Psychopharmacology (2021) 238:3533–3541

https://doi.org/10.1007/s00213-021-05970-0

ORIGINAL INVESTIGATION

Effects of stimulant medication on divergent and convergent thinking

tasks related to creativity in adults with attention‑deficit hyperactivity
disorder
Molly McBride1 · Carrina Appling2 · Bradley Ferguson2,3,4 · Alyssia Gonzalez5 · Andrea Schaeffer1 · Amanda Zand1 ·
David Wang6 · Alinna Sam1 · Eric Hart4 · Aneesh Tosh7 · Ivan Fontcha8 · Sophia Parmacek9 · David Beversdorf1,2,3,4,10

Received: 1 April 2021 / Accepted: 19 August 2021 / Published online: 3 September 2021
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021

Abstract
Rationale  Common pharmacological treatments for attention-deficit hyperactivity disorder (ADHD) are central nervous
system stimulants acting as norepinephrine-dopamine reuptake inhibitors. The noradrenergic and dopaminergic systems
have been shown to impact performance on tasks assessing creativity. Some previous studies suggest higher performance on
creativity tasks in ADHD. Stimulant medication has been shown to differentially impact creativity in those without ADHD.
However, the full range of effects of stimulant medication on creativity in those with ADHD is not known.
Objectives  This study examined the effects of stimulants on convergent and divergent tasks associated with creativity in
adults with ADHD.
Method  Seventeen adults diagnosed with ADHD who were prescribed stimulant medication attended two counterbalanced
sessions: one after taking their prescribed stimulant dose and one after the dose was withheld. Participants completed
convergent problem-solving (anagrams, Compound Remote Associates) and divergent generative (letter/semantic fluency,
Torrance Test for Creative Thinking (TTCT)-Verbal) tasks.
Results  There was a significant increase in words generated on the semantic fluency task for the stimulant session. Addition-
ally, significant increases were found in the stimulant session for originality, flexibility, and fluency scores on the TTCT.
Stimulant medication did not have an effect on any of the problem-solving tasks.
Conclusions  Stimulant medication enhanced verbal fluency in adults with ADHD but had no effect on convergent abilities.
Furthermore, stimulants enhanced fluency, flexibility, and originality scores on the TTCT. Therefore, stimulants appear to
have positive effects on divergent task performance in adults with ADHD, but not convergent tasks. This finding warrants
further studies into the specific roles of norepinephrine and dopamine in this effect.

Keywords  Stimulant medication · Attention-deficit hyperactivity disorder · Creativity · Dopamine · Norepinephrine

5
* David Beversdorf California State University, San Marcos, CA, USA
beversdorfd@health.missouri.edu 6
School of Medicine, Emory University, Atlanta, GA, USA
Bradley Ferguson 7
Department of Child Health, University of Missouri,
fergusonbj@health.missouri.edu
Columbia, MO, USA
1 8
School of Medicine, University of Missouri, Columbia, MO, Department of Biological Sciences, University of Missouri,
USA Columbia, MO, USA
2 9
University of Missouri Interdisciplinary Neuroscience Department of Psychological Sciences, University
Program, Columbia, MO, USA of Missouri, Columbia, MO, USA
3 10
Thompson Center for Autism & Neurodevelopmental Departments of Radiology, Neurology, and Psychological
Disorders, University of Missouri, Columbia, MO, USA Sciences, University of Missouri, Columbia, USA
4
Department of Health Psychology, University of Missouri,
Columbia, MO, USA

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3534 Psychopharmacology (2021) 238:3533–3541

