For Many Kids, ADHD Pills Kick Off A Drug Cascade 勉强发齐，凑合着吧

Children prescribed the medication often wind up on other powerful drugs

By Shalini Ramachandran , Betsy McKay and Tom McGinty

Danielle Gansky was 7 years old when an administrator at her upscale private girls’ school in suburban Philadelphia flagged problems with her academic performance. She was a bubbly and creative kid, but she was easily distracted in class and her schoolwork was sloppy. The school told Gansky’s mother that the girl should see a psychiatrist, who diagnosed her with attention-deficit/ hyperactivity disorder, or ADHD, and prescribed a stimulant. Concerned that Danielle might get kicked out if her focus didn’t improve, her mother broke into tears and agreed. But the pills made Gansky agitated, moody and angry. So another doctor put

 

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her on Prozac.

More pills followed. Over the years, Gansky was always on two and sometimes three or more psychiatric drugs at once. By her late 20s, she had taken 14 different kinds of psychiatric pills.

 

 

None of it ever felt right. The pills dulled her mind and made her irritable or sleepy. But when Gansky complained about the drugs, her doctors would up her dose or try another medication.

“I was living in a body hijacked by the medication,” said Gansky, 29, who is still struggling to wean herself off an antidepressant.

Tens of thousands of kids who take prescription ADHD medication also wind up on other powerful psychotropic drugs—including antipsychotics and antidepressants, studies show. For some of them, the ADHD drugs themselves can be a trigger, according to doctors, patients and psychologists, who say additional medications are often prescribed to manage side effects such as insomnia, despite limited scientific evidence supporting these combinations in young, developing brains.

About 7.1 million American children ages 3 to 17 have an ADHD diagnosis, according to an analysis of 2022 federal data. About half took ADHD medication for it that year, and prescriptions are growing.

 

 

The decision to treat ADHD with medication is often made by desperate parents trying to keep their kids from falling behind or being kicked out of school or daycare, parents and mental health clinicians say. For preschool-age kids, the drugs are often dispensed against pediatric guidelines, which call first for behavioral therapy, a treatment that can be hard to get.

For one in five kids who take them, ADHD drugs are just the beginning. A Wall Street Journal analysis of Medicaid data from 2019 through 2023 shows that children who were prescribed a medication for ADHD were far more likely to take additional psychiatric drugs over the ensuing four years.

The Journal compared about 166,000 children aged 3 to 14 who started on ADHD medications in 2019 to kids who didn’t. The medicated group was more than five times as likely to be on additional psychiatric medications four years later.

 

The data also show that for most children, medications are the first stop in ADHD treatment. Only 37% of the kids newly prescribed ADHD drugs in 2019 had prior behavioral therapy appointments, the Journal’s analysis showed.

The Journal analysis identified nearly 5,000 providers who ordered ADHD drugs for at least 100 children each between 2019 and 2022. On average, they gave additional psychiatric drugs to 25% of their patients. A tiny number ordered the combinations at much higher rates, including 128 who did so for more than 60% of their patients.

Children taking ADHD medicines could be prescribed additional drugs for many reasons, and the Journal analysis didn’t assess what triggered the prescribing. ADHD and other conditions including depression and anxiety often occur together, researchers have found.

Clinical trials have shown ADHD drugs—among them stimulants such as Ritalin and Adderall—are safe and effective for many patients. But less is known about the impact of multiple psychiatric drugs on young children.

 

 

The best scientific evidence suggests that it is very rare for two or more medications in kids to be helpful and there are concerns about safety, because there can be additive adverse effects of different types of medications,” said Dr. Javeed Sukhera, a child and adolescent psychiatrist and chair of psychiatry at the Institute of Living at Hartford Hospital in Connecticut.

Many adults say that ADHD medications vastly improved their lives, and some scientific studies show that medicating reduces risk of other potential problems such as juvenile delinquency and subsequent mental-health disorders.

Still, side effects of the ADHD medications on young children can be severe and unpredictable, sometimes pushing parents to accept additional pills to address them.

‘Like a zombie’

Easton was 3 years old when his daycare provider sent up a flare about his behavior. His inability to sit still was so disruptive that the provider said something had to change fast. His aunt and caregiver, Kymberly Stacks, was at wit’s end, and took Easton to Siskin Children’s Institute, a nonprofit healthcare organization in Tennessee that accepted his Medicaid insurance.

 

 

A physician assistant diagnosed him with ADHD and oppositional defiant disorder, and told Stacks that guanfacine, a blood-pressure medication often prescribed for ADHD, could calm him down enough to stay in daycare. She never disclosed that guanfacine wasn’t approved for toddlers by the Food and Drug Administra tion, said Stacks. (Doctors do prescribe it off-label to young children as an alternative to stimulants). Siskin declined to comment.

On the medication, though, Easton “was like a zombie,” recalled Stacks, who has since adopted the boy, whose biological parents were unable to care for him. Each time the family raised concerns to the physician assistant, she upped his dose.

As the dosage lost effectiveness every few months, he again became aggressive to other children in daycare. He often had to sit in the school director’s office all day.

A new psychiatrist told Stacks he was overmedicated on guanfacine and put him on Abilify, an antipsychotic, which seemed to lessen his defiance. Adding the stimulant Evekeo only made him more hyperactive; Concerta and ProCentra also didn’t help.

Easton has rotated on and off of six psychiatric medications, many times on two at the same time, since age 3.

