The No Such Thing as Normal podcast looks at pharmaceutical treatment for ADHD. Photo / 123RF
The use of ADHD stimulant medication has surged in New Zealand. With it comes a new wave of questions about the safety, side effects and benefits of this treatment.
To launch the new season of NZ Herald podcast No Such Thing as Normal, Sonia Gray turns to a topic that has been the subject of scrutiny and misinformation since the 1980s: Pharmaceutical treatment for ADHD.
The season begins not with statistics, but with 11-year-old Tilly taking her morning pill. Over the next hour, the change is audible as the medication begins to take effect.
“It’s more calm now,” Tilly says, describing the shift from a brain where “everything is happening at once” to one that feels manageable.
Tilly is one of more than 65,000 New Zealanders taking ADHD stimulant meds, a number that has grown dramatically in the past 20 years. With recent changes allowing some GPs and nurse practitioners to prescribe, that figure is likely to increase.
Despite that growth, many still feel uneasy. The word “stimulant” still carries weight, and decisions about medication, particularly for children, are not easy ones. Professor Dave Coghill, a child and adolescent psychiatrist, says the concerns are understandable, but the idea that we’re “drugging” kids is misplaced.
“There’s a whole continuum of stimulants from coffee at one end to methamphetamine at the other,” he says.
“The ones we use to treat ADHD are much closer to coffee than they are to the drugs that are abused and misused. The nice thing about the ADHD medications is they can do what we want … And actually, you don’t get a high from them … they’re pretty poor party drugs … they don’t work in that way.”
Coghill has published dozens of research papers on ADHD and his work has helped shape global treatment guidelines. Coghill has published widely on ADHD and helped shape clinical practice internationally. And, for him, the evidence base is clear.
“The stimulant medications for ADHD are among the top performers of any medications we have,” he says. “Not just medications for mental health difficulties, but medications for pretty much anything. They can punch above their weight against most other medications around. And so they are really, really effective.”
Coghill cautions that effectiveness is reliant on careful prescribing and ongoing adjustment to treatment as required.
“These medications are only as good as the people giving them, and the way they’re being given.”
While prescription treatment can be life-changing, it is not a cure-all. Research consistently shows the best outcomes occur when medication is part of a broader treatment plan – one that might include things like environmental adjustments, coaching and school or workplace supports.
For some people with ADHD, effective treatment doesn’t involve prescription stimulants at all. But for many, the right medication can reduce impulsiveness, improve focus, and ease emotional volatility, creating space for children, adults – and families as a whole – to function more consistently.
Professor Coghill says we still don’t fully understand every detail of how these medications work in the brain, but new research is beginning to clarify the picture.
In a recent international study, researchers analysed thousands of brain scans and found something unexpected. Despite ADHD being defined as an “attention disorder”, stimulant medication doesn’t appear to directly target the brain’s attention networks.
Instead, it seems to boost systems linked to alertness and motivation. In practical terms, this suggests that when the brain feels more awake and more willing to engage with a task, sustained attention is a natural consequence.
As ADHD diagnoses rise and access expands, the conversation around the pros and cons of medication is unlikely to fade. With its third season, No Such Thing As Normal steps into that debate with nuance – and the voices of the families living it.
No Such Thing as Normal is an NZ Herald podcast, hosted by Sonia Gray, with new episodes available every Saturday.
Made with the support of NZ on Air.
You can listen to it on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts.