ADHD Meds Don’t Work In The Long Run: Study
10 CommentsBy Ed Silverman // November 12th, 2007 // 7:33 am
Here’s a report that is likely to stir controversy. Treating kids with drugs, such as Ritalin and Concerta, simply don’t work any better than therapy after three years of treatment, according to a study obtained by a BBC program. The findings also suggested long-term use of the drugs could stunt children’s growth and the benefits are exaggerated, the BBC reports.
The Multimodal Treatment Study of Children with ADHD has been monitoring the treatment of 600 children across the US since the 1990s. In 1999, it concluded that, after one year, medication worked better than behavioural therapy for ADHD. This finding influenced medical practice on both sides of the Atlantic, and prescription rates in the UK have since tripled. Now, after a longer-term analysis, William Pelham, the report’s co-author and a pediatric and psychiatry professor at the University of Buffalo, had this to say:
“I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run. The children had a substantial decrease in their rate of growth so they weren’t growing as much as other kids in terms of their height and in terms of their weight.” He adds that there were “no beneficial effects” of medication and the impact was seemingly negative instead. [UPDATE: This quote appears differently than it did earlier due to a change in the wording of the BBC report.]
The BBC’s Panorama program reported that UK docs prescribed ADHD drugs such as Ritalin and Concerta to around 55,000 children last year, at a cost of about $120 million. The report features footage of a 14-year-old from Stoke-on-Trent, who has been on ADHD medication for a decade.
Craig Buxton’s family kept a video diary of his behaviour and captured on camera examples of just how explosive his behaviour can be - he recently assaulted three school teachers. His mother Sharon said things had gone from bad to worse.
“He has broke down and cried when he gets into situations,” she says. “He says: ‘Why am I like this mum, I don’t want to feel like this, I don’t want to be like this, you know, help me’. And all I can do is go back to the doctors and say: ‘Is there anything more you can do?’ All they say is, well, we are doing what we can.”
Robert McMaster
Thing is, lazy docs will just keep on pumping the drugs out. They simply don’t have anything else and are in denial about alternatives. So much for “Evidence-Based Medicine”.
Janet
What exactly defines ‘beneficial effects of the medication’ and what is defined as ‘an outcome’? What exactly does ‘not work in the long run’ and ‘don’t work any better than therapy’ mean?
To say there are “no beneficial effects of the medication†appears misleading as there is plenty of evidence to support improvements in concentration, focus and mood with ADHD medications.
Earlier articles by Pelham have stated that, “Thirty years of research show that ADHD drugs used alone do not help children avoid long-term outcomes that are a hallmark of the disorder — substance abuse, domestic problems, school dropout, delinquency and criminal behaviors. More parents would opt out of using medication as the first line or sole treatment if they were provided with this information, and if physicians didn’t opt for medication first.”
As a parent, I am personally more interested in helping my child sit still in the classroom and be able to concentrate and learn, than I am in worrrying about potential domestic problems in 20 years. To say these drugs have no beneficial effects ignores this whole short-term issue. I do concur that these drugs are not appropriate for everyone, should not automatically be considered first-line therapy, are not risk free, and are not a substitute for teaching effective behavioral and coping strategies.
Perhaps the BBC article missed the point of the study which was reflected in the following NICE statement: “The National Institute of Clinical Excellence in England (NICE) has advised that drug therapy should only be part of a comprehensive treatment programme that includes a range of social, psychological and behavioural interventions” and “Careful, informed clinical decision-making, involving the parents and child should involve discussion of the benefits versus the risks of all interventions.â€
Laurie
Not knowing the long term effects of these drugs HAS to be a concern for parents. These are effects that could effect that child for a lifetime. Risk vs benefit cannot be evaluated with only short term use data. We have no idea what these children face in their futures. I don’t deny the ADHD diagnosis in a small percentage of children. But if the numbers are as staggering as we are seeing documented today, then it’s not the kids. It’s the educational process.
Anna Reters, MD
How can one be so cruel to drug their children for convenience–avoiding their parenteral responsibilities. How easy it is to medicate our problems away.
He says: ‘Why am I like this mum, I don’t want to feel like this, I don’t want to be like this, you know, help me’… Well.. unfortunately the problem is your parents. If your were to wean from the deliberate poisoning of your system, life would blossom before you.
Janet
Dear Anna -
“The problem is your parents”?? (Do you always provide diagnoses and treatment recommendations based on a sentence or two?)
Do you disagree with the NICE statement? Are there no situations in which you think medication can be part of an effective treatment program?
Ken Thomas, RN
Dr. Reters is right. Just because a parent thinks that it’s more important to see that their child sits still and can concentrate better is not an indication that the medication is therapeutic. Street drugs can do the same. Being that childhood is only a 4th or 5th of their lifespans, I’d like to see a child get a fighting chance without neurologic damage or dependency on a drug for life. I can’t agree with NICE’s statement when they are one-sided in their solutions. I have helped and seen many kids get off of ADHD meds and onto supplements with no side effects and thrive very well in school. It’s not like there isn’t precedence for the alternatives. There is mostly ignorance on the part of parents. But I see it as my duty to educate and inform them that there are alternatives that work without side effects.
Jon Stettin
Knowing that William Pelham is a well respected academic who has done a lot of work in ADHD, I suspect that we may be seeing some one-sided reporting. It is certainly interesting that long term benefit may not be as good as was first hoped, however that doesn’t mean that ADHD doesn’t exist or that it could not be treated with a mixture of therapy and medication. The benefits of treating ADHD are huge. It’s been shown that treatment (with Ritalin/Conerta/Adderall) has a positive effect on learning but also seems to prevent ADHD children falling into drug abuse later in life.
Malcolm Roberts
Dear Janet,
http://www.jewishworldreview.com/strips/mallard/2000/MFT20071102.jpg
Janet
So Malcolm -
What are your thoughts on adults with ADHD? Are they too suffering from lack of parental attention, discipline, etc. etc.?
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[...] Melissa OrlovReally interesting read I found today:The Multimodal Treatment Study of Children with ADHD has been monitoring the treatment of 600 children across the US since the 1990s. In 1999, it concluded that, after one year, medication worked better than behavioural therapy for ADHD … [...]