Risks of Stimulant Use for Attention Deficit Hyperactivity Disorder on the Developing Brain: Primum Non Nocere

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The prognosis of attention deficit hyperactivity disorder (ADHD) continues to “show heightened risk of multiple mental health and social difficulties as well as premature mortality in adult life” after nearly 50 years of primary pharmacological treatment.1 If the prognosis of ADHD is not changed by stimulants, then 2016 research that stimulants may cause cardiac arrhythmia and myocardial infarction associated with subsequent death in children younger than 17 years prescribed methylphenidate (MPH)2 raises the question of whether stimulants should be used. Furthermore, a 2015 Cochran Review found 98·6% of ADHD randomized clinical trials were considered high risk for bias and the remaining trials could also have been considered high risk by using a stricter definition.3 Has medicalization and marketing of the diagnosis and treatment of ADHD become the basis of putting children at risk by using stimulants, especially in the United States?4,5