Does psychostimulant treatment in children with ADHD increase later risk of substance use disorder?

Psychostimulants are the first choice medication in children with attention-deficit/hyperactivity disorder (ADHD). Despite the proven high efficacy of psychostimulants, at least in the short term, for ADHD core symptoms, concerns continue to be raised on their adverse effects, including putative increased risk of substance use disorders (SUDs). A recent multicentre, case-control, longitudinal, prospective, European study by Groenman and colleagues found that treatment with psychostimulants in children with ADHD lowered the risk of SUDs in adolescence. However, this finding is at odds with other recent evidence concluding that ADHD children with and without medication treatment history did not significantly differ on any subsequent SUDs rates. In the present paper, we discuss the study by Groenman and colleagues in view of its methodological strengths and limitations, and we suggest possible implications for day-to-day clinical practice.