Contrary to longstanding concerns, stimulant medications commonly prescribed to children and adolescents do not appear to directly cause psychotic experiences, according to a new study published on May 12 in the journal Pediatrics.

Researchers from the University of Edinburgh’s Centre for Clinical Brain Sciences, led by Dr. Kirstie O’Hare, analysed data from the large-scale Adolescent Brain Cognitive Development (ABCD) Study to explore whether there is a causal link between stimulant use and the development of psychotic symptoms in young people.

The study involved 8,391 participants aged 9 to 14, of whom 460 (5.5%) had received prescriptions for stimulant medications—commonly used to treat attention-deficit/hyperactivity disorder (ADHD). These medications have previously raised alarms among some clinicians and parents due to reports of hallucinations, paranoia, or other psychotic symptoms.

In initial unadjusted analyses, researchers observed a 46% increased risk of psychotic experiences in children who had been prescribed stimulants. However, further analysis revealed that children who already exhibited psychotic symptoms were nearly twice as likely to be prescribed stimulant medications later on. This reverse relationship highlighted a more complex dynamic between underlying psychological conditions and treatment.

Using advanced statistical methods known as doubly robust estimation, the researchers ultimately found no evidence that stimulant use directly caused psychotic symptoms. Instead, the findings suggest that individual patient characteristics, such as pre-existing mental health issues, are more likely to explain the observed association.

“Our findings suggest that although there is an increased risk of psychotic experiences in children and adolescents who are prescribed stimulant medication, this increased risk is driven by patient characteristics rather than by stimulant treatment itself,” the authors wrote.

The study offers reassurance to clinicians and families concerned about the psychiatric safety of stimulant medications in young patients.

It underscores the importance of careful patient evaluation and individualized treatment plans, especially in cases where children present with complex mental health profiles.