Are ADHD medications overprescribed in kids?

Are too many kids taking ADHD medication?  

The question of whether stimulant medications for ADHD are overprescribed has been around for years. Lately, it’s been coming up more and more. On September 9, the Make America Healthy Again Commission published a report featuring concerns that too many children are being treated with prescription medication for ADHD. 

But is there a way to know if ADHD drugs are overprescribed, and if so, by how much? There’s no data to suggest they are. It’s possible that ADHD meds are prescribed to the right number of kids. Or even too few.

ADHD is a relatively common condition. Roughly 7 million U.S. kids ages 5–17 (11.3 percent) have been diagnosed with ADHD at some point.¹ That’s according to a survey taken between 2020 and 2022 by the National Center for Health Statistics, part of the Centers for Disease Control (CDC). 

But nearly one-third of the 7 million kids in the survey had never taken medication for ADHD. Also, according to the CDC, the percentage of kids with an ADHD diagnosis who took ADHD drugs varied widely from state to state. The numbers ranged from 38 percent to 81 percent.² 

There are two types of ADHD medications — stimulant and non-stimulant. The stimulant type is the most effective for the majority of people. It’s also the most prescribed. This group includes drugs like Ritalin, Concerta, Focalin, Adderall, and Vyvanse. 

Stimulant drugs for ADHD have been around for many decades. Ritalin, the first, was approved for use in kids in 1962. It’s been widely used to treat ADHD since 1980. That’s when ADHD (then called ADD) was recognized as an official psychiatric diagnosis.³ 

Stimulant medications are shown to reduce ADHD symptoms and limit the negative effects ADHD can have on a child’s life.

The process starts with a diagnosis from a licensed professional. After that, you’ll talk with your child’s health care provider about treatment options. These may include:

• Behavioral treatment

• Stimulant or non-stimulant medication

• Medication and behavior treatment 

Health care providers have clear guidelines for how and when to prescribe ADHD medications to kids, according to Understood Expert and developmental pediatrician Elizabeth Harstad, MD. These guidelines come from the American Academy of Pediatrics (AAP). The group also has guidelines for evaluating and diagnosing ADHD in kids.

First-line treatment recommendations depend on the child’s age:

Ages 4–6: Evidence-based parent training in behavioral management (PTBM) and/or behavioral classroom interventions, if available.

Ages 6–12: FDA-approved medications for ADHD, along with PTBM and/or behavioral classroom intervention (preferably both). 

Ages 12–18: FDA-approved medications for ADHD, if the adolescent agrees. (Evidence-based training interventions and/or behavioral interventions as treatment of ADHD are encouraged, if available.)

The prescriber monitors how the child is doing on the medications and makes any needed adjustments.

ADHD is partly caused by differences in how the brain functions. With ADHD, networks of brain cells don’t work efficiently. 

People with ADHD have trouble getting enough of the brain chemicals dopamine and norepinephrine. These chemicals carry messages from one brain cell to another. They also help with attention and other executive skills. 

Stimulant medications help release more dopamine in the brain, which reduces some ADHD symptoms. But they don’t work for all kids. About 20 percent of kids and adults either don’t respond to these medications or can’t tolerate them.

When the medications work well, they’re very effective at reducing symptoms that create daily challenges. Common challenges associated with ADHD symptoms include:

• Making and keeping friends

• Following directions

• Managing emotions

• Starting and finishing tasks

• Thinking before acting

• Controlling impulses

Whether too many kids take ADHD medications is often related to another question: Are too many kids being diagnosed with the disorder? 

The rate of diagnosis has risen a lot in recent years, from 6 million in 2016 to 7 million in 2022. Research suggests that an increase in awareness of ADHD, and changes to the criteria for diagnosing it, are part of the reason for the rise.⁴ “There is more assessing and looking for symptoms,” says Harstad.

Another factor may be the increase in the number of girls being diagnosed. In the past, ADHD was thought of as something only boys had. Girls were often underdiagnosed because they’re more likely to have symptoms that are easier to miss or dismiss. But a growing understanding of what ADHD tends to look like in girls is closing the gap. The ratio of boys versus girls being diagnosed has narrowed to less than 2:1.¹

It makes sense that as more kids are diagnosed with ADHD, more kids take medication. “Rates of medication have increased along with rates of diagnosis,” says Hardstad.

The question about overprescription is often tied to safety concerns over long-term use of stimulants.

Both types of ADHD medications are approved and recommended for use in kids. They’ve been around for decades and are considered safe, even though they may cause some short-term side effects.

There is one known long-term consequence. Some kids show a slight reduction in height. It’s not clear if reductions affect a child’s adult height.⁵ Your child’s prescriber should monitor your child’s growth during treatment.

“There aren’t great long-term studies,” says Harstad. Still, she believes that the possibility of a small effect on height shouldn’t keep parents from giving their child ADHD medication, if the meds are really helping.

“If [a child’s] adult height is a few centimeters lower, it does not have as much of a functional impact as not using medication,” she says. 

Studies show that undiagnosed and untreated ADHD can lead to poor outcomes. These include:

• Underachievement at school

• Depression and anxiety

• Increased risk of accidents and injuries

• Difficulties at work

• Unemployment

• Substance abuse

• Suicidal thoughts and behaviors⁶ 

ADHD medication isn’t a cure. But it’s the most effective way to treat ADHD and lower the risk of lifelong problems, especially when used in combination with psychotherapy.

Still, there’s no way to answer the question of whether these drugs are overprescribed, prescribed at the right amount, or even underprescribed. If you’re concerned about ADHD medication for your child, talk to your child’s health care provider.

You may be hearing questions about whether ADHD medication is overprescribed in kids and also about long-term safety concerns. There’s no way to know if “too many” kids are taking medication for ADHD or what the “right” number might be.

There’s been a sharp rise in diagnosis in recent years, which means that more kids are candidates for medication. But research shows that 30 percent of kids who’ve been diagnosed with ADHD don’t get any treatment for it.

Medication is the most effective treatment for the majority of kids with ADHD, and is recommended by the American Academy of Pediatricians (AAP). 

The most common type is stimulants. These medications can produce side effects, which are usually short-term. A possible long-term consequence is a slight reduction in height, although it’s not clear if this affects a child’s eventual adult height. 

There are risks to not treating ADHD, too. Consequences include problems at school and work, underachievement, mental illness, suicidal thoughts and behavior, substance abuse, injuries and accidents, and more.

If you’re concerned about ADHD medication, talk to your child’s health care provider.