Parents: ADHD drugs don’t work

If you want to start an argument, try telling a parent – any parent – how to raise their kids. So I'm going to preface this by saying that I'm just trying to make parents aware of something that might concern them. One of the most controversial issues among parents of school-age children today is the shockingly large number of children who are being treated with drugs to control their behavior, especially those children who have been diagnosed with attention-deficit hyperactivity disorder (ADHD). Now it appears that these drugs simply don’t work, except in the short term. The results of a scientific study reported this past week showed that long-term use of drugs to children with ADHD doesn’t provide any benefit over behavioral therapy. Not only that, but children who took medication ended up, on average, one inch shorter than children who didn’t. That’s right: ADHD drugs stunt children’s growth.

This seems to be rather shockingly bad news for the ADHD drug manufacturers. The news was reported on the front page of the Washington Post and in many other media outlets. The study, an 8-year followup of the Multimodal Treatment Study of Children With ADHD (MTA), was reported in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study divided children into 4 groups: medication (M), behavior therapy (B), both treatments (M+B), or no treatment. The authors of the study had reported in 1999 – with great fanfare – that children who received drugs (M and M+B) did better than children who only had therapy (B) after 14 months and at 2 years followup. In other words, over the short term, the drugs seemed to work. As the Washington Post reported: “Because children given drugs alone appeared to do about as well as those treated with both drugs and talk therapy, the study skewed treatment in the direction of medication.”

However, over longer time periods, the drugs (including Adderall and Concerta, two of the most commonly prescribed drugs for ADHD) didn’t help at all – and they stunted growth. Children who took ADHD drugs for 3 years or longer were an average of one inch shorter than children who didn’t take drugs. The study looked at “grades earned in school, arrests, psychiatric hospitalizations, [and] other clinically relevant outcomes,” and found no differences in children given drugs compared to children given only behavioral therapy.

What should be even more disturbing is that this isn’t really news at all – it was reported two years ago, in 2007. The same authors reported then, in a 3-year followup study, that “treatment groups did not differ significantly on any measure at 36 months.” In other words, the benefits of drugs disappeared by 3 years after treatment started. Some of the scientists involved have downplayed these results, but one, William Pelham, was quoted in the Post saying his colleagues are “embarrassed to say they were wrong and we led the whole field astray.”

Another scientists leading the study, Peter Jensen, shot back that Pelham was biased against drugs. However, Jensen has been pushing drug therapy quite publicly for years. In the press release from the National Institute of Mental Health after the 2007 report, he said that “medication can make a long-term difference for some children if it's continued with optimal intensity.” This despite the fact that the 2007 results indicated that medication was not providing any benefit over behavior therapy, results that appear even stronger now. In contrast, William Pelham was already saying in 2007 that ADHD drugs were “all risk and no reward.”

It’s worth noting also that NIMH heavily promoted the initial results of this study back in 2000, and its website still states that “combination treatments as well as medication-management alone are both significantly superior to intensive behavioral treatments and routine community treatments in reducing ADHD symptoms.”

Reporter and blogger Maggie Mahar tried to draw attention to the story in 2007, but the U.S. media simply didn’t pick up on the story. Mahar also pointed out that “drug manufacturers have a serious interest in keeping the U.S. discussion on ADHD married to the medical-disease model.”

All of this made me wonder if Peter Jensen, who seems determined to continue to support the use of drugs to treat ADHD, might have ties to pharmaceutical companies. It took me only a few minutes to discover that he has received funding or grants from: UCB-Pharma, Cephalon, Novartis, McNeil Consumer & Specialty Pharmaceuticals, and Janssen Pharmaceutica. I found confirmation of these ties here. Novartis and UCB-Pharma are manufacturers of ADHD drugs (Ritalin or methylphenidate), and Cephalon makes Provigil, which they attempted to promote as an ADHD drug for years until the FDA rejected it.

Far too many of our children – primarily boys, who are diagnosed with ADHD 3-4 times more often than girls – are being medicated for ADHD. There is ongoing controversy, which I won’t get into here, over whether ADHD is grossly overdiagnosed. Whether ADHD is correctly diagnosed or not, though, it now seems clear that putting children on drug therapy might cause them long-term harm (stunting their growth) while only providing temporary, short-term changes in behavior.