ADHD Drugs Disappoint Down the Road

ADHD Drugs Disappoint Down the Road

Almost 40 million prescriptions were written last year for ADHD drugs in the US alone. Parents deserve to know if these drugs won’t improve the long-term success of their children. They also deserve to know if most of the kids these drugs long term will have permanent side effects. Both of these appear to be true. While these ADHD drugs may provide immediate relief of ADHD symptoms, after two years or so the kids on average are not better off than those who didn’t get the drugs at all. And those who take the drugs for three years or more appear to end up almost an inch shorter than they would have otherwise. Their growth rate slows and does not appear to rebound. These results come from a large federal study called the Multimodal Treatment Study of Children with ADHD (MTA). The latest news from this long-term study, the 8-year snapshot, was just released in the Journal of the American Academy of Child & Adolescent Psychiatry. At the beginning of the study, the children were randomly assigned to get medication alone, behavior therapy and parent training alone, medication and therapy combined, or routine community care for 14 months. At the end of the first year, those who got medication with or without the behavior therapy and parent training were doing significantly better than the others. But by three years, these differences had largely evaporated whether or not the child continued to take the medications.

Now we know that eight years later the type of treatment received initially made no difference in their long-term outcome, whether looking at grades earned in school, arrests, other psychiatric problems, or other ADHD symptoms – as assessed by parents, teachers, or the kids themselves. The specific question of substance abuse is being analyzed separately, and results are not yet available.

Some of the kids remained on the medications continuously for 6 to 8 years. Those children fared no better than those who never received meds or who used them briefly when comparing on almost all measures of success, including school grades, homework completion, quiz and test performance, school office visits, disciplinary actions, conflicts with parents, and so on. They did score a couple points higher score on a math achievement test. They also ended up shorter. Of course, these are averages. Some individuals may benefit significantly more from the medications. Or less.

To me, this suggests that when ADHD medications are used their greatest benefit would not be to “solve” ADHD, but rather to provide a window of relief and focus for a year or two in which to pursue lifestyle changes that can make a long-term difference. These might include changes in nutrition, in physical activity, in sleep, in chemical exposures, in peer groups, in study strategies, in parenting strategies, and in school environments.

“MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study.” MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; SWANSON, JAMES M. Ph.D.; ARNOLD, L. EUGENE M.D., M.Ed.; VITIELLO, BENEDETTO M.D.; JENSEN, PETER S. M.D.; EPSTEIN, JEFFERY N. Ph.D.; HOZA, BETSY Ph.D.; HECHTMAN, LILY M.D.; ABIKOFF, HOWARD B. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; NEWCORN, JEFFREY H. M.D.; WELLS, KAREN C. Ph.D.; WIGAL, TIMOTHY Ph.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; HOUCK, PATRICIA R. M.S.; the MTA Cooperative Group. Journal of the American Academy of Child & Adolescent Psychiatry. Published ahead of print, March 24, 2009. DOI: 10.1097/CHI.0b013e31819c23d0.  “Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-up.” SWANSON, JAMES M. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; WIGAL, TIMOTHY Ph.D.; ARNOLD, L. EUGENE M.D.; VITIELLO, BENEDETTO M.D.; HECHTMAN, LILY M.D.; EPSTEIN, JEFFERY N. Ph.D.; PELHAM, WILLIAM E. Ph.D.; ABIKOFF, HOWARD B. Ph.D.; NEWCORN, JEFFREY H. M.D.; MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; WELLS, KAREN C. Ph.D.; HOZA, BETSY Ph.D.; JENSEN, PETER S. M.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; STEHLI, ANNAMARIE M.P.H.; DAVIES, MARK M.S.; MARCH, JOHN S. M.D., M.P.H.; CONNERS, C. KEITH Ph.D.; CARON, MARK Ph.D.; VOLKOW, NORA D. M.D. Journal of the American Academy of Child & Adolescent Psychiatry, August 2007. 46(8):1003-10014.

Dr. Alan Greene

Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.

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  1. RENEE COX

    PLEASE HELP ME !!!! MY 3 YEAR OLD GRANDSON, I KEEP BEING TOLD BY MY DAUGHTER, KEEP GETTING DIAGNOSED, WITH HAND-FOOR-MOUTH DISEASE. THIS AS HAPPENED AT LEAST 4 TIMES THAT I KNOW OF IN THE PAST 2 YEARS, I KNOW ITS PROB BEEN MORE SINCE I DO NOT GET TO SEE MY GRANDSON VERY OFTEN. I HAVE MET MY GRANDSONS DR HERE IN NASHVILLE TN, AND HE DOES NOT IMPRESS ME AT ALL !!! HE SEEMS TO BE A KNOW IT ALL THAT RUNS NO TESTS, JUST DIAGNOSES. I WANT TO FIND MY GRANDSON THAT IS 3 YRS OLD A BETTER DR. A DOCTOR, THAT RUNS TESTS AND CARES. MY GRANDSON HAD WHAT MY DAUGHTER THOUGHT WAS JUST A BUG BIT NEAR HIS EYE AREA, SHE SAID IT MIGHT BE PINK EYE, BUT NEVER TOOK HIM TO THE DR. I KEEP READING ALL THESE DIFFERENT THINGS ABOUT HEALTH, THAT COULD HAVE TO DO WITH MY GRANDSON, GETTING THIS HAND FOOT MOUTH DISEASE AND THIS LAST TIME IT WAS WORSE THAN IT HAD EVER BEEN, THE DR WAS NOT IN AND THE NP SAW MY GRANDSON AND SAID IT WAS HAND FOOR AND MOUTH AGAIN, THIS WAS 3 WEEKS AGO, A WEEKS AFTER THAT MY DAUGHTER SAID HER 3 YR OLD WAS VOMITING IN THE EARLY HOURS OF THE MORNING. THEN WAS OK. I AM SO VERT WORRIED AND WANT TO FIND NOT ONLY A PEDITRICIAN / FAMILY DR FOR MY GRANDSON BUT AN INFECTIOUS DISEASE DR ALONG WITH BEING A PEDITRITION. MY GRANDSON IS ON TENN CARE OR MEDICAID TYPE INSURANCE, CAN YOU PLEASE REFER ME TO A DR THAT WILL DO FURTHER TESTING ON MY GRANDSON, ALSO I THINK MY GRANDSON IS AUTISTIC, AT 3 YRS OLD HE STILL DOES NOT TALK, MAYBE 5 WORDS AND DOES NOT EVEN SPEAK THOSE CLEARLY. IM VERY VERY CONCERNED. PLEASE HELP ME. MY PHONE NUMBER IN NASHVILLE TN IS [redacted]. THANK YOU IF YOU CAN PLEASE HELP ME, HELP MY SWEET LITTLE GRANDSON, THATS ONLY 3YEARS OLD. I LOVE HIM SO VERY MUCH. I WILL TAKE HIM MYSELF TO ANY APPTS, HIS PEDITRITION

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    • Dear Renee,

      I can hear how upset you are. This sounds very tragic. I can not make any recommendations for doctors in your area, but I do have a recommendation. Contact Monroe Carell Jr. Children’s Hospital at Vanderbilt and ask who they would recommend. You can try general pediatrics or one of the specialties you think he may need. Vanderbilt will know who in your area is highly respected and practices medicine the way you describe.

      NOTE: Our comment guidelines do not allow for personal email or phone numbers to be posted. This is to protect the person commenting.

      I hope that’s helpful.
      Best, @MsGreene
      Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

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  2. Lisa

    Thank you for posting this information–I have never heard it. I will have to look into the study you mentioned.

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