- Researchers say ADHD medications such as Ritalin and Adderall may affect different parts of the brain than previously thought.
- They said the stimulants appear to help reduce ADHD symptoms by interacting with the brain’s reward and wakefulness centers.
- They say the drugs also produce patterns of brain activity that are similar to quality sleep, something many people with ADHD have difficulty achieving.
A new study reports that common medications prescribed for attention deficit hyperactivity disorder (ADHD) may work differently than previously thought.
Experts say the findings could alter the way medical professionals treat and manage ADHD.
In the study published in the journal Cell, researchers at the Washington University School of Medicine in St. Louis say prescription drugs such as Ritalin and Adderall may be effective in treating ADHD because they interact primarily with the brain’s reward and wakefulness centers.
In particular, the researchers said these medications produce patterns of brain activity that are representative of quality sleep – something that people with ADHD can have trouble achieving.
The researchers stated that prescription stimulants enhance performance by making individuals with ADHD more alert and interested in tasks, rather than directly improving a person’s ability to focus.
These conclusions counter previous theories that these stimulant medications interacted most directly with the brain’s attention circuitry.
“I prescribe a lot of stimulants as a child neurologist, and I’ve always been taught that they facilitate attention systems to give people more voluntary control over what they pay attention to,” said Benjamin Kay, MD, a co-author of the study and an assistant professor of medicine at Washington University who works at St. Louis Children’s Hospital.
“But we’ve shown that’s not the case. Rather, the improvement we observe in attention is a secondary effect of a child being more alert and finding a task more rewarding, which naturally helps them pay more attention to it,” Kay said in a statement.
Grace Cheney, MD, a clinical assistant professor of psychiatry and behavioral sciences at Stanford University in California who specializes in ADHD assessment and treatment, says these findings are important.
“This study validates what clinicians have long observed, while clarifying how stimulant medications are actually helping,” Cheney, who was not involved in the study, told Medical News Today. “Rather than directly boosting attention networks, stimulants appear to act on systems involved in wakefulness, motivation, and reward, shifting the brain into a more alert and engaged state.”
“The study corrects the common misconception that stimulant medications simply ‘increase attention’ in a direct or mechanical way,” she added.
To reach their findings, the Washington University researchers used data from resting-state MRI exams on 5,795 children ages 8 to 11 who participated in the Adolescent Brain Cognitive Development (ABCD) Study.
The researchers compared brain connectivity patterns between children who took prescription stimulants and children who were not given medications on the day of their scan.
They reported that children who took stimulants the day of the scan showed “increased activity in regions of the brain related to arousal or wakefulness.”
They stated that the scans did not show significantly increased activity in regions typically associated with attention.
“Essentially, we found that stimulants pre-reward our brains and allow us to keep working at things that wouldn’t normally hold our interest — like our least favorite class in school, for example,” said Nico Dosenbach, MD, a co-author of the study and a professor of neurology at Washington University, in the statement.
Cheney said these findings can help medical professionals when assessing and treating ADHD.
“This data should prompt clinicians to refine how they explain what stimulant medications can and cannot do. Rather than generally increasing focus, stimulants instead improve wakefulness, motivation, and the ability to persist with tasks that the individual does not naturally find rewarding or interesting,” Cheney said.
“This research gives scientific backing to a biking metaphor I often use with patients and families,” she added. “In ADHD, mundane tasks (be it math homework or laundry) feel like a very steep hill to pedal up. Medication won’t push the bike uphill for you, but it lowers the steepness of the hill. You still must pedal, but getting started takes less effort, and maintaining momentum is easier.”
The researchers also said their findings point to the importance of people with ADHD getting adequate quality sleep.
Cheney said this is an important aspect of the study.
“The study reminds us of sleep’s importance; it suggests that some of the brain patterns associated with stimulant treatment overlap with patterns seen when people are better rested, whether or not they have ADHD,” she said.
“Sleep cannot be emphasized enough. Adequate, consistent sleep is vital for attention and cognitive functioning for both children and adults,” Cheney added.
It’s estimated that 7 million children ages 3 to 17 in the United States have been diagnosed with ADHD. Boys are almost twice as likely to be diagnosed as girls.
ADHD is a neurological disorder that causes people with the condition to have difficulty focusing on a specific task or sitting still for long periods of time.
- Inattention
- Hyperactivity-impulsive
- Combination of inattention and hyperactivity
- Daydreaming
- Difficulty focusing
- Making “careless” mistakes
- Losing personal items
- Running or climbing at inappropriate times
- Making unnecessary noises
- Tapping of hands and feet
In addition to medications, ADHD can be treated with behavioral therapy and counseling. Medical professionals say parents can help children with ADHD by:
- Providing a written schedule of all tasks
- Breaking down large tasks into smaller, more manageable tasks
- Keeping school materials and toys organized
- Establishing clear, consistent rules
Cheney noted that behavioral therapy and other strategies are important components of treatment, along with medication.
“That’s why non-medication supports at home and at school remain critical to support attention in ways medication alone cannot; for example, reducing environmental distractions and using pacing strategies like brief work intervals and movement breaks,” she said.
