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A Pill Cannot Replace Parents

The Washington Post offers a front page article on the controversy surrounding ADHD (Attention Deficit Hyperactivity Disorder) medications. A very large multiyear study initially showed promising results when comparing medicated children to non-medicated children with ADHD. At the fourteen month point, medicated children fared much better. However, by three years this difference was questionable and by eight years the difference has disappeared. One of the researchers, psychologist William Pellham, is ready to declare that the initial reports were misleading.

New data from a large federal study have reignited a debate over the effectiveness of long-term drug treatment of children with hyperactivity or attention-deficit disorder, and have drawn accusations that some members of the research team have sought to play down evidence that medications do little good beyond 24 months.

The study also indicated that long-term use of the drugs can stunt children's growth.

The latest data paint a very different picture than the study's positive initial results, reported in 1999.

One principal scientist in the study, psychologist William Pelham, said that the most obvious interpretation of the data is that the medications are useful in the short term but ineffective over longer periods but added that his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of medication. When their explanations failed to hold up, they reached for new ones, Pelham said.

"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," said Pelham, of the State University of New York at Buffalo. Pelham said the drugs, including Adderall and Concerta, are among the medications most frequently prescribed for American children, adding: "If 5 percent 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?"

As a family physician, the problem I have seen with these medications is too many parents want to use them as a substitute for parenting. Don’t bother them with behavioral assessments and discipline strategies. Just give them the pill so they can have some peace. I realize that there are very good parents of children with ADHD who use the medications as an adjunct to parenting. In my clinical experience, however, this was not the norm. At the end of the article, William Pelham offers a very concise summary of how the ADHD therapy should be used:

Pelham, who has conducted many drug therapy studies, said the drugs have a valuable role: They buy parents and clinicians time to teach youngsters behavioral strategies to combat inattention and hyperactivity. Over the long term, he said, parents need to rely on those skills.

A yet-to-be-published study, Pelham added, found that 95 percent of parents who were told by clinicians to first try behavioral interventions for ADHD did so. When parents were given a prescription for a drug and then told to enroll their children in behavioral intervention programs, 75 percent did not seek out the behavioral approaches.

You cannot replace parenting with a pill. Considering the high cost of ADHD medications and the fact that we spend more on these medications than we do on asthma or diabetes medications for our children, this is a very significant development.


Barb, sfo said…
Excellent to hear a doctor speaking out in this fashion! I've seen too many kids in classrooms who are just energetic kids, but their teachers are pushing the parents to medicate them so they're easier to handle. That is a grave injustice to the child.

That 75% of parents offered drug therapy as well as behavioral for their child only choose to use the drug therapy says a LOT.
Jen said…
Great post! We have just gotten guardianship of my niece (who does NOT have ADHD, but has been on meds for that and a host of other things she doesn't have). We are gradually weaning her off the meds and teaching her new behavioral strategies.

We need more doctors like you who are willing to speak the truth... even when the truth can be hard for parents to hear!
Michelle said…
Thanks for this. Just in the last week, I've talked to my second son who claims to always be distracted as his excuse for disappearing when I tell him to go get his math book. I explained that if he truly has difficultly concentratng and following through with simple instructions, then there are drugs we can give him to combat that.

I know that if he were in a classroom setting, the teachers would be calling for drugs. But in my heart, I feel he really just needs to practice obedience. (I might feel differently if he claimed that he was trying to focus, but couldn't).
Victoria said…
As a doctor what do you think of the Gardasil vaccination?
Catholic Mom said…

I've written extensively about the Gardisil vaccine. You can read the collection of posts here. Bottom line is there is nothing intrinsically immoral about the vaccine. It should be a parent's decision to give it, not the state's decision. I can see a reasonable parent electing to have her daughter vaccinated. I did not recommend it for my 18-year-old daughter when it was introduced because I want to see a longer safety profile before I heartily recommend it. I also thought Merck's marketing of it bordered on unethical so that gives me less confidence in their claims of safety. I will sound like I am from Missouri and say, "Show me!"

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