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My purpose here is to respond to inaccurate information about ADHD which shows up in print and Internet media.  In my opinion, based upon my knowledge and experience diagnosing and treating ADHD since 2005, the findings and reports often do not include an overall perspective and context for many of the items presented. 

March 21, 2019. News brief on CNN reported on an article published in the New England Journal of Medicine about the risk of psychosis in teens and young adults taking stimulants for ADHD. 


‚ÄčThe headline "young people on amphetamines for ADHD have twice the psychosis risk compared to other stimulants".   Which is true.  .001% vs .0005%.  There was no definition of "psychosis" mentioned thus no way of knowing how serious it was, whether it continued after stopping the medication, any context whatsoever. I cared for an 8 year old who after a few weeks on a stimulant had an hallucination. He "saw" his deceased grandmother standing at the foot of his bed. His mother didn't give him any more of it and I agreed with her 100%. He never had any more, he had no harm done and is at no risk of ongoing or recurring problems from it.  Medically speaking that was a psychotic episode. Does it represent a psychotic condition? Not at all. Does it mean he "developed psychosis"? Not at all


The risk to teens for developing a substance (drugs or alcohol) abuse condition when their ADHD is untreated is 20-25%, DOUBLE those in the general population or those taking stimulants for ADHD. That is clearly a problem of much greater significance and life-changing, or life-ending, consequences. That is 200,000 times the risk of showing signs of "psychosis" as reported in the article. 


An ongoing study begun 33+ years ago simply tracked the life course of people with and without ADHD from age 8-10. Some with ADHD chose to take medication, some did not. Along the years those not taking medication were 50% less likely to graduate from High School, had at least double the risk of substance abuse problems as teens or adults, twice the rate of car accidents, ten times the risk of involvement in an unwanted pregnancy, lower paying jobs, more failed relationships and a higher incidence of injuries or death. Those are  clearly much more significant and dangerous than the tiny risk of "psychosis". 


Side note: people with ADHD don't get addicted to stimulant medication. Period. If they take more than what is effective, they don't feel good! There is no incentive to take more and more. Those without ADHD feel great, super-energized, hyperfocused after taking Adderall for instance. But those effects soon wear off...unless they take more...and more...and more. They become addicted. There is a warning on the label of stimulants because it is possible to become addicted to them. But not if you have ADHD. 


That's my take on it.    David Pomeroy MD   written 3/21/2019