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No Link Seen Between Child Stimulant Use and Later Drug Abuse

An analysis published Wednesday by the American Medical Association said children with attention deficit hyperactivity disorder who take stimulant medication do not have a lower risk over all for later substance abuse, contradicting the longstanding and influential message that such medicines tend to deter those with the disorder from abusing other substances.

The paper, written by three researchers at the University of California, Los Angeles, examined data from 15 previous studies on the subject and determined that, on average, medications like Adderall and Ritalin had no effect one way or the other on whether children abused alcohol, marijuana, nicotine or cocaine later in life.

A 2003 study in the journal Pediatrics had concluded that the introduction of stimulant medication to children with A.D.H.D. reduced the risk of such abuse later in life, a finding that has been repeated by doctors and pharmaceutical companies not only to assuage parents’ fears of medication but also to suggest that the pills would protect their children from later harm.

“I always doubted the whole ‘protection’ argument, and I wasn’t the only one, but that message was really out there,” said Liz Jorgensen, an adolescent addiction specialist at Insight Counseling in Ridgefield, Conn. “Hopefully, this message will be heard loud and clear.”

The study comes amid growing concern about the persistent rise in A.D.H.D. diagnoses and prescriptions for medication among children. A recent New York Times analysis of data collected by the Centers for Disease Control and Prevention found that 11 percent of all children ages 4 through 17 — 6.4 million over all — had received a diagnosis of A.D.H.D. from a medical professional. The diagnosis rate rose to 19 percent for boys of high school age.

Stimulant medication is by far the most prevalent treatment for childhood A.D.H.D., with the vast majority of children at least trying medication and about 60 percent of them staying on it long term. Stimulants can drastically improve the lives of children with severe A.D.H.D. but are also increasingly abused by high school and college students for their jolts of focus toward schoolwork.

Side effects can include appetite and growth suppression, sleep disturbance and occasionally psychosis, especially when the stimulants are abused.

The paper released Wednesday in the journal JAMA Psychiatry analyzed data from studies conducted from 1980 to 2012, and included more than 2,500 children with A.D.H.D. from the United States, Canada and Germany. They were followed from an average age of 8 into young adulthood.

Steve S. Lee, an associate professor of psychology at U.C.L.A. and the study’s senior author, said the data had distinct limitations — primarily that his team knew only whether a child had ever taken medication at all, not at what age, which medication, how much or for how long.

Dr. Lee also acknowledged that while his study found no average effect of stimulant medication on future substance abuse, that net of zero could have resulted from the counterbalance of two groups: children who were deterred from later abuse (because they felt no need to self-medicate) and children whose use of stimulant medication desensitized them to other mind-altering substances.

“There may be subgroups based on gosh knows what factors that could alter that risk up or down — even though the effect right now is statistically zero,” Dr. Lee said.

Ms. Jorgensen said her clinic sees several new cases each month of adolescents whose introduction to drugs came from an A.D.H.D. diagnosis and prescription.

“It teaches them very boldly that this is the way to feel different — this is the way to feel better,” she said. “Aversion to prescription drugs can be lifted at that early age.”

A version of this article appears in print on  , Section A, Page 17 of the New York edition with the headline: No Impact Found for Stimulants on Later Drug Abuse. Order Reprints | Today’s Paper | Subscribe

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