58 Drug treatment of ADHD in children and adolecents – tenuous scientific basis

Abstract

This presentation highlights recent publications showing that the evidence for the efficacy of pharmaceutical treatment in children with ADHD diagnosis is weak, especially over the long term and that it comes with previously unrecognized risks of side-effects.Despite widespread pharmacological treatment of ADHD, the first comprehensive systematic review on the use of methylphenidate in children and adolescents was not published until 2016. A Cochrane group examined 185 randomised controlled trials with more than 12 000 children and adolescents and concluded that existing studies were of such low quality due- to high risk of bias – that it was not possible to say for certain whether methylphenidate is beneficial for children and adolecents with an ADHD diagnosis. An additional review from Cochrane concludes that the evidencebase for the use of amphetamines in ADHD is similarily weak. Spring 2017, the latest results form the Multimodal Treatment Study of Children with ADHD (MTA) concluded, 16 years after the start of the study, tht longterm use of stimulants is associated with suppression of adult height, but no reduction in symptoms. A new Cochrane review (in print 2018) included 260 relevant non-randomized studies with 2,283,509 participants worldwide. The occurrence of serious adverse events in the comparative cohort and patient-controlled studies was 1.36 times more frequent in participants that used methylphenidate when compared to controls. The proportion of withdrawals from methylphenidate due to serious adverse events in cohort studies without a control group was 1.50%, and the proportion of withdrawals due to adverse events of unknown severity was 7.30%. In addition, the proportion of withdrawals due to non-serious adverse events was 6.2%, and 16.2% for unknown reasons. These findings are discussed in light of overdiagnosis. Children with ADHD have genuine and serious problems. However, we cannot ignore the fact that several recent studies have yielded only weak evidence to support the extensive use of medication that occurs today. This state of affairs should trigger renewed public and expert discussion on the pharmacological treatment of ADHD in children and adolecents. Objectives A presentation of recent reviews on the pharmacological treatment of ADHD in children and adolecents in light of overdiagnosis. Method Discussant review. Results Recent studies have yielded only weak evidence to support todays extensive use of ADHD-medication to childen and adolecents. Conclusions The state of affairs should trigger renewed public and expert discussion.