Updated 14 June 2017

ADHD drugs may lower kids' tendency to smoke

Kids with ADHD who are treated with medications like Ritalin are about half as likely to smoke as children with this disorder who remain untreated, according to a new analysis.

Kids with ADHD who were treated with these so-called stimulant medications were about half as likely to smoke as children with this disorder who weren't treated with these medications, researchers found.

"We found an association between treatment with stimulant medications and a lower risk of smoking in adolescence and adulthood," said study researcher Erin Schoenfelder, clinical psychologist at Duke University School of Medicine in Durham, North Carolina.

About 11% of American children aged 4 to 17 have a diagnosis of ADHD, according to the US Centres for Disease Control and Prevention (CDC). Children with ADHD can be impulsive, have trouble concentrating and may have other behaviour problems. About 70% to 80% of children respond to stimulant medicine, according to the CDC. Behaviour therapy can also help.

Experts have long known that children with ADHD have a higher risk of starting to smoke cigarettes. Teens with ADHD are two to three times more likely to smoke cigarettes than their friends who don't have the diagnosis, according to Schoenfelder, citing previous research.

But, research on the effects of ADHD stimulant medicine on the risk of smoking has been conflicting.

Stimulant medications

To try to better answer the question of whether or not these medications could help prevent kids from smoking, the Duke researchers re-analysed the results of 14 studies of cigarette smoking and ADHD treatments. The studies included more than 2 300 children with ADHD. About 1 400 of the kids were being treated with stimulant medications, according to the new analysis.

The studies were published between 1980 and 2013. The average follow-up time was about seven years. The researchers compared the teens treated with stimulants to those who weren't to see which group was more likely to smoke.

Overall, those on medications were about half as likely to smoke as those not on the medications, Schoenfelder said.

Association found

"Those who took their medication consistently and for a longer period of time had an even lower risk of smoking," she added.

The data she analysed overwhelmingly showed that medications appear to decrease the risk of smoking, according to Schoenfelder.

Like all medications, ADHD medicines have side effects. This analysis showed a "slight effect" on growth, she said. However, that finding must be weighed against the many positive long-term benefits, she explained.

Schoenfelder pointed out that the researchers "can't say based on this study that the treatment caused the lower rate of smoking, but there is an association we found."

However, association does not prove a cause-and-effect relationship.

Kids try to self-medicate

One potential reason medication might have an effect is that both nicotine and the stimulant medications used to treat ADHD operate on the same pathways in the brain. They both improve the same processes that are disrupted in ADHD, according to Schoenfelder.

"Kids who have ADHD know that something is not quite right," said Dr Trevor Resnick, chief of the department of neurology at Miami Children's Hospital, who commented on the study.

"They try to self-medicate," he explained, and "cigarettes would be an example of self-medication." As a result, children with ADHD have a much higher risk in general of turning to cigarettes, pot or illicit drugs, he said.

"What this study shows, similar to previous research, is that successful treatment of ADHD with stimulant medication decreases the risk of self-medication in these children," Resnick noted.

While stimulant medications do have several possible side effects, Resnick said, "most kids are able to tolerate" the medication.

Read more:

Kids exposed to smoke at risk of ADHD

Link between ADHD meds and smoking still unclear


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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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