ADHD Studies Cast Doubt On ADHD Treatment

A series of studies in December's Journal of the American Academy of Child & Adolescent Psychiatry is suddenly getting some attention because it raises serious questions about how ADHD is treated in children and teens, how well treatment works, what really drives ADHD--and whether it makes sense to medicate kids at all. The studies are based upon a cohort of 188 Finnish teens--the research is led by a Brit and an American, the teens have been tracked for several years--considered to have probably or definite signs that the disorder will continue into adulthood.

What the studies--including a central piece of research--found was that for many youngsters diagnosed with ADHD the disorder ebbed away in their later teen years. I don't want to read too much into the studies yet since they are complicated even if their implications are fairly clear.

These studies have not gotten much press attention so far, aside from an article last week on Psych Central and a good article yesterday in the Los Angles Times. That's too bad, because their publication represents yet another brain shake for the world of psychiatry. I'll pinch from the LAT version, especially because one of the researchers said something quite remarkable.

"Researchers found it is the can't-sit-still kids -- the stereotype of the "ADHD generation" -- who are most likely to mature out of the disease. Among those with persistent ADHD, they also found, half have problems with cognitive skills that are key to success in adulthood, but half have no such deficits.

"And when researchers compare the findings from Finland to studies of Americans with ADHD, an even more intriguing discovery emerges: By the time they're in their late teens, those who receive drugs for attention problems seem to fare about the same as those who do not."

Basically, the kids who daydream more do worse in the long term versus kids who are a fidgety who do better in the long-term, regardless of their meds situation.

"'This begs the question: Are current treatments really leading to improved outcome over time?' wrote UCLA neuropsychologist Susan L. Smalley and co-author Dr. Marjo-Riitta Järvelin."

Sounds like the answer is no for a significant proportion of kids diagnosed with ADHD.

"In Finland, as in studies of U.S. populations, about half of older teens with persistent ADHD performed poorly on tests of short-term, or working memory, and in cognitive skills that are key to problem-solving, making plans and executing tasks. And in each group, roughly the same proportion of children 'mature out' of the disorder.

"Although about 60% of American children diagnosed with ADHD are medicated -- at least at some point -- for its symptoms, virtually no Finnish children are given medication. And yet, by the time they reach 16 to 18 years old, these two populations look very much the same.

"In an interview, Smalley stressed that the studies do not cast doubt on the short-term benefits a child with ADHD may get from a stimulant or other medication that treats the symptoms of the disorder. She cited recent studies showing that at the end of one year, children medicated for ADHD symptoms function better at home and school than those who get behavioral and cognitive therapy. But after three years, the difference between the two groups begins to wane."

Interestingly, the Finnish studies parallel conclusions from a set of American studies in November, showing that ADHD kids in the US do just fine over time. They also tie in with points Bruce Levine made yesterday about the pathologizing of teen defiance (sometimes diagnosed as ADHD).

I am beginning to think we are seeing a decent body of evidence supporting the idea that we've gone a bit too far as a culture--and I am talking Western civilization, not just the US--in diagnosing disorders in kids and teens and making them and their parents feel like fools for not getting the kids on meds. In other words, we need to be a bit more flexible in our cultural assumptions of how children should be allowed to behave and how we expect them to develop. It's time to let kids be kids--and in particular it is time we let boys be boys again, as most of the ADHD diagnosing and medicating in this country at least is among boys.

Happily for me at least, Smalley agrees with my basic argument:

"'We need to step back and embrace neurodiversity, diversity in human behavior and try to work on ways to embrace and enhance being at the extreme, instead of only focusing on the deficits and disorder aspects of ADHD,' Smalley said."

Yes, we do. And while we're at with regards to ADHD, there are some other disorders--alleged or otherwise--that deserve a thorough rethinking. But I won't go there today. But, as Psych Central noted last week, this does sort of demand a new approach to treating ADHD.

I'm sure that these studies will generate as much controversy as did the studies last November, now that they are getting slightly wider attention. Can a Judith Warner column be far off in the New York Times? I see another round of the so-called Ritalin Wars a-comin.'

The studies didn't take up any questions around the use of anti-psychotics in treating ADHD in boys, which seems to be enjoying a creepy vogue in the US. I've written about this before here.

I'll have more on these studies as soon as I've been able to review them in their entirety.

It's nice to see the LAT out in front on one of these stories for a change. In the past, the paper has been a strong voice (particularly on the editorial page) for the "medicate 'em and forget 'em" paradigm of mental health care and I have given the paper hell over this. Lately, the paper seems to be doing a better job, amazing considering all the cost cutting and personnel insanity that the paper's new owners (and its most recent previous owners, the Tribune Company) have been enforcing upon what's a pretty good shop.