Hallucinations can happen on stimulants, and usually resolve when you stop the drug
STUDY: Chrétien B et al, J Child Adolesc Psychopharmacol 2026;36(3):121–127
STUDY TYPE: Retrospective pharmacovigilance disproportionality analysis
FUNDING: Independent
Background
Methylphenidate is the first-line medication for ADHD in children, but package inserts from every major manufacturer warn that it can cause hallucinations. This study estimates how common this is.
The Study
Researchers mined the World Health Organization’s global pharmacovigilance database of over 36 million adverse drug reaction reports, comparing psychotic symptoms in children and adolescents (ages 5–17) on methylphenidate versus those on non-stimulants for ADHD medications (atomoxetine, guanfacine, clonidine, and others). Among 46,233 reports, 1,992 involved psychotic symptoms and 1,250 involved hallucinations specifically.
Methylphenidate was associated with a 27% higher rate of psychotic symptoms across all ages (adjusted reporting odds ratio 1.27), with the signal driven by the younger children’s group, ages 5–11 (adjusted reporting odds ratio 1.35)
Most cases involved hallucinations specifically, with adjusted odds were 1.35 overall and 1.43 in younger children. The most common type of hallucination was visual (43%), followed by auditory (31%). Over half were classified as serious.
When methylphenidate was stopped or the dose was reduced, symptoms resolved in 89% of cases, versus 12% in those where no change was made.
Practice Implications
- Stimulants are effective for significant ADHD in children, but ADHD symptoms can also be the first presentation of disorders like schizophrenia and bipolar.
- This study focused on methylphenidate because it is more common worldwide. Other studies tell us that amphetamines (Adderall, Vyvanse) have a higher risk of psychosis.
- Watch for psychotic symptoms on stimulants and lower or stop the dose if they occur.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
