A new study of Scottish children published in the JAMA Pediatrics this week, suggests that the 1.0% of subjects (N= 7413) that were being medicated for attention deficit hyperactivity disorder had poorer outcomes on a wide range of measures compared with others in the study (N=766,244). The outcomes included: poor academic attainment, unauthorized absence from school, more likely to be unemployed, and more likely to be hospitalized.
Naturally, these results are going to be used by the ADHD powers-that-be to indicate that ADHD is a serious disorder that must be treated as a significant threat to a child’s well being. However, there are a number of questions that remain unanswered in the study. First, were there other children in the study with a diagnosis of ADHD who weren’t taking medications, and if so, what were their outcomes in comparison with the medicated group? Only 1% of the total group were taking medications, and yet statistics from another study suggest that 4.5% of Scottish children were hyperactive as measured by the ubiquitous Connors Teacher Rating Scale (and this figure was from 1989, before the international explosion in ADHD diagnoses had occurred). If there was an unmedicated group with a diagnosis of ADHD, and they had better outcomes than the medication group, then maybe psychoactive medications had a role in the resulting negative outcomes.
Second, if the 1% of kids being medicated had such poor school and health outcomes, then what does this say about the power of medications to treat ADHD? The point that ADHD advocates have made over and over again is that ADHD is a serious disorder that is most effectively treated with psychoactive drugs. In this case, the psychoactive drugs didn’t seem to work, and unless you argue that the outcomes would have been worse without them (and there’s no evidence for this in the study), then the study should be interpreted as suggesting that ADHD drugs seem to be ineffective in helping kids with regard to school, home, and health outcomes. In such a case, a broad implication of the study should be that non-drug alternatives be explored in ameliorating the symptoms and outcomes associated with an ADHD diagnosis. Unfortunately, most non-drug alternatives receive scant attention in the ADHD literature.
If you’d like practical information about non-drug alternatives, get my book The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion.