A three year study into ADHD treatments has shown that while drugs like Ritalin reduce ADHD childrens’ “difficult” behaviour in the short term (in fact even up to a year), looking at them over three years shows that not only are the children still on these drugs not showing sustained improvements in their behaviour but some are showing significantly adverse effects such as stunted growth.
There’s a real emphasis in the dominant medical model on quick fixes. Arthur Frank, in his excellent The Wounded Healer, calls this approach the “restitution” one – the patient’s narrative is one of “I’m broken, please fix me and I’ll be on my way”. He says this is like the Fast Oil Change approach to medicine, but it’s very, very common, and it’s nurtured by both the medical profession (as fixers) and by the health industries (not least Big Pharma with its pill-for-every-ill approach to suffering). It is supported by a short-termist managerialism which insists on measurable targets or “outcomes” in clearly defined groups of patients. So we end up with people being classified according to diagnoses and then given treatments intended to produce changes in a set of variables defined by experts.
In ADHD (Attention Defecit Hyperactivity Disorder) the thrust has been to classify it, turn it into a defined entity and then “treat” the symptoms. The pharmacological approach is not curative but in the short term it takes the edge of the more extreme behaviours and so makes the child’s behaviour more acceptable. To be fair, this can also produce real benefits for the child who can then progress socially and educationally. What this study shows, however, is that in the longer term these benefits are often not sustained. And worse than that, in the longer term, the disadvantages of a drug approach become more apparent – stunted growth being one of the main findings.
What’s a better way? Well we don’t know yet but a complex approach involving the parents, the child, and the school seems to bring sustained benefits. And what about the roles of diet and the lived environment?
The trouble is those kinds of approaches are not as easy to deliver as a drug and the outcomes are not necessarily so measurable. But we have to bite that bullet if we want to move away from drug-focussed containment, to genuine improvement in terms of coping, resilience and growth.
Heroes Not Zombies 
I am an adult with ADD. There are many alternative methods that are great approaches, such as biofeedback, diet management, and meditation and I agree that medication should be avoided if it can be helped if only for financial reasons. However, I have problems with articles written as this one is.
I am not sure what kind of long-term effect Ritalin or any other drug was predicted to have; I never heard any such promises before or after diagnosis at age 26. I’m not sure why anyone would think a medication would cure a disease when it hasn’t been promoted that way.
Ritalin is not the only drug available for ADD now, there are a few others on the market. Yet when ADD comes up, Ritalin is the drug that is stigmatized. I understand the other drugs probably have not been through all of the stages of study, but still, concentrating on Ritalin is a very myopic view of what goes on in modern day treatment when other drugs are available and being used.
It would be so refreshing to see an article that is not merely critical of a specific drug and then vaguely, generally encouraging of alternative treatments. It would be refreshing to see an article that provides statistics, results and anecdotes from patients undergoing alternative treatments. If an article discusses something like stunted growth, it would be comforting if more facts such as what age the children with stunted growth began drug treatment, if the age you start taking drug treatment matters, if the dosages for the patients adversely affected were truly appropriate for their weight, etc, etc, etc.
What works for one ADD patient will not necessarily work for another, and any good doctor will explain that, and explain not every ADDer will respond to medication, will explain the side effects of the available medications and how they affect the body, and then give the patient trials starting at very low doses. I haven’t met any parent of an ADD child who just doses up their kid without thoroughly looking into all of the facts although those types of parents may be out there. And it would be lovely to see an article that reflects these realities.
Hi CAK and thanks for this thoughtful comment.
Oh dear! I think you’re looking for something my blogging doesn’t do! I agree that it would be fabulous to have the kind of information you are looking for online and if you know where it is I’d be really grateful for the links and will put up a post about it.
This post was only about one particular study – one which was being publicised by the BBC this week – and the details about growth retardation and so one will only be partially answered by your reading the full research – but I can tell you the research so far hasn’t broken down the elements you’re interested in (age of commencement of drug taking vis a vis growth retardation and dose specific amounts with regard to body weight) but I agree these are interesting and important questions.
The study was specifically designed to look at the drug approach as compared with behavioural, psychological and parental interventions – so it wasn’t being myopic by focussing on the effects of the medication.
I totally agree with your statement that different interventions will work for different people. I profoundly dislike the one-size-fits-all approach which is neither rational nor realistic.
You are right about the extent to which parents differ in their consideration of options and effects of different treatments and, also, there are differences between doctors in the extent to which they help their patients make properly informed choices.
The first point of this post is to highlight that short term gains are insufficent to recommend a treatment for a chronic condition, but, sadly, almost all clinical trials are short term so the evidence of longer term effects needs to specifically sought to help us understand a more real life picture. Until this study was conducted, for example, doctors were not in a position to inform patients about the short term vs the long term outcomes or about issues such as growth retardation.
The second point of this post is to warn against the quick fix mentality of much contemporary practice. True healing takes time and frequently requires complex interventions.
Sorry you were disappointed but you seem a pretty knowledgeable person about these issues and I’d be really grateful if you’d send me any links to articles about ADHD and its treatment which do answer some the interesting questions you pose. Maybe you’ve even written something like that yourself?
Thanks again for taking the time to write such a helpful comment highlighting so many important issues.