This blog post explores recent studies of the brain function of children taking drugs to treat attention deficit hyperactivity disorders (ADHD). It vividly captures differing expert interpretations of how the results should be applied to clinical practice. Readers will come away with a good sense of the murkiness of available evidence. The story missed on some criteria, though, mostly because it seems to assume that readers are very familiar with ADHD and common treatments.
The numbers of children diagnosed with ADHD and the prescription of stimulants has increased tremendously over the past 15 years or so. Many people worry about the long-term consequences for children’s brains. While some recent research suggests that there is little to fear, those advocating for this view are very strongly affiliated with the drug industry.
The costs of ADHD medications and other common therapies are readily available. The story would have been better if it had included at least a brief reference to these costs
The story seems to assume that readers are familiar with ADHD and the common range of treatment effects in children. It would have been nice to see more background, including specific numbers, rather than vague references to how children may feel “more focused and in control” or “impressive short-term relative benefits of medication.” Different people may have different definitions of “impressive.” Numbers would help.
The story cries out for some details about the downsides of medication. It includes a statement that most children quit taking their medicine. Why? Again, the story seems to assume that readers are ADHD aficianados.
A strength of this story is that it clearly tackles limitations in the available studies. Without going into dense details of methodology, it makes clear that leading experts have differing interpretations of the evidence that is available.
For those interested in that detailed context, we’d note that this story raises an issue we commonly discuss with scientific studies: correlation vs. causation. Is drug treatment responsible for changes on brain scans recorded during and after drug treatment for ADHD — or is it merely associated with those changes? Note that drug treatment brings about changes in children’s perception, attention, and behavior, and such changes have the potential to “rewire” the brain independent of any drug effect. It’s conceivable that any intervention that promotes attention and focus could yield the same effects on the brain without the need for drugs.
It is clear that the discussion is about the more than 6-million children in the United States who already have been diagnosed with ADHD.
The best feature of this story is the presentation of experts with different perspectives who outline the reasons for their views. It also notes concerns about financial ties between some experts and the pharmaceutical industry.
While we’ll award a satisfactory rating, we wish the story had put more emphasis on some of these researchers’ checkered history with respect to conflict disclosure. Notably, the lead author of the study cited as evidence for a normalizing effect on brains reportedly failed to disclose payments totaling more than $1.6 million dollars from drug companies. And the source citing that study, Dr. Timothy E. Wilens, failed to disclose similar payments.
While the story seems open to the possibility that ADHD can be treated without drugs, it doesn’t specify any alternative approaches or how they compare with drug treatment.
It is clear that the medications being discussed are widely available.
The key point of the story is that experts are applying relatively recent study results and theories about the effects of ADHD medications on the brains of children. While the drugs themselves have been in use for many years, the story presents evolving views about how to apply the results of recent studies to treatment decisions. As the story notes, recent research might encourage more parents “to start their children on these medications early and continue them for longer.”
The story appears to be based on original reporting and the expertise of the writer.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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