Q: “What Are the Long-Term Effects of ADHD Medication on the Brain?”

ADHD medication use has lasting, positive effects on the brain, according to findings from brain imaging studies. Research also shows that leaving ADHD symptoms untreated carries far greater risks, including unemployment and substance abuse, than does lifelong medication use.

By Walt Karniski, M.D. Verified Updated on April 12, 2023

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Q: “What do we know about the long-term effects of ADHD medication on the brain? My child has ADHD and benefits from taking medication, but I worry about what medication will do to the brain, if anything, after taking it for years. On that note, does my child have to be on ADHD medication for life?”

ADHD medications, especially stimulants, dramatically reduce the core symptoms of attention deficit hyperactivity disorder, which include inattention, distractibility, hyperactivity and disorganization. We know this from decades of research, including the hundreds of studies published every year on the efficacy of ADHD medications.

How Do Stimulants Affect the Brain?

First, it is important to know that there are three areas of the brain that are smaller in children with ADHD than they are in children without ADHD¹ — the prefrontal cortex, the fronto-striatal-cerebellar projections, and the caudate nucleus. Not surprisingly, these areas of the brain are critical for a child’s ability to plan, focus, learn and retain information. ADHD medications enhance neurotransmitter activity in these areas, which ultimately improve learning and behavior.

Does ADHD Medication Change the Brain in the Long-Term? It Appears So.

Findings from brain imaging studies suggest, incredibly, that long-term ADHD medication use has lasting, positive effects on the brain.

Research studies reveal that individuals who were untreated for ADHD in childhood continue to exhibit the previously mentioned smaller, underdeveloped areas of the brain into adulthood. But it’s a whole different story for those adults who were treated with stimulant medication as children. Over time, these same, smaller brain areas actually develop to reach average, adult size — no different than the brain areas of adults without ADHD.² ³ ⁴ ⁵ These findings do not prove that medication “cures” ADHD. But they strongly suggest that, over time, stimulants reduce or even eliminate some of the brain differences that may be responsible for the symptoms of ADHD.

[Read: A Parent’s Guide to ADHD Medications]

Will My Child Need to Take ADHD Medication for the Rest of Their Life?

ADHD stimulant medications work quickly. They begin to take effect in about 30 minutes and symptom improvement is often noticeable even after the first dose of medication. Side effects may also occur while the medication is active. Then, depending on the preparation, the medication will leave the body anywhere from four to 24 hours after a dose. Once that happens, ADHD symptoms will return. These benefits are seen in children, adolescents, young adults, and even in older adults.

But it is ultimately up to families, after consultation with their physician, to decide at what point, if any, their child can come off medication. As a clinician, though, I can confidently say that if I had ADHD, I would continue to take medication for the rest of my life. Why?

ADHD does not go away for the vast majority of people.⁶
There are no serious long-lasting side effects from ADHD medications.
The benefits of ADHD medication are highly significant — and the consequences of untreated ADHD are serious.

What Are the Consequences of Untreated ADHD?

ADHD impacts all domains of life, from educational attainment and job performance to social relations and personal finances. Compared to individuals without ADHD, those with ADHD…

[Watch: How ADHD Affects Life Expectancy]

…are less likely to finish high school and college.⁷
…are more likely to experience unemployment.⁷
…have more difficulty paying bills.⁸
…are more likely to experience substance use issues.⁹

I know it is difficult to read this list if you are raising child with ADHD. But there is amazing news. All of these risks are significantly reduced or eliminated when individuals take ADHD medication — especially if they have been treated for ADHD since childhood.

Will ADHD Medication Use Put My Child at Risk?

When some parents ask about long-term medication use, they sometimes really mean to ask one or all of the following questions:

Do ADHD medications harm the brain after long-term use?
Research reveals that long-term ADHD medication use changes the brain – and that all of these changes are clearly positive. ADHD medications are highly effective, both in the short-term and over decades, without any serious or long-term adverse effects.

Will my child become addicted to stimulants and other drugs?
Multiple research studies indicate that the opposite is true; children with ADHD who are treated with stimulants are less likely to abuse drugs.⁹

Can my child grow up to be successful in life?
Absolutely. I have seen some incredibly successful people with ADHD who channel their condition into greatness. It’s also my experience that individuals with ADHD are usually outgoing and communicative, which helps them excel.

Long-Term Effects of ADHD Medication: The Bottom Line

ADHD is a disorder caused by a chemical imbalance in certain areas of the brain important for attending, focusing, learning and memory. There are three lines of evidence that prove ADHD medications are highly effective for treating the condition.

ADHD medications are effective over the short-term, even after a single dose of medication. Children and adults treated with ADHD medications experience a dramatic reduction in hyperactivity and impulsivity with improved ability to focus, attend and learn.
Adults with ADHD are more likely to experience difficulties in all aspects of adult life, but they are far less likely to develop those difficulties if they were treated with ADHD medication as children.
Children with ADHD have three area of the brain that are smaller than in children without ADHD. If a child is not treated with ADHD medication, these brain differences persist into adulthood. Adults with ADHD who were treated with stimulant medication as children no longer exhibit these brain differences.

How to Treat Children with ADHD: Next Questions

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

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View Article Sources

¹Seidman, L. J., Valera, E. M., & Makris, N. (2005). Structural brain imaging of attention-deficit/hyperactivity disorder. Biological psychiatry, 57(11), 1263–1272. https://doi.org/10.1016/j.biopsych.2004.11.019

²Schweren, L. J., de Zeeuw, P., & Durston, S. (2013). MR imaging of the effects of methylphenidate on brain structure and function in attention-deficit/hyperactivity disorder. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 23(10), 1151–1164. https://doi.org/10.1016/j.euroneuro.2012.10.014

³Frodl, T., & Skokauskas, N. (2012). Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta psychiatrica Scandinavica, 125(2), 114–126. https://doi.org/10.1111/j.1600-0447.2011.01786.x

⁴Spencer, T. J., Brown, A., Seidman, L. J., Valera, E. M., Makris, N., Lomedico, A., Faraone, S. V., & Biederman, J. (2013). Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies. The Journal of clinical psychiatry, 74(9), 902–917. https://doi.org/10.4088/JCP.12r08287

⁵Pretus, C., Ramos-Quiroga, J. A., Richarte, V., Corrales, M., Picado, M., Carmona, S., & Vilarroya, Ó. (2017). Time and psychostimulants: Opposing long-term structural effects in the adult ADHD brain. A longitudinal MR study. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 27(12), 1238–1247. https://doi.org/10.1016/j.euroneuro.2017.10.035

⁶Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

⁷Kuriyan, A. B., Pelham, W. E., Jr, Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of abnormal child psychology, 41(1), 27–41. https://doi.org/10.1007/s10802-012-9658-z

⁸Altszuler, A. R., Page, T. F., Gnagy, E. M., Coxe, S., Arrieta, A., Molina, B. S., & Pelham, W. E., Jr (2016). Financial Dependence of Young Adults with Childhood ADHD. Journal of abnormal child psychology, 44(6), 1217–1229. https://doi.org/10.1007/s10802-015-0093-9

⁹McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E. (2016). Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 479–486. https://doi.org/10.1016/j.jaac.2016.03.011