"Dr. Mark Bertin is no A.D.H.D. pillpusher. The Pleasantville N.Y. developmental pediatrician wont allow drug marketers in his office and says he doesnt always prescribe medication for children diagnosed with attention deficit hyperactivity disorder. Yet Dr. Bertin has recently changed the way he talks about medication offering parents a powerful argument. Recent research he says suggests the pills may normalize the childs brain over time rewiring neural connections so that a child would feel more focused and in control long after the last pill was taken. There might be quite a profound neurological benefit he said in an interview. A growing number of doctors who treat the estimated . million American children diagnosed with A.D.H.D. are hearing that stimulant medications not only help treat the disorder but may actually be good for their patients brains. In an interview last spring with Psych Congress Network https an Internet news site for mental health professionals Dr. Timothy Wilens chief of child and adolescent psychiatry at Massachusetts General Hospital said we have enough data to say theyre actually neuroprotective. The pills he said help normalize the function and structure of brains in children with A.D.H.D. so that over years they turn out to look more like nonA.D.H.D. kids. Medication is already by far the most common treatment for A.D.H.D. with roughly  million American children taking the pills  mostly stimulants such as amphetamines and methylphenidate. Yet the decision can be anguishing for parents who worry about both shortterm and longterm side effects. If the pills can truly produce longlasting benefits more parents might be encouraged to start their children on these medications early and continue them for longer. Leading A.D.H.D. experts however warn the jury is still out. Sometimes wishful thinking gives us hope that the impressive shortterm relative benefits of medication over other treatments will persist beyond childhood but I havent seen it said James Swanson director of the Child Development Center at the University of California at Irvine. Dr. Swanson a coauthor of a landmark federally funded study the Multimodal Treatment of Attention Deficit Hyperactivity Disorder said that followup research found overall improvement but no greater longterm benefits after three years for children who were treated with medication compared to those who werent. One possible reason as the report noted was that many children refuse to continue taking medication after a year or so something most parentsof such children well know. Research has shown that the brains of people with A.D.H.D. on average look and function differently than those who dont have the disorder particularly when it comes to processing two important neurotransmitters dopamine and norepinephrine. For most people with A.D.H.D. stimulants can temporarily boost focus motivation and selfcontrol by increasing the availability of these chemical messengers. The question is whether these effects can last once the drugs have left the bloodstream. In arguing for normalization Dr. Wilens cited a major review in the Journal of Clinical Psychiatry https in late  which looked at  brainscan studies. Although the studies had different methods and goals the authors said that together they suggested that stimulants are associated with attenuation of abnormalities in brain structure function and biochemistry in subjects with A.D.H.D. But other A.D.H.D. experts challenge this conclusion. Dr. F. Xavier Castellanos director of research at the New York University Child Study Center called assertions that stimulants are neuroprotective exaggerated adding The best inference is that there is no evidence of harm from medications  normalization is a possibility but far from demonstrated. A.D.H.D. is an exceptionally controversial diagnosis with particular controversy zeroing in on researchers including Dr. Wilens himself and some of the authors of the  report he cited who have received financial support from pharmaceutical firms. In an email Dr. Wilens said he had not received any personal income from the pharmaceutical industry since . As several experts noted a major impediment to determining the longterm impacts of A.D.H.D. medication is that a goldstandard study would require researchers to assign children randomly to groups that either received medication or didnt. Such a practice has been deemed unethical due to the widespread belief that the medication can help struggling children at least in the shortterm. And other research has raised new concerns. One peerreviewed  study https coauthored by Dr. Swanson suggested that the stimulants may change the brain over time so as to undermine the longterm response to the medication and even exacerbate symptoms when people arent taking them. Dr. Peter Jensen the former associate director of child and adolescent research at the National Institute of Mental Health cautioned that parents should not try to force children with A.D.H.D. to take medication when they dont want to adding that most kids dont want to. Dr. Jensen who now heads the REACH Institute a national nonprofit organization concerned with childrens mental health once surveyed  parents of sons and daughters in their s who had been diagnosed with A.D.H.D. asking what made the most difference. Eighty percent of them said Love your child. Help him or her advocate for themselves and find a doc wholl work with you through thick or thin whether you medicate or not Dr. Jensen said. Only a minority of these parents mentioned medication. Katherine Ellison is a Pulitzer Prizewinning former foreign correspondent and author and coauthor of seven books including the forthcoming What Everyone Needs to Know about A.D.H.D. Oxford University Press coauthored with Stephen Hinshaw ViceChair for Psychology Department of Psychiatry University of California San Francisco. Katherine Ellison is an author or coauthor of four books about A.D.H.D. and education including Buzz A Year of Paying Attention."