 

Frustrated, Stacks weaned Easton off all the meds over the summer with his doctor’s blessing. His ADHD tendencies didn’t seem to change much; he seemed like a normal 6-yearold kid who loved to run and play outside. But his outlook darkened: He threatened to stab a child at camp and would laugh when he got into trouble. Doctors put him back on the antipsychotic and he seemed to stabilize but started gaining weight. Once kindergarten started, the phone calls home began again: he wouldn’t stay seated. The school suggested he try stimulants again. In recent weeks, Stacks tried Ritalin (it made him bounce off the walls and act “completely unmedicated”) and now, Quelbree, another ADHD medication.

The Journal’s Medicaid analysis additionally found that patients who started ADHD medications early were more likely to be prescribed additional psychiatric drugs. The youngest children—those between 4 and 6 years old in 2019—were the most likely to be on additional psychiatric medications four years later. The analysis didn’t assess the reasons.

Over 23% of the ADHD group in the Journal’s analysis— more than 39,000 children— were on at least two psychiatric medications at once by 2023. More than 4,400 were on four different drugs simultaneously, with a vast majority of them on an antipsychotic.

Many parents say that effective behavioral therapy can be hard, if not impossible, to find. 她儿子was diagnosed with A D H D in kindergarten at age five. As he fell behind in first grade, his doctor referred him to occupational therapy and a psychologist.

Rogers said she took a day off work and called every single psychologist or therapist she could find, both in-network with her insurance and out-of-network, and “literally nobody was accepting new patients for in-person care in the entire Seattle area. We got zero support because there is such a shortage with behavioral health for pediatrics.”

With no options for therapy, she started her son on the Adderall dose he was prescribed, she said. The medication has generally helped her 8-yearold’s impulse control, but he still struggles with emotional ups and downs at times.

 

 

More than 42% of children aged 3 to 5 are prescribed medication within 30 days of an ADHD diagnosis, meaning doctors may be directing parents to drugs before giving behavioral therapy a chance to work, according to a 2025 Stanford University paper. That’s despite American Academy of Pediatrics guidelines advising against starting with medication for those ages, instead recommending behavioral interventions first.

The Journal’s analysis showed that about one-third of 4-year-olds who were prescribed ADHD drugs in 2019 were taking additional psych medications four years later.

Rogers says she gave up waiting, with no end in sight, for a therapy appointment for her son. She now asks ChatGPT what to say when she needs direction in tough moments, and it provides scripts to her based on ADHD parenting advice.

Real guinea pig’

When he was 11, Tyrell Cooley was taking a very high dose of Concerta, along with guanfacine, sometimes used as an adjunct to a stimulant, at night. He had been impulsive, couldn’t sit still and hated school—his stomach hurt every morning when he went. “I used to get in trouble a lot in school,” Tyrell recalled. “I had a detention every other day.”

He was frequently anxious and sullen, a result of trauma from his birth mother’s drug use, according to his adoptive mother, Mallory Cooley. He was medicated not to treat the underlying psychiatric condition, his mother said, but to keep him calm in school.

Tyrell hated medication. He had little energy or appetite. “It made me feel drained overall,” he said. “I didn’t like talking to people. I couldn’t bring up the energy in my body to talk.”

The Cooleys spent a month searching for a family therapy program for Tyrell, who is on Medicaid. They wanted one that would address the trauma of an unstable childhood they felt was driving his angry, impulsive behavior. Twice a week for about a year a therapist came to their home in Clinton, Miss., and Tyrell’s school. They worked with Tyrell on how to control his anger and impulsiveness and how to talk with people and trust them. The therapist met with the family to talk about how to help Tyrell. The Cooleys gradually weaned Tyrell off his medications, feeling that the pills were fueling some of the wild behavior and masking problems that were better dealt with in talk therapy.

Tyrell, now 15, said he feels much better off the medication and after the therapy. “I’m more connected with people,” he said. His mother said he “talks 24/7 all day every day” and while he can be hyperactive, “I do feel he can control himself.”

Nancy Gansky lives with regret over her decision to give her daughter medication. When Danielle was 11, doctors added Wellbutrin and guanfacine to her medications briefly. Then Ativan or Xanax in her teens. An antipsychotic, risperidone, when she was 15 made her sick and put her in the hospital.

When Danielle was 16 years old and on Prozac, Concerta, and Ativan, she felt dizzy and so tired she couldn’t get up in the morning. She was late so often for school that administrators said she might have to repeat some classes and asked for a doctor’s note to explain the tardiness. The doctor wrote the note—and raised her Prozac dose. More antipsychotics came in her 20s.

 

Gansky quit taking a stimulant regularly in high school, but remains on an antidepressant, fluvoxamine. She has tried to stop it twice, but fell into painful withdrawals— leading to more medications, including antipsychotics Seroquel and Zyprexa, which prompted symptoms of their own, like shaking and emotional numbness. She has had to go to the emergency room a few times, her body shaking. Her brain fog and some other symptoms remain.

She lives with her parents and had to pull out of a master’s program in school counseling. Her experience with withdrawal from her antidepressant led her to push for change as an adviser to a new advocacy group and to attend events held by the Make America Healthy Again movement, led by Health and Human Services Secretary Robert F. Kennedy Jr.

The decades of medication, Gansky said, “changed my brain.” “I feel like I am the real long-term study that the pharmaceutical companies have neglected to do,” she said. “I’m the real guinea pig.”