Introduction generate ideas that are both novel and useful, is associated
with a decreased signal-to-noise ratio in the brain that results
Attention-deficit hyperactivity disorder (ADHD) is charac- in defocused attention (Beversdorf 2019; Heilman et al. 2003;
terized by a behavioral pattern of inattention, hyperactiv- Farah et al. 2009). While creativity is a valued attribute in
ity, and impulsivity that is often identified in childhood and society, defocused attention, impulsivity, and hyperactivity
leads to disruptions in the classroom as well as difficulty symptoms are often the targets of pharmacotherapy (Randles
with schoolwork, which can continue to impact function- and Ballantyne 2018; Piper et al. 2018).
ing later in life (American Psychiatric Association 2013). Routinely prescribed medications for ADHD are psy-
Reduction in attention is the hallmark symptom of ADHD. chostimulants, such as methylphenidate or combination
Hypoactive regulatory regions in the brain (e.g., frontal amphetamine salts (Wolraich et al. 2019). These common
limbic, frontal striatal, thalamus, dorsal anterior cingulate psychopharmacological stimulant therapies for ADHD
cortex, striatum regions, amygdala, ventrolateral, and dor- function as norepinephrine-dopamine reuptake inhibitors,
solateral prefrontal cortex), which are critical for regulation which prevent the reuptake of dopamine and norepinephrine
of emotion, impulse control, and behavior are observed in into the presynaptic neuron. Specifically, stimulants block
ADHD (Dickestein et al. 2006; Nigg and Casey 2005). How- norepinephrine and dopamine transporters, thus increasing
ever, a recent meta-analysis revealed a more focused set of concentrations of these neurotransmitters in the synaptic
findings including atypical reactivity of the left pallidum/ cleft, resulting in increased neurotransmission (Volkow
putamen on task-based functional neuroimaging studies and et  al. 2001). Without the use of stimulants, individuals
a male-only decrease in left inferior frontal gyrus reactiv- with ADHD have lower levels of dopamine, as indicated by
ity, with the findings possibly limited by the heterogeneity higher dopamine transporter availability on positron emis-
of samples across studies (Samea et al. 2019). Functional sion tomography (PET), compared to people without ADHD
impairments of the dopamine and norepinephrine neu- (Krause 2008), and lower norepinephrine has also been
rotransmitter systems are believed to be associated with suspected, but not borne out by norepinephrine transporter
ADHD (del Campo et al. 2011). Dopamine is critical in the PET studies (Vanicek et al. 2014). Dopamine receptor-ligand
hypofunctioning mesolimbic and mesocortical pathways studies with PET suggested decreased tonic release at rest
associated with ADHD for impulse control, altering behav- in the right caudate but increased phasic release during
ior in a “failure to inhibit” fashion (Sagvolden et al. 2005). task performance (Badgaiyan et al. 2015), consistent with
ADHD is also associated with defocused attention related to the hypothesis of fronto-subcortical dysfunction as part of
altered “top-down” regulation of noradrenergic activation, the pathophysiology of ADHD (Genro et al. 2010). With
which impacts cortical arousal and executive functioning the mechanism of action resulting in increased intrasyn-
(Karalunas et al. 2014). aptic dopamine as well as norepinephrine, stimulants help
Despite the adverse symptoms experienced by those with overcome inhibitory control deficits, focus attention, and
ADHD, there is evidence to suggest ADHD may confer improve alertness in those with ADHD (Santosh and Taylor
some cognitive benefits. An international study investigated 2000). Interestingly, both the dopaminergic and noradrener-
the abilities of individuals with ADHD and found elevated gic systems have also been shown to differentially influence
levels of energy, determined effort, creativity, and selective creativity (Flaherty 2005; Zabelina et al. 2016; Alexander
hyper-focus to be the most consistent strengths associated et al. 2007; Beversdorf 2019).
with ADHD (Mahdi et al. 2017). Other studies have sup- Divergent and convergent thinking are aspects of crea-
ported that individuals with ADHD have enhanced creative tivity and are thus often found in creativity assessments,
abilities relative to those without ADHD (White and Shah occasionally with discordant results (Goldschmidt 2016).
2006). For example, verbal creativity, flexibility, and origi- Divergent and convergent tasks are also considered aspects
nality scores have been shown to be significantly higher in of cognitive flexibility (Heilman et al. 2003; Beversdorf
adolescents with ADHD compared to those without ADHD 2019). There are several types of tasks that are used to
(Verma and Kushwaha 2013). However, reviews suggest assess creativity; some focus on the convergent tasks
these results are mixed (Hoogman et al. 2020). As a result (Bowden and Jung-Beeman 2003), where a participant must
of this potential strength in creativity with ADHD, however, consider a wide range of possible solutions but for which
many patients have been hesitant to take ADHD medications the task requires a convergence on one single, albeit chal-
for fear of repressing their creativity (Brinkman et al. 2012; lenging, answer, while others focus on the divergent tasks
Kovshoff et al. 2016). (Skalicky et al. 2017; Ritter and Ferguson 2017; Harada
Inattention in ADHD may facilitate divergent thinking, 2020), where a participant must generate creative responses
which is considered essential to the creative process (Gabora, in an open-ended manner. As described above, creativity
2010; Boot et al. 2017; 2020). Creativity, or the ability to has also been associated with both noradrenergic and dopa-
minergic activity. The noradrenergic system is well known

