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Are ADHD Drugs All They’re Cracked Up To Be?

In a recent editorial in The New York Times entitled Ritalin Gone Wrong L. Alan Sroufe, Ph.D. challenged the convention of treating children long-term with ADHD stimulant medications such as Ritalin and Adderall. A professor emeritus of psychology at the University of Minnesota’s Institute of Child Development, Sroufe’s comments have reignited a debate that’s as old as the treatment itself.

While acknowledging the value of short-term use of ADHD medications to increase concentration, Sroufe takes exception with the use of pharmaceuticals as a long-term solution, which is how they’re prescribed most often. “When given to children over long periods of time,” he maintains, “they neither improve school achievement, nor reduce behavior problems.” Plus, he adds, “The drugs can also have serious side effects, including stunting growth.”

Misinterpreting Evidence

In cogent detail, Sroufe builds a case for why physicians and parents are not aware of how ineffective drugs are for ADHD—the implication being that if they knew, the prescription rate for ADHD medications would not have increased twentyfold in the past 30 years:

  • In the 1960s psychologists believed that ADHD was the result of an inherited biochemical problem and, therefore, could be corrected with drugs that altered brain chemistry. Sroufe maintains there is “little to no evidence to support this theory.”
  • By the early 1970’s there was a body of scientific evidence showing the drugs improved performance on certain tasks that required concentration. Sroufe contends that led to increased   drug treatment, which in turn “led many to conclude that the ‘brain deficit’ hypothesis had been confirmed”
  • A 1990 review of the literature concluded that all children, “whether they had attention problems or not, responded to stimulant drugs the same way…They enhance the ability to concentrate, especially on tasks that are not inherently interesting or when one is fatigued or bored, but they don’t improve broader learning abilities.”
  • Finally, Sroufe argues that the effects of the drugs fade with prolonged use: Children “apparently develop a tolerance to the drug, and thus its efficacy disappears.”

Conclusion: No Long-Term Benefit

Putting it all together, Sroufe notes: “To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve.” This includes a well-respected long-term, randomized, controlled trial that studied 600 children for more than a decade. Although the study continues, results to date show no lasting academic or behavioral benefit to children using medication.

The editorial goes on to challenge the way neuroscience is currently being used to support what Sroufe terms the “inborn defect” hypothesis, at the expense of studying other explanations for ADHD, such as experience, an emerging field of inquiry having a hard time garnering research dollars:

Policy makers are so convinced that children with attention deficits have an organic disease that they have all but called off the search for a comprehensive understanding of the condition. The National Institute of Mental Health finances research aimed largely at physiological and brain components of A.D.D. …

Thus, only one question is asked: are there aspects of brain functioning associated with childhood attention problems? The answer is always yes. Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.

This tack, Sroufe concludes, is potentially dangerous for a number of reasons: it plays into societal notions that there is a “single solution for all children with learning and behavior problems;” drugs are the answer to life’s problems; children with ADHD are “inherently defective;” and searching for other, comprehensive solutions to help children with ADHD is unnecessary.

As anticipated, Sroufe’s comments have sparked vigorous debate, including a response from MD and ADHD expert, Dr. Ned Hallowell, in which Hallowell takes exception to what he calls “scare tactics and wrong-headed assumptions” in the article.

Read Sroufe’s full editorial on The New York Times website and let us know what you think about using ADHD medications long-term by joining the discussion on the Smart Kids Facebook page.

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