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More Controversy about Drugs for ADHD
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The long-running debate about the effectiveness of drugs prescribed for children with attention-deficit disorder or hyperactivity (ADHD) has been re-ignited by new research on a large federal study. The new research, which appears in the online version of the Journal of the American Academy of Child and Adolescent Psychiatry, claims the drugs do little good beyond 24 months and may stunt children's growth.˙That is very different from the study's initial˙report back in 1999.

The report followed 485 children for eight years. All of the children had been diagnosed with ADHD. Children who continuously took stimulant medications and children who did not take stimulants were no different from each other after eight years in the categories of inattention, hyperactivity, or social functioning.

Another report in the same journal analyzed the same group of 485 children and found that stimulant medications affected the children's growth. Children who never took stimulants were three-quarters of an inch taller and weighed six pounds more on average than children who took stimulants for three years. Other reports had already indicated that stimulants stunt children's growth, but defenders of the drugs said that children would make up the difference once they stopped taking the drugs. This latest report shows that children who take the drugs will remain somewhat smaller throughout their lives. In 2007, when researchers first reported that children who took stimulants were smaller, the National Institute of Mental Health issued a press release spinning the data by stating that children who were not on medication "grew somewhat larger."

One principal scientist in the latest analysis of the study, psychologist William Pelham, says that the medications are useful in the short term but not over longer periods. Pelham says that his colleagues repeatedly tried to explain away evidence that challenged the long-term usefulness of the medication. "The stance the group took in the first paper was so strong that the people are embarrassed to say they were wrong and we led the whole field astray," says Pelham. Initially, after 14 months of treatment, the medicated children showed improved behavior. But as time went on and scientists continued to monitor the children, those who took drugs and those who didn't began to look more and more similar in their behavior. Meanwhile, prescriptions for stimulant drugs soared nationwide. In 2004, American physicians wrote 28 million prescriptions for ADHD drugs; last year, they wrote 39 million.

Adderall and Concerta are among the medications most frequently prescribed for children. Dr. Pelham said, "If 5% of families in the country are giving a medication to their children, and they don't realize it does not have long-term benefits but might have long-term risks, why should they not be told?"

Dr. Peter Jensen, a fellow researcher, criticized Pelham as biased against the use of drugs. "We were struck by the remarkable improvement in symptoms and functioning across all treatment groups," said Jensen, also pointing out that some children who took drugs did show more improvement than average over the long term. But this does not explain why children who didn't take drugs showed the same degree of improvement on average as those who did. Many of the non-medicated children, as well, showed greater-than-average improvement.

Another co-author, Dr. Brooke Molina, agreed with Dr. Pelham that the data "do not support that children who stay on medication longer than two years have better outcomes than children who don't." Molina also noted that academic reviewers of reports on the study "thought we were bending over backward (inappropriately) to dismiss the failure to find medication effects at eight years."

Dr. Pelham believes that behavioral interventions are the better choice for ADHD treatment. "Behavioral parent training is widely available — it is not rocket science, and it's proven to help," says Pelham. The prevalence of drug treatment, however, means that fewer parents try behavioral interventions than otherwise would. Pelham mentioned another study, soon to be published, that examines the treatments that parents pursue when their children are diagnosed with ADHD. When physicians tell parents to try behavioral interventions first, 95% of parents do so. But when physicians both prescribe a drug and recommend behavioral intervention programs, only 25% of parents try out the behavioral approaches. (Washington Post, 3-27-09)

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