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for its role in arousal, but performance on unconstrained ADHD, of particular interest as data suggests distinct neu-
cognitive flexibility (tasks where participants are asked to ral mechanisms underly convergent and divergent think-
generate a response from a very broad solution set), such ing (Zhang et al. 2020). Regardless of the mixed findings
as the previously described convergent tasks (e.g., perfor- previously, with the effect of the dopaminergic system on
mance on Compound Remote Associates and anagrams), divergent task performance (Flaherty 2005; Zabelina et al.
tends to be impaired by increased noradrenergic activity 2016), we would predict an enhancement of performance
(Alexander et al. 2007). On the other hand, performance on on the divergent tasks in our study, but with the effects of
constrained flexibility tasks (where participants are asked the noradrenergic system on convergent task performance
to flexibly change rules in choosing from between a limited (Beversdorf 2019), it is possible that we may see decreased
set of options) has been found to improve with increased performance on the convergent tasks in our findings. This
noradrenergic activity (Aston-Jones and Cohen 2005). area of study is especially important as defocused attention
Spontaneous eye blink rate can be used as a behavio- is associated with both ADHD and creativity, and many
ral marker of dopaminergic activity (Groman et al. 2014). people with ADHD are prescribed stimulant medication
Interestingly, an inverted U-shaped relationship has been which may impact their creative endeavors. Therefore, a
found between spontaneous eye blink rate and perfor- broader understanding of the effects of stimulants on crea-
mance on prominent measures used for assessing creativ- tivity in people with ADHD is critical. This study exam-
ity, including the Alternative Uses Task and the Remote ined the full range of effects of stimulant medication on
Associates Task (Chermahini and Hommel 2010). High- verbal creativity, verbal fluency, and problem-solving in
lighting the role of catecholamines in creativity, with the adults with ADHD. This is of particular importance given
suggested role of the noradrenergic system impacting con- patients’ concerns regarding the potential for ADHD medi-
vergent task performance, and the dopaminergic system cation repressing their creativity (Brinkman et al. 2012;
impacting divergent task performance (Beversdorf 2019), Kovshoff et al. 2016).
the effects of stimulants on creativity in individuals with-
out ADHD depend on novelty-seeking personality char-
acteristics of the participants, with stimulants increasing Materials and methods
creativity in those with lower novelty seeking but decreas-
ing creativity in participants with higher novelty seeking Participants
(Gvirts et al. 2017). On divergent and convergent tasks
associated with creativity, dextroamphetamine/ampheta- Recruitment for the study occurred through an advertise-
mine enhances scores of low performing individuals, but ment which was included in a weekly mass email from the
has no effect on high performing adults without ADHD University of Missouri to all in-house faculty and students.
(Farah et al. 2009). Other recent work has suggested that All participants were native English speakers (i.e., English
methylphenidate does not impair divergent or convergent as the first language given the verbal nature of the tasks),
task performance in individuals without ADHD (Baas 18 years of age or older, had a current diagnosis of ADHD
et al. 2020). Stimulant prescriptions doubled between 2006 from a physician, were prescribed stimulant medication to
and 2016 in the USA (Piper et al. 2018), yet questions treat their ADHD symptoms, and were taking this medica-
remain about the effects of stimulant medication on crea- tion as instructed. Participants who had other psychological
tivity in adults with ADHD. Studies comparing individuals or medical diagnoses (that may alter test performance), had
with ADHD on medication to different individuals with a known history of dyslexia (as this may interfere with the
ADHD off medication did not reveal significant differences performance on the verbal tasks), took medications other
in creativity measures (Boot et al. 2017). One crossover than stimulants for ADHD, or participated in heavy exercise
study suggested decreases in aspects of divergent task or caffeine consumption during the mornings of the study
performance with methylphenidate in ADHD (González- were excluded. Birth control and nonstimulant allergy medi-
Carpio Hernández and Serrano Selva 2016), another small cation were considered permissible. Two separate session
study showed lower performance on only one aspect of dates were scheduled for each participant with the under-
divergent task performance with methylphenidate in standing that they would be required to either take or with-
ADHD (Swartwood et al. 2003), others showed improved hold their prescribed stimulant prior to each session (A or B,
performance on divergent tasks with methylphenidate in in counterbalanced order). All participants provided written
ADHD (Solanto and Wender 1989; Douglas et al. 1995), informed consent, and the University of Missouri Health
and one showed no effect (Funk et al. 1993). To our knowl- Sciences Institutional Review Board approved the study.
edge, and according to a recent review (Hoogman et al. Seventeen participants met the criteria and were invited to
2020), the effects of stimulants have not been examined attend two counterbalanced sessions: one session where they
on both convergent and divergent tasks simultaneously in took their prescribed dose of stimulant medication at least

