The first clinical observations of the impact of stimulants on what was then called hyperactivity occurred in the late 1930s, at the dawn of modern psychopharmacology. Stimulants are both the crown jewel and the bane of child psychopharmacology. No medicine available to psychiatrists produces a more rapid and dramatic effect more safely than the proper dose of a stimulant to a patient with ADHD. Again and again, researchers have demonstrated the ability of stimulants to reverse the key symptoms of inattention, hyperactivity, and impulsivity with remarkable precision and relatively minor side effects.
At the same time, stimulants highlight many of the frustrations of child and adolescent psychiatrists and the patients and families with whom they work. They are not effective for everyone; although an 85 percent response rate is excellent for field, it leaves 15 percent who continue to suffer. In addition, although the effects are prompt, they are also transient. It is clear these medications do not change whatever lies at the core of ADHD; rather, they target its manifestations. Also, despite years of innovative research, how stimulants affect the course of this potentially devastating disorder over time is still uncertain. |
Stimulants have proven highly effective for the management of acute ADHD symptoms. Furthermore, starting in the late 1990s, options have expanded not only in the types of formulations available for stimulants but also in nonstimulant alternatives for treating ADHD.
The late 1980s and the 1990s were a time of major attitude shifts concerning the use of stimulants for treating ADHD. Researchers convincingly demonstrated that ADHD could affect adolescents and adults as severely as it does younger children. In addition, conventional wisdom that ADHD was a problem limited to school hours yielded to empirical evidence that it also affects many other aspects of life, including leisure time activities, peer relationships, and home life. A broad consensus among researchers, clinicians, affected families, and patients called for more vigorous identification and treatment of ADHD. This has included both more intense treatment at any time, longer during each day, for more days of the week, and more weeks of the year, but also over time, into adolescence and even adulthood. |