In conclusion, although outcomes from the Multimodal Treatment Study of ADHD indicate that treatment with methylphenidate conferred the largest benefits for ADHD,48 concern remains over potential adverse effects (eg, effects on height49) of treatment with stimulant medication. The present study conducted a rigorous review and update on the empirical literature, prioritizing methodologically rigorous designs (ie, longitudinal) to characterize the association of treatment with stimulant medication and later substance outcomes. Nonhuman animal evidence suggests that adolescent exposure to low-doses methylphenidate resulted in greater cocaine self-administration.10 However, the ability to draw parallels to human clinical literature remains difficult given the méthodologie and developmental differences across species.50 The present findings do not support the sensitization hypothesis7,34 as an additional factor in the decision-making process in the treatment of ADHD, although, importantly, the present findings do not support the role of a protective effect for medication treatment for ADHD in both substance use initiation or substance use disorders across a number of substance types. Future work remains to better understand the role of stimulants, if any, on substance use outcomes.
