ADHD Myth: The Paradoxical Stimulant Effect

Does Lack of Response to a Stimulant Rule Out ADHD?

Since an appropriately dosed stimulant can improve focus and thinking in most people, a positive response to a stimulant does not help to diagnose ADHD. But is the opposite true as well? In other words, if a child suspected of having ADHD does not respond to a stimulant, or actually gets worse on a stimulant, does this mean the child does not have ADHD? Sometimes, but not always.
The first step is to make sure the stimulant is appropriately dosed, since a dosage that is too high will make ADHD worse, and if it's too low, it won't be effective. If it's clear that stimulants cause a worsening of symptoms for an individual, the ADHD diagnosis should probably be questioned but certainly not ruled out entirely. A referral to a child psychiatrist is probably in order, if the child is not already seeing a psychiatrist. It is possible that the child may have a different condition altogether, such as bipolar disorder, or might have another condition on top of ADHD.
Even if the child is simply one of the few who responds poorly to stimulants for ADHD, a child psychiatrist will be able to appropriately treat the condition with nonstimulant medications.

Letting Go of the Paradoxical Effect Myth

Despite the overwhelming evidence against it, the paradoxical effect myth just won't go away. Why does it persist? There are likely several reasons to explain its persistence, such as:
  • Older healthcare providers may have been taught this myth during medical school or nursing school many years ago.
  • Parents like this myth, as it provides reassurance that the ADHD diagnosis is accurate and that stimulant treatment is the correct course of action for their child. It also removes any questions about giving the child an unfair advantage and alleviates concerns about potential stimulant abuse.
  • The myth makes sense intuitively based on what the general public knows about stimulants and their "usual" effects.
Parents in particular are hesitant to let go of this myth. It is a comforting, reassuring myth that helps to validate their parenting decisions. However, it simply isn't true. For the sake of our children -- with or without ADHD -- we need to let go of this belief. 
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