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3536 Psychopharmacology (2021) 238:3533–3541

30 min prior to starting the session and one where they with- and the average between the raters was used to represent the
held their prescribed dose of stimulant medication until after dependent variable. Participant activity scores were calcu-
the study visit. Information regarding medication type, dos- lated individually, and these scores were averaged to form a
age amount, and the last dose time was acquired at the start cumulative score for flexibility, fluency, and originality for
of the session to ensure protocol compliance. The patient each condition.
confirmed the medication type and dosage by either send-
ing a photograph of their medication bottle to the study staff Letter and category fluency tasks
via email or by bringing the bottle to the initial study visit.
To examine the effect of stimulants on cognitive tasks, Participants were given one of two sets of three letters (e.g.,
participants completed one of two versions of the follow- F, A, S) at each visit and asked to give as many words that
ing cognitive assessments at each session administered in a begin with that letter, without using proper nouns or the
counterbalanced manner. same root words with different endings, to test letter flu-
ency (Strauss et al. 1998). A maximum time of 60 s was
Cognitive tasks allowed for each letter. A total number of answers given
were recorded. For semantic fluency, participants were given
Torrance Test of Creative Thinking one of two sets of three categories (e.g., animals, clothes,
vegetables) at each visit and asked to name as many words
Participants completed the Torrance Test of Creative Think- as possible that fit into that category (Strauss et al. 1998). A
ing (TTCT)-Verbal, which involves prompts that test diver- maximum time of 60 s was allowed for each category. The
gent thinking and other problem-solving skills to measure total number of distinct words given was recorded.
verbal creativity (Torrance 1974). For both sessions, a ver-
sion (A or B) of the TTCT was completed. Participants were Convergent tasks
given a picture with instructions for each task and then asked
to write down a list of answers within the time allotted for Anagrams  Participants received one of two sets of 20 ana-
each of six activities in the TTCT (activities one through grams at each visit (14 5-letter anagrams and six 7-letter
five and seven). The activity categories were ask-and-guess, anagrams), with a maximum of 2 min allowed for each ana-
understanding the context, actions occurring in a scene, gram. For example, the correct response to “OGRF” would
possible consequences of actions, product improvement, be “FROG.” A number of anagrams solved, solution latency
unusual uses for an item, and effects of an impossible situ- (with failed anagrams recorded as 120 s), and natural log
ation. Participant responses were evaluated using the scor- for each solution latency were recorded, as with previous
ing guide (Torrance 1974) on three scales: fluency, flexibil- research from our laboratory (Campbell et al. 2008).
ity, and originality. Fluency is the total number of relevant
answers given. Originality is the number of uncommon Compound Remote Associates  Participants were given one
answers, where each response is counted towards the score of two sets of 18 Compound Remote Associates (CRA) tasks
if the answers were not found on the exclusion list. Flex- at each visit to assess semantic network flexibility in verbal
ibility is measured using the 16 given flexibility categories, problem-solving (Bowden and Beeman 1998, 2003). Par-
awarding one point for each category used. For example, ticipants were given a card with a list of three words and
on the “ask-and-guess” activity on version A, a drawing of asked to generate a fourth word that would form a compound
an elf-like individual staring at a reflection in the water is word with those words listed on the card. For example, the
presented, and the participant is instructed to ask questions answer to BAG/PLANE/PORT would be AIR. A maxi-
regarding what is going on in the picture, beyond what is mum of 7 s was allowed for each card (with failed CRAs
already observable. The total number of relevant answers recorded as 7 s). A total number of items solved and solution
given is the fluency score. The number of answers given that latency were recorded, as with previous research from our
are not on a pre-determined list of common responses, cat- lab (Campbell et al. 2008).
egorized as “zero-originality” responses (such as “does he
want to drink the water?” “What kind of hat is he wearing?” Brief intellectual assessment
or “Is he looking for something?”), is the originality score.
The flexibility score is how many different categories are The North American Adult Reading Test (NAART) was
covered across the participant’s responses, such as questions administered during the stimulant medication session. The
regarding the character in the picture, questions regarding NAART was used as a control variable to account for the
the clothes the character is wearing, and questions regarding potential effects of verbal intelligence on cognitive task per-
emotions associated with the scene, from a pre-determined formance (Blair and Spreen 1989).
list of categories. Two independent raters scored all items,

