The American public has come to view ADHD drug treatment as a rather benign option for common behavioral and academic issues. A recent report by the Centers for Disease Control and Prevention indicates that 14% of American children receive a diagnosis of ADHD before the end of childhood. Rates of diagnosis and treatment vary by geographic region. In some communities rates of treatment are much higher than the national average. By most any reasonable measure, the number of children who are medicated under the guise of ADHD is out of bounds. Current levels of ADHD drug treatment are unsafe for individuals and society.
The more a drug is prescribed, the more it will be diverted for illicit purposes. Borrowing, swapping, selling, and stealing ADHD drugs has become increasingly common on American high school and college campuses. The ubiquitous availability of these drugs has led teens and young adults to believe that they are harmless. They freely mix them with alcohol — a potential lethal combination. Nationwide, emergency room visits and deaths associated with adverse reactions to ADHD medications are on the rise.
Too few of the professionals who have issued lax ADHD diagnoses or overprescribed drugs for the condition realize that better and safer options exist. This is due, in part, to the way the media has played up the results of our country’s landmark MTA study — the only large, national, longitudinal study comparing the benefits of behavioral and drug therapy. The popular media-issued interpretation is that medication is the most effective treatment option.
The truth is that the MTA study actually provided evidence to consider behavioral interventions — not drug therapy — as the first line of defense. As reviewed by Dr. William Pelham, a clinical psychologist who was one of the MTA researchers:
- The benefits of drug treatment (even carefully monitored and titrated treatment) fade over time while the benefits of behavioral treatment endure.
- Drug treatment is not effective as delivered as part of routine community care.
- Drug treatment does not result in better academic outcomes.
- Over time, behavioral interventions are more effective than drug treatment.
- When behavioral interventions are implemented prior to the initiation of drug treatment, 75% of children fully resolve their ADHD symptoms.
In the wake of mounting evidence of Adderall abuse and addiction, it is more important that every mental health professional seek to distinguish between scientific fact and marketing spin. Fortunately, a front-page New York Times story that detailed the tragic case of Richard Fee’s addiction to Adderall captured national attention and put the spotlight on the dangers of current diagnostic and treatment practices.
Soon after Richard Fee’s story hit the newsstands the reporter, Richard’s parents, and psychiatrist Dr. Edward Hallowell were invited to be guests on the popular national Dr. Oz Show about health care trends. Dr. Oz managed to get Dr. Hallowell — a leading and compelling ADHD spokesperson that has had a significant influence on the ADHD practice in this country — to admit on air that he regretted having promoted the notion that ADHD drug treatment is “as safe as aspirin.” That’s progress. Hats off to Hallowell.
It remains to be seen whether other popular opinion leaders who sought to expand the use of ADHD drug treatment options will follow suit. Will clinical psychologist Russell Barkley — another notable ADHD advocate who emphatically maintained that too few children are medicated for ADHD — admit that scientific evidence does not support his view on this matter?
Regardless of what key opinion leaders like Drs. Hallowell and Barkley say next, it is ironic that provocative ADHD stories recently published by Alan Schwarz in the New York Times may compel some clinicians to turn to the academic literature for information about what constitutes the best treatment options for their patients. Hopefully, blogs such as this one will inspire some to read the peer-reviewed articles, perhaps beginning with these:
- Antonuccio, D. (2008). Treating depressed children with antidepressants: More harm than benefit? Journal of Clinical Psychology in Medical Settings, 15, 92-97.
- LeFever, G.B., Arcona, A.P., Antonuccio, D.O. (2003). ADHD among American schoolchildren: Evidence of ADHD overdiagnosis and overuse of medication. Scientific Review of Mental Health Practice, 2(1), 49-60.
- Pelham, W.E. & Fabiano, G.A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 37,(1), 184-214.