Adverse effects of stimulant medications in children and adolescents: focus on sleep and growth disturbances

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by various degrees of attention dysfunction, impulsivity and/or hyperactivity [1], [2]. Its etiologic underpinnings include abnormalities in the central nervous system’s neurotransmitter system that includes the noradrenergic, serotonergic and dopaminergic systems [3]. Large epidemiologic studies from the United States note an ADHD prevalence of 8.7% in children [4] and 4.4% in adults [5]. Caring for patients with ADHD requires both psychosocial and pharmacologic management [1], [2], [3]. Stimulant medications have become the most popular psychopharmacologic agents for ADHD management fueled by many research studies over the past several decades and beginning with the classic paper by Bradley in 1937 on d-1 amphetamine (Benzedrine) as well as Knobel et al.’s 1959 paper on methylphenidate [1], [2], [3], [6], [7], [8]. The Food and Drug Administration (FDA) of the United States has approved of two classes of stimulants for ADHD – methylphenidate (MPH) and amphetamine (AMP) – from ages 6 to 65 years of age. This discussion reflects on the potential adverse effects seen with these stimulants and suggests management options. Emphasis in this editorial is on general comments and then sleep and growth disturbances.