Long-term effects of in utero ADHD medication exposure

The use of ADHD medication during pregnancy is on the rise, and the issue or whether ADHD medication has long-term effects on offspring has been raised. 

ADHD is a typical childhood neurodevelopmental disorder. It is usually diagnosed in childhood and often persists into adulthood. A child with ADHD may have difficulty paying attention, controlling impulsive behaviors (may act without considering the consequences) or be excessively active.

Some children have difficulty focusing and behaving at some point in their lives. Despite this, children with ADHD do not simply grow out of these behaviours. As long as the symptoms persist, they can be severe and cause difficulties at school, at home or with friends.

A child with ADHD might [1]:

  • Daydream a lot
  • Forget or lose things a lot
  • Have a hard time resisting temptation
  • Have trouble taking turns
  • Have difficulty getting along with others
  • Make careless mistakes or take unnecessary risks
  • Squirm or fidget
  • Talk too much

Depending on the individual’s strongest symptoms, ADHD manifests in three different ways:

  • Predominantly Inattentive Presentation: The individual has trouble organising or completing tasks, paying attention to details or following instructions. The person needs to be more focused and remember the details of daily routines.
  • Predominantly Hyperactive-Impulsive Presentation: Fidgeting and talking are expected behaviours. Sitting still for an extended period (for instance, during a meal or while doing homework) is difficult. It is common for small children to run, jump or climb constantly. There is a feeling of restlessness and impulsivity in the individual. An impulsive person may interrupt others often, grab things from them or speak inappropriately. The person needs help with waiting their turn or listening to directions. Accidents and injuries are more likely to occur in people with impulsiveness.
  • Combined Presentation: Both types of symptoms are present equally.

As symptoms change over time, the presentation may also vary.

Scientists are studying ADHD to manage and reduce its chances by better understanding its cause/s and risk factors. Genetics play an important role in ADHD, but the cause/s and risk factors are unknown. Recent studies link genetic factors with ADHD.

Apart from genetics, research is looking into the following:

  • Alcohol and tobacco use during pregnancy
  • Brain injury
  • Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
  • Low birth weight
  • Premature delivery

Despite popular belief, research does not support the idea that ADHD is caused by overeating sugar, watching too much television, parenting or social and environmental factors like poverty. Certain things, including these, may worsen symptoms, especially in some individuals. The evidence is insufficient to conclude that these are the main causes of ADHD.

There are several steps involved in determining whether a child has ADHD. It is impossible to diagnose ADHD with a single test since many other problems can have similar symptoms, such as anxiety, depression, sleep problems and learning disabilities.

A medical exam, including hearing and vision tests, is conducted to rule out other problems with symptoms like ADHD. When diagnosing ADHD, parents, teachers and sometimes even the child is asked to rate ADHD symptoms and provide a history of the child.

Typically, ADHD is treated with a combination of behavior therapy and medication. Behaviour therapy, especially training for parents, is recommended as the first line of treatment for preschool-aged children with ADHD. 

A child’s and family’s needs can determine what works best. Good treatment plans will include close monitoring, follow-ups and making changes, if needed, along the way.

In a study published on February 3, 2023, researchers investigated whether long-term exposure to ADHD medication during pregnancy would negatively impact offspring’s growth and development [2]. During the period 1998 to 2015, 1,068,073 singletons in the Danish national registers were monitored until any developmental diagnosis, death, emigration or December 31, 2018. 

Cox regression was used to compare children of mothers who continued ADHD medication (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine, modafinil, atomoxetine, clonidine) during pregnancy with children whose mothers discontinued the medication before pregnancy. Neurodevelopmental psychiatric disorders, impairments in vision or hearing, epilepsy, seizures, or growth impairment during childhood or adolescence were the primary outcomes.

There were 898 children exposed to ADHD medication during pregnancy compared with 1270 children whose mothers discontinued the medication before conception. After adjusting for the mother’s demographic and psychiatric characteristics, the offspring had no increased risk of any developmental disorder.

No increased risk was found in the analyses of negative controls or sibling controls. Offspring’s neurodevelopment and growth are not affected by antenatal ADHD medication exposure. The findings provide reassurance for pregnant women with ADHD who depend on ADHD medications for daily functioning.

In March 2021, a study looked into the same issue, as ADHD medications were being used steadily by adults of childbearing age and pregnant women[3]. The study used Quebec Pregnancy/Child Cohort (QPC) data. 

Between January 1, 1998 and December 31, 2015, the QPC collected data on all pregnant mothers covered by the provincial prescription drug insurance in Quebec and their children. Mothers and children are also prospectively recorded after the end of pregnancy. A long-term effect of in utero ADHD medication use on offspring’s ADHD occurrence has not been studied.

According to findings, in utero exposure to ADHD medications does not increase the risk of ADHD in children. In the sub-cohort of ADHD pregnant women and sibling analysis, the association was not statistically significant.

[1] https://www.cdc.gov/ncbddd/adhd/facts.html
[2] https://www.nature.com/articles/s41380-023-01992-6
[3] https://www.sciencedirect.com/science/article/abs/pii/S0924977X21000055

Photograph: Freepik
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