Pediatrics

ADHD stimulant use not tied to psychotic symptoms in youth

May 13, 2025

Study details: This study estimated the causal effect of stimulant medications on psychotic experiences in adolescents ages 9 to 14 years. Using data from the Adolescent Brain Cognitive Development Study, researchers emulated a trial and derived treatment propensities from demographic and mental illness severity covariates. The average causal effect was estimated using inverse probability of treatment weighting and standardization.

Results: Among 8,391 participants, 460 (5.5%) reported receiving stimulant prescriptions. Initial unweighted analyses showed an association between stimulant use and psychotic experiences (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.15-1.84). However, baseline psychotic experiences also predicted subsequent stimulant treatment (OR, 1.93; 95% CI, 1.57-2.37). When applying doubly robust estimation, no causal effect of stimulant prescription on psychotic experiences was found (OR, 1.09; 95% CI, 0.71-1.56).

Clinical impact: The association between stimulant use and psychotic experiences is confounded by underlying factors. Clinicians should consider these factors and monitor for psychotic symptoms, but the study doesn't support a direct causal link. The findings emphasize the need for careful assessment and personalized treatment plans.

Source:

O'Hare K, et al. (2025, May 12). Pediatrics. Stimulant Medication Use and Risk of Psychotic Experiences. https://pubmed.ncbi.nlm.nih.gov/40350165/