one of the most important psychostimulants is methylphenidate, also referred to as Ritalin. In a study conducted in 2020 by Sidish Venkataraman et al., Ritalin was seen to function as a dopamine transporter blocker, binding to transporters responsible for reuptake of the neurotransmitter from the neuronal synapse, leaving more dopamine available to the postsynaptic neuron. These increases of dopamine levels were prominent in brain regions important for motivation and reward, namely the prefrontal cortex, caudate nucleus, ventral tegmental area, and nucleus accumbens. The study focused on the frontostriatal connections between the frontal cortex and caudate nucleus, since these connections have been implicated in drug seeking, addictive behavior and general drug use, especially with the upregulation of their functions through Ritalin. The data also explained how Ritalin was able to induce behavioral sensitization and tolerance based on the dosage of the drug, indicating that this psychostimulant has addictive potential.
In both drugs of abuse and psychostimulants, we see the activation and elevation of dopamine levels in the nucleus accumbens of the brain, as well as prominence of sensitization. These neurological underpinnings are indicative of addictive substances and can lead to dependence in the future. With Dr. Steidl’s explanation of the importance that dopamine plays in the nucleus accumbens and the activation of the region with Ritalin administration in Venkataraman’s study, it makes sense why many parents are skeptical and hesitant to have their child ingest a drug that has a high abuse potential.
Signs of Treatment or Early Stages of Addiction?
Given this data, it would be safe to assume that due to Ritalin’s high abuse potential, it is unsafe to prescribe to children struggling with ADHD, however, this deduction is inaccurate. Although the data from the study performed by Venkataraman et al. indicates that there are many points of interest in the addictive properties of Ritalin due to drug seeking behaviors and sensitization, (predictable of drugs of abuse through Dr. Steidl’s work) the researchers make it clear that the addictive potential would only be manifested in individuals abusing the drug. In other words, the use of Ritalin by healthy individuals gives rise to copious amounts of the neurotransmitter in the brain, initiating pathways for addiction and drug seeking behaviors. On the other hand, with individuals that are diagnosed with ADHD and truly have this characteristic dopamine deficiency, taking a psychostimulant such as Ritalin can bring dopamine up to normal levels, alleviating some of the negative symptoms brought on by the disorder. Ultimately, there are little to no addictive properties manifested in taking Ritalin as prescribed for the goal of treating ADHD.
Should Parents Continue to Worry?
With the research conducted by Steidl et al. and Venkataraman et al., it is clear that Ritalin has a high abuse potential only when not taken for its sole purpose of ADHD treatment. Based on this research and other thoroughly conducted studies examining the beneficial impacts that a psychostimulant, such as Ritalin, has on child attention and cognitive development, parents should not have to worry about the possible risk of future substance abuse. There are many factors that may lead a child to grow up to be dependent on drugs, such as environmental stressors or genes; medication that is being prescribed to help a child with a neurodevelopmental disorder may play an insignificant role in this future risk when considering more prominent influencing factors. Parents should take a step back, assess the stigmas around the use of psychostimulants, educate themselves about Ritalin and its neural actions, and then formulate their thoughts and decisions on the course of treatment for their child.
Works Cited
Nevid, J. S., Rathus, S. A., Greene, B. (2018). Abnormal psychology in a changing world. Pearson, 10, 138.
Steidl, S., Wasserman, D. I., Blaha, C. D., Yeomans, J. S. (2017). Opioid-induced rewards, locomotion, and dopamine activation: A proposed model for control by mesopontine and rostromedial tegmental neurons. Neuroscience and Biobehavioral Reviews, 83, 72-82. 10.1016/j.neubiorev.2017.09.022
Venkataraman, S. S., Claussen, C. M., Kharas, N., Dafny, N. (2020). The prefrontal cortex and the caudate nucleus repons conjointly to methylphenidate (Ritalin). Concomitant behavioral and neuronal recording study. Brain Research Bulletin, 157, 77-89. https://doi.org/10.1016/j.brainresbull.2019.10.009
Wolpert, S. (2022). Are children who take Ritalin for ADHD at greater risk of future drug abuse? UCLA Newsroom. https://newsroom.ucla.edu/releases/are-children-who-take-ritalin-246186
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