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Psychopharmacology (2021) 238:3533–3541 3537

Statistical analysis A

100

*
Averages and standard deviations were calculated for the
NAART. Analysis of the TTCT was conducted using a
90
paired t-test to compare scores from the drug and no drug
conditions. In addition, as above, the anagram data was log
transformed to correct for skewness. A comparison of ver-

Originality Score
80
sion A and version B of the TTCT was done to check for
score differences noncontingent to the drug condition, and
70
none was found. A paired t-test was also used on anagrams,
the Compound Remote Associates, and the letter/category
fluency tasks. 60
No Drug Drug
*p<0.05; **p<0.01

Results B

The 17 participants ranged in age from 20 to 43 (mean 180

age (years) = 27.88 ± 6.65 standard deviation (SD), 10 170

160
females and seven males), with an average estimated IQ
150
(NAART-VIQ 108.47 ± 6.12, NAART-PIQ 109.85 ± 2.89,
140
NAART-FSIQ 110.07 ± 5.37). Prescribed stimulant *
Fluency Score
130
medication type varied. Ten participants took a combi- 120
nation of amphetamine and dextroamphetamine (average 110
23.5 mg ± 7.09 mg), five took lisdexamfetamine dime- 100
sylate (average 44 mg ± 10.2 mg), one took methylpheni- 90
date (36 mg), and one took dexmethylphenidate (10 mg). 80
70
60
No Drug Drug
Verbal creativity *p<0.05; **p<0.01

Stimulants significantly increased originality scores C

(83.76 ± 35.12) on the verbal TTCT as compared to the

no drug session (75.23 ± 28.78), t(16) = 2.08, p = 0.027 **
54
(Fig.  1A; Table  1). Significantly better performance
was found on fluency between the drug (110.0 ± 43.58) 52

as compared to the no drug (98.38 ± 36.86) condition 50

t(16) = 2.30, p = 0.018 (Fig. 1B). Flexibility scores with
Flexibility Score

drug (49.85 ± 10.08) compared to no drug (45.97 ± 9.49) 48

also were significantly better on the TTCT in this within- 46

participant design t(16) = 2.89, p = 0.005 (Fig. 1C). The
44
effect sizes for all of these (Cohen’s d) were in the small
to medium range (Table 1). Correlation for scores between 42

raters was at least 0.85 for each individual score within the
40
TTCT aside from the originality score, which was lower at No Drug Drug
0.65. However, to minimize the effects of rater variability on *p<0.05; **p<0.01

our target outcomes, we ensured that the same rater was used
across the two visits for each participant. Two participants
Fig. 1  Effects of stimulants on the scales of the Torrance Test of Cre-
did not complete activity seven of the TTCT. ative Thinking-Verbal. A Originality score comparison between the
no drug and stimulant drug conditions. B Fluency scores from the no
drug and drug conditions. C Flexibility scores from the no drug and
drug conditions. Error bars represent SEM; *p < .05, **p < .01

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3538 Psychopharmacology (2021) 238:3533–3541

