Healthy Skepticism Library item: 12014

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Publication type: news

Jofre S.
What Next for Craig?
Panorama, BBC 2007 Nov 12
http://news.bbc.co.uk/1/hi/programmes/panorama/7079233.stm

Full text:

Most of the estimated half million children in Britain with the behavioural condition Attention Deficit Hyperactivity Disorder (ADHD) receive no treatment at all.

Those that do, tend to be given powerful stimulant medication like Ritalin and Concerta. These drugs can help inattentive and unruly children focus and have been the first choice for doctors treating ADHD over the last decade.

However, stimulant medication is not without its problems.

Similar to amphetamine, it can cause insomnia and suppress the appetite, causing weight loss and stunt growth. There have even been reports of children becoming suicidal on them.

Anxious parents though, have long been reassured by doctors that the benefits of medication far outweigh the risks. Children with ADHD are at an increased risk of delinquency, substance misuse and even of going to jail.

The implication has always been that medication will improve those dire prospects.

But – now that so many children have been on these drugs for years – what scientific evidence is there to support that?

Seven years ago, I filmed with a lively young lad from Stoke-on-Trent who’d recently been diagnosed with ADHD.

Craig Buxton was just four and a half when his mum first agreed – on a child psychiatrist’s recommendation – to start him on Ritalin.
She was worried about the side effects even then, but with little other support on offer, she felt it was the only thing she could do to bring some normality to family life.

The psychiatrist’s view seemed to be backed up by the findings of the biggest and most influential study ever done on the treatment of children with ADHD that had just been published.

As Panorama revealed in 2000, the US-based Multimodal Treatment Study of Children with ADHD (MTA study) compared the treatment of 600 children with ADHD and found that medication was superior to behavioural therapy.

Fast forward to 2007, though, and I discovered that the MTA study group was about to publish some new findings.

They had continued to monitor the 600 children and – after three years – reached a surprising conclusion; medication is actually no better than therapy in the long-term and can stunt children’s growth.

MTA co-author, Professor William Pelham, a world authority on ADHD, told Panorama:

“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.”

That prompted me to get back in touch with Craig Buxton’s mum, Sharon, to find out what has happened since we last met.

It turns out things have gone from bad to worse for Craig, despite having remained on medication for the best part of a decade.

He has no friends, has self-harmed, suffers night terrors, is aggressive and – after assaulting three school teachers – prison looks like a very real prospect if the family don’t get the help they’re crying out for.

The good news is that the National Institute for Clinical Excellence is currently revising the treatment guidelines for ADHD. Chair of the working group, Dr Tim Kendall says:

“I hope that we will be able to make recommendations that will give people, based on the best evidence we’ve got, a comprehensive approach to treatment which will advise about the use of parent training programmes, the use of behavioural interventions.

“The important thing is that we have an approach which doesn’t focus just on one type of treatment.”

Panorama: What Next for Craig? BBC One 8.30pm, Monday 12 November 2007

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Read more about the findings
As a result of the MTA study, four reports were published in August, 2007 in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

You will need to register for the full reports but can read an abstract at the following urls:

3-Year Follow-up of the NIMH MTA Study:
http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200708000-00010.htm

Delinquent Behavior and Emerging Substance Use in the MTA at 36 Months: Prevalence, Course, and Treatment Effects:
http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200708000-00013.htm

Secondary Evaluations of MTA 36-Month Outcomes: Propensity Score and Growth Mixture Model Analyses:
http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200708000-00011.htm

Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-up:
http://www.jaacap.com/pt/re/jaacap/abstract.00004583-200708000-00012.htm

The National Institute for Mental Health website has information about the clinical trials and additional publications:
http://www.nimh.nih.gov/topics/adhd.shtml