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Panorama: ADHD drugs have "no beneficial effects"
A Panorama investigation (Monday 12 November, 8.30pm, 91Èȱ¬ One) reveals that one of the biggest and most influential studies of Attention Deficit and Hyperactivity Disorder (ADHD) ever done suggests that drugs widely used to treat children do not work in the long term.
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The Department of Health can't say how many children are on ADHD medication but the 91Èȱ¬ has discovered that GPs in the UK prescribed powerful drugs like Ritalin and Concerta to around 55,000* children last year. Many stay on these drugs for years at a time. Last year alone this cost the NHS £28million**.
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But new research from the US suggests that – while the drugs work in the short term – there is no demonstrable improvement in children's behaviour after staying on ADHD medication for three years.
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The Multimodal Treatment Study of Children with ADHD (MTA) – conducted by some of the world's leading authorities on the behavioural disorder – has been following the treatment of 600 children across the US since the Nineties.
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In 1999, it concluded that after one year, medication worked better than behavioural therapy for ADHD. This finding was to influence medical practice on both sides of the Atlantic and prescription rates in the UK have since tripled.
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However, the MTA study has just published its latest findings, having continued to monitor the 600 children. It found that the benefits of medication disappeared after three years and that the children who stayed on drugs for the full period had stunted growth.
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Co-author, Professor William Pelham, of the University at Buffalo, says: "The children had a substantial decrease in their rate of growth so they weren't growing as much as other kids both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects – none."
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"In the short run [medication] will help the child behave better, in the long run it won't. And that information should be made very clear to parents."
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Professor Pelham adds: "I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn't happen to be the case. There's no indication that medication's better than nothing in the long run." Ìý
Not only are the long-term benefits of medicating children with ADHD now open to question, Panorama has uncovered an even more worrying trend in the treatment of children's behavioural problems. The number of children being prescribed powerful antipsychotic drugs – normally used to treat psychosis and schizophrenia in adults – is on the increase.
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The 91Èȱ¬ has discovered that around 8,000* children across the UK were prescribed anti-psychotics like Risperdal and Zyprexa in 2005, often for behavioural problems. These drugs – also known as heavy tranquillisers – are known to cause facial spasms, rapid weight gain and diabetes and have even been linked to brain damage in adults.
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Dr Tim Kendall of the Royal College of Psychiatrists research group is heading a team for the National Institute for Clinical Excellence (NICE) that is writing new guidelines for the treatment of ADHD.
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He says of the rise in antipsychotic prescribing to children:
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"A generous understanding would be to say that doctors have reached the point where they don't know what else to offer and they haven't got the right supports to help parents and children in difficult circumstances. But I think perhaps even that is no real excuse for drugs which are associated with such severe side effects."
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The new NICE treatment guidelines will be published next year.
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Dr Kendall says: "I hope that we will be able to make recommendations that will give people, based on the best evidence we've got, a comprehensive approach to treatment which will advise about the use of parent training programmes and the use of behavioural interventions of other kinds, which will advise about what teachers might be able to do within the classroom when they're trying to deal with kids who have difficult problems of this kind.
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"I think the important thing is that we have a comprehensive approach which doesn't focus just on one type of treatment." Ìý
The programme contains disturbing footage of 16-year-old Yaz Shah from Louth in Lincolnshire having to be pinned to the floor because of her uncontrollable rage just last year.
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She was diagnosed with ADHD ten years ago but finally decided to come off medication at the start of 2007 to see if she could control her behaviour herself.
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She has managed to turn her life around, passing eight GCSEs this summer when previously she had been just scraping by at school.
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Craig Buxton, 14, from Stoke-on-Trent in Staffordshire, is still on the stimulant Concerta. He has been on medication for ADHD for nearly a decade. Panorama first filmed with him in 2000 but his behaviour now is worse than ever.
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His family agreed to keep a video diary and captured on camera disturbing examples of just how explosive Craig's behaviour can be. He recently assaulted three school teachers and is now out of school.
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In a rare moment of reflection, Craig contemplates what things in life make him feel happy.
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He says: "I'm happy when I'm not angry, I'm happy when I don't swear, I'm happy when I see my parents and I'm happy when they're happy."
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But good times are all too fleeting for Craig and his family. His parents say they have repeatedly asked for help with Craig and fear he will end up in prison if he does not get more than just medication.
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Craig's stepdad, Alan Hudson, says: "One day Craig's going to get himself in a lot of trouble and then we won't be able to help him. I just hope that day doesn't come but I can see its well on its way. As he's getting older he's getting much stronger and who knows what he's going to do."
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Notes to Editors
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Sources:
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*Centre for Paediatric Pharmacy Research, University of London
** Prescription Cost Analysis 2006 (England, Wales, Scotland, Ireland)
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Panorama, What Next For Craig? Monday 12 November 2007, 8.30pm, 91Èȱ¬ One
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