Table 1  A paired t-test compared Torrance Test of Creativity-Verbal difference between stimulant (2.34 ± 0.49) and no stimulant
scores of originality, fluency, and flexibility between the drug and conditions (2.38 ± 0.47), t(16) = 0.038, p = 0.51.
no drug condition, showing t-score, degrees of freedom, p-value,
Cohen’s d effect size
Main effects for divergent and convergent tasks
Drug-no drug t df p Cohen’s d

Originality 2.08 16 .027* .296 Since multiple measurements were performed during this
Fluency 2.30 16 .018* .325 evaluation, correction for multiple comparisons would leave
Flexibility 2.89 16 .005* .408 only the flexibility scores on the TTCT as a significant result
after Bonferroni correction. However, as the primary ques-
*
 p < .05 tion was regarding stimulant effects on convergent and
divergent tasks, we performed MANOVA across all diver-
gent tasks (TTCT measures and fluency task performance)
68 and across all convergent tasks (CRA solution latency and
66 ** natural log of anagram latency). MANOVA across divergent
64
62
tasks revealed a significant beneficial effect of stimulants on
60 task performance across tasks (F(5,12) = 3.22, P = 0.045).
Semanc Fluency Score

58 MANOVA across convergent tasks did not reveal a signifi-

56
54
cant effect of stimulant on task performance (F(2,13) = 0.24,
52 P = 0.79). Furthermore, age and gender were entered as fac-
50 tors for the divergent task performance to examine for any
48
46
potential effects. No significant interactions were found for
44 age (F(5,10) = 0.38, P = 0.91) or gender (F(5,10) = 0.25,
42 P = 0.97). However, it should be noted that, as predomi-
40
38
nantly college students were recruited, only 6 participants
No Drug Drug
were over the age of 30, limiting the range for this factor.
*p<0.05; **p<0.01

Fig. 2  Semantic fluency score comparison of means of the drug and

Discussion
no drug condition. Error bars represent SEM; *p < .05, **p < .01
ADHD is characterized by inattention, impulsivity, and
hyperactivity, and it is associated with alterations in
Letter and category fluency fronto-subcortical function and altered dopaminergic
activity, particularly in the caudate, compared to those
There was no significant difference between stimulant without ADHD (Dickestein, et al. 2006; Aron and Poldrack
(42.47 ± 9.66) and no stimulant (41.24 ± 11.13) for the let- 2005; Sagvolden et  al. 2005; Krause 2008; Badgaiyan
ter fluency task, t(16) = 0.61, p = 0.55. However, there was et al. 2015; Genro et al. 2010). ADHD is also associated
a significant difference between stimulant (61.41 ± 11.42) with higher performance on creativity tasks compared to
and no stimulant (55.94 ± 12.85) for the category (semantic) individuals without ADHD (Mahdi et al. 2017; White and
fluency task, with stimulants improving performance on this Shah 2006; 2011; Verma and Kushwaha 2013), although
task, t(16) = 3.27, p = 0.005 (Fig. 2). the findings are mixed in this regard (Hoogman et  al.
2020). Dopamine and norepinephrine reuptake inhibitors
increase neurotransmission of these catecholamines and
Convergent tasks are often prescribed to treat ADHD (Chermahini and
Hommel 2010; Santosh and Taylor 2000; Wolraich et al.
There was no significant difference between stimulant 2019). Evidence suggests norepinephrine and dopamine
(34.54 ± 14.47) and no stimulant (32.67 ± 12.58) for the have varied effects on creativity (Beversdorf 2019). In
average solution latency of anagrams, t(16) = 0.68, p = 0.74. individuals without ADHD, stimulant medications have
There was also no significant difference between stimulant shown differing effects on creativity depending on baseline
(5.7 ± 0.37) and no stimulant (5.86 ± 0.49) for the average levels of creativity (Gvirts et al. 2017).
latency to solve Compound Remote Associate problems, Our findings indicate an overall positive effect of stimu-
t(14) = 0.43, p = 0.33. In addition, as with our previous lants on divergent task performance in individuals with
work (Campbell et al. 2008), the log transform of the solu- ADHD, with small to medium effect sizes, consistent with
tion latency for the anagrams task revealed no significant some previous studies (Solanto and Wender 1989; Douglas

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Psychopharmacology (2021) 238:3533–3541 3539

et al. 1995; Hoogman et al. 2020). Stimulants significantly apparent observed beneficial effect of stimulants on diver-
improved performance on the semantic fluency tasks and gent task performance in this study. Furthermore, partici-
all three measures (fluency, flexibility, and originality) on pants were aware of their drug condition during the assess-
the TTCT in adults with ADHD, thus revealing a signifi- ment, which could affect performance. Subsequent studies
cant positive effect on divergent task performance. It can should confirm this exploratory finding with a double-blind
be argued that the network in semantic fluency is more design and larger sample sizes, examining both convergent
broadly represented than in letter fluency, making it more and divergent task performance. Importantly, our findings
sensitive to network effects, as supported by pharmaco- indicate that the use of stimulant medication does not hin-
logical effects in other patient populations (Beversdorf der creativity in those with ADHD. Rather, this study sug-
et al. 2011). Differences in performance were not found gests some aspects of creativity are actually improved by
in convergent tasks: both anagrams and CRA solution stimulant medication. This finding is important for individu-
latency revealed no significant difference between drug als with ADHD who are engaged in work involving verbal
conditions. It is possible that our mixed results may may creativity. Larger studies may allow investigators to parse
be due to opposing effects of norepinephrine and dopa- the effects of individual stimulant medication formulations,
mine on different aspects of creativity on convergent tasks. which is of particular salience due to the variability in phar-
Dopamine has been observed to improve performance on macological binding properties of the various types of stim-
convergent tasks (Chermahini and Hommel 2010), while ulants, including those taken by participants in this study
increased norepinephrine has been associated with poorer (Wang et al. 2017). Future research should further assess the
performance on convergent tasks (Alexander et al. 2007; effects of stimulant medication on other areas of creativity,
Campbell et al. 2008; Beversdorf 2019). and figural creativity is of particular interest since previ-
The exact mechanism of the effects of stimulant medica- ous studies examining the TTCT-Figural either revealed
tions on divergent thinking is not fully understood. Future no beneficial effects (Funk et al. 1993) or negative effects
studies are needed to understand the role of norepineph- (González-Carpio Hernández and Serrano Selva 2016) of
rine and dopamine in neuronal networks associated with stimulants in ADHD. Understanding the specific effects of
creativity in the brain of those diagnosed with ADHD. One noradrenergic and dopaminergic transmission on creativity
possible mechanism by which stimulants enhance perfor- may also have important implications for the effects of other
mance on divergent thinking tasks is due to improving agents, so more research in this area is warranted to bet-
reward and drive via dopaminergic mechanisms (Salamone ter understand the effects of these specific neurotransmitter
and Correa 2012), potentially relating to the findings of systems on creativity.
previous studies showing that genetic variants affecting the
dopaminergic system differentially affect divergent task Acknowledgements  We would like to thank the participants in this
study and the work of our collaborators Molly Wasserman and Amir
performance in contrast to other measures such as creative Neshatfar, MD. This work was supported by the MU School of Medi-
achievement survey results (Zabelina et al. 2016). cine Summer Medical Student Research Fellowship, the MU Life Sci-
Additionally, research has shown sex differences in ences Fellowship, the NSF Neuroscience REU program, and the MU
ADHD pharmacological treatment efficacy. Atomoxetine Department of Radiology Mission Enhancement funds.
(a nonstimulant pharmaceutical ADHD treatment) has been
Funding  This work was also supported by the National Science Foun-
recently recommended over methylphenidate as a more dation Division of Biological Infrastructure (Grant # 1659831).
effective treatment for females compared to males (Kok
et al. 2020). Additional studies are needed to determine the Declarations 
impacts of nonstimulants compared to stimulants on creativ-
ity, and how this might interact with sex in individuals with Competing Interests  Dr. Beversdorf has served as a consultant for
ADHD. Our pilot study was likely not adequately powered Quadrant Biosciences, Yamo Pharmaceuticals, Impel Pharmaceuticals,
to address sex differences due to the small number of males, MA Pharmaceuticals, and Stalicla Biosciences, which are all unrelated
to the work presented herein. No potential conflicts of interest were
but no effects of sex were observed with our sample. Assess- reported by the other authors.
ing individuals of other ages and developmental levels will
also be critical. No effects of age were observed in our sam-
ple, but the range of ages was rather limited. Our study is
a within-subjects design and has a relatively small sample References
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