Friday, October 07, 2005

The Dark Side of Treatment of Children with ADHD

A parent's decision whether or not to use medication in their children is often an agonizing one. It is a perfect example of having to make weighty decisions under uncertain conditions or incomplete knowledge.

Check out this recent research study from the Department of Health Care Policy at Harvard Medical School:

"Childhood treatment of ADHD is associated with significantly elevated odds of adult persistence (OR = 4.5, p =.002), after controlling for socio-demographics and childhood ADHD severity." p 1444

What does that mean? It means that if a child were actually treated with stimulant medication as a child, he was 4.5 x more likely to have residual ADHD symptoms as an adult. This was true even if the children were controlled for socio-demographic factors or even severity of ADHD symptoms in childhood. This is an astounding finding, of which we can find no coverage in the news. This was clearly an unexpected finding of the group, and we hope that there will be significant research attention into investigating possible deleterious effects of medically-prescribed stimulant use in childhood.

The discussion of this surprising result on p. 1447 is disappointing at best, and misleading at worst. There seems to be reluctance of the researchers to discuss the implications of the most obvious findings of their work: "The possibility exists, of course, that childhood treatment promotes adult persistence (of ADHD symptoms). Indeed a suggestion along these lines has been made that stimulant treatment promotes subsequence drug use disorders among children with ADHD (Goldman et al 1998). However, review...."

If you read on, you'll see the researchers shift the discussion to possible substance abuse in adulthood. But that is not the question that must be answered. It's about whether stimulant use in children will increase the likelihood more than 4-fold that they will have persisting symptoms in adulthood. This finding needs to be studied in blinded and controlled studies, and we should think long and hard about whether federal resources have given proper attention to other non-stimulant approaches to strengthening focus and improving impulsivity in children.

The reference in PubMed is: Patterns and Predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005 Jun 1;57(11):1442-51.

Surprisingly, since last night, the article has been removed from ajp.psychiatryonline.org and substituted with a different article. Apparently with free registration you can still find it at Biological Psychiatry in the June 2005 issue: Biological Psychiatry

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