News: General Press

The article debating the MTA study returns: Debate Over Drugs For ADHD Reignites:Long-Term Benefit For Children at Issue" (by Shankar Vedantam)

Source: Washington Post (American newspaper of general information) / Date: March 27, 2009 / Category: General Press

The publication of new data on an important research study (the MTA mentioned above) has reopened the debate over the long term effectiveness of treatment of children with hyperactivity or attention deficit disorder, and has caused some members of the research team to recognize that there is no evidence that the medication does much after 24 months of treatment. The study also suggests that long-term use of this medication may slow the growth of children. These data, paint a picture quite different from the positive initial results, which were published in 1999. One of the principal investigators of the study, the psychologist William Pelham, said that the most obvious interpretation of the results is that medication is helpful in the short term, but ineffective for longer periods. But he added that his colleagues have repeatedly tried to find data to indicate that it is useful in the long term and when their explanations could not be sustained, they started seeking new ones. "The position of the research group in the first article published was so strong that after they hesitated to acknowledge that they were wrong and that has confused us all," said Pelham, University of New York at Buffalo (USA). Pelham said that the drugs, including Adderall (a product base of amphetamine salts) and Concerta (methylphenidate extended release), are among the medications most commonly prescribed to American children, and added: "If 5% of the households in the country are giving a drug to their children and do not realize that it does not provide long-term benefits and could even generate long-term risks, why shouldn’t they clearly be told that? "

The lack of agreement has produced a variety of comments among researchers about how to properly present the results to the public. Some wonder why the members of the research group appeared to be looking the other way in order to overlook the potential implications of the medication.

Peter Jensen, one of the colleagues of Pelham, responded that Pelham himself was conditioned against the use of these drugs and was making his personal opinion as if it were a science. Jensen added that Pelham was the only member of the research team with the simpleton belief that the study cast doubt on long-term medication, but messages and subsequent interviews showed that he was not alone.

The MTA study was designed to test whether children diagnosed with ADHD improved when treated with medication, with medication and psychotherapy, with psychotherapy alone or with common medical care. Drug manufacturers distributed thousands of copies of the article to doctors at a time when the diagnosis of ADHD was becoming all the more frequent. Given that the children who took only medication improved as well as those who received both treatments at the same time, medication and psychotherapy, the outcome of the study skewed more towards the medication.

In a second phase of the study, researchers followed the children and compared their data, but researchers no longer randomly assigned participants to different treatment options, so this phase of the study was much less rigorous from a scientific point of view.

In August 2007, the MTA researchers reported the first results of the follow-up, which showed no differences in the behavior of children receiving medication versus those who did not. But the data showed that those children who had received medication for 36 weeks, were a few centimeters shorter and a few pounds leaner than those who did not.

A press release from the National Institute of Mental Health in the U.S. issued at the same time, presented the results more favorably. The statement, issued on July 20, 2007, was titled "The improvement in the continuation of treatment for ADHD was maintained in most children." The release noted that the initial advantages of drug treatment were no longer evident, but it was Jensen himself who said that this did not mean that the long-term treatment was not effective.

Jensen said "We were surprised by the improvement in symptoms and functioning in all of the treatment groups.” And instead of stating that the growth of the children taking the medication was slowed, the release came to say that the children who did not take medication grew somewhat more.

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