Special Editorial: Shooting Holes in the Argument for Ritalin

By Anita M. Schimizzi, Ph.D.

I became intrigued by an article that I read a few weeks ago in the NY Times and I keep finding myself coming back to it as I work with parents.  The topic?  Medication may not be as magical in treating ADHD as we had all hoped.

Now before I go any further, let me make clear that I am not a medical doctor and I am in no way trying to urge parents to discontinue their child’s ADHD medication.  I am, however, suggesting that parents continue to inform themselves of research findings in this area so they can discuss new information with their child’s treating physician and make informed choices as a result.

Dr. Sroufe, the author of the article and professor emeritus at the University of Minnesota’s Institute of Child Development, argues that the research world has a pattern of focusing on short-term effects of ADHD medication and fails to pay enough attention to long-term effects. 

It has been well-established that medications like Ritalin and Adderall can improve concentration and focus in individuals with ADHD.  These short-term effects can render a child once known for climbing the classroom walls able to sit and focus on reading.  Score one for medication!  (By the way, Dr. Sroufe states that these effects ring true for everyone and not just those with ADHD.) 

Dr. Sroufe goes on to look at the effects of long-term use of stimulant medication, and these don’t sound as fabulous.  He tells us that the positive effects lessen over time as people develop a tolerance to the drugs.  He also argues that the upsurge in behavior problems that parents report when they take their child off stimulant medication is actually due to withdrawal effects in a body that has become accustomed to the drug.  

Here’s the juicy part.  Dr. Sroufe reports that no studies have been able to support long-term benefits of using ADHD medication in the areas of behavior, academic performance, or relationships with peers.  “What?!” you may ask.  In fact, a long-term, well-conducted study that he cites from 2009 looked at a large group of children (almost 600) with attention problems that were placed into one of four groups: medication alone, medication + cognitive-behavioral therapy (CBT), CBT alone, or no treatment.  While initial results tooted medication’s horn, the results diminished over time to the extent that by eight years there were no detectable benefits to medication use in the areas of behavior and academics.  “Double what?!” you may now ask.

Argument is also made for a profound environmental component to the development of ADHD, effects that Dr. Sroufe says the research community has not addressed because the focus has been placed on brain and biological research.  And, Dr. Sroufe states, medication is no cure for environmental causes of ADHD symptoms.  For example, exposure to trauma can change the way our brains operate and the way we think, feel, and behave.  In fact, many trauma-related symptoms look a whole lot like what we see in ADHD.  A psychostimulant may help the traumatized child focus better at school, but does it address the trauma? 

In my own work with children with ADHD and their parents, I find that the most work gets done when there is a meaningful shift made at home and at school.  More structure, more predictability, more skills to help regulate emotions, plenty of fresh air and active play, changes meant to soothe and to ease anxiety and distress, improve adult-child communication and increase self-care in academic and social settings.  I could go on and on here.  My point is that there really are an astounding number of ways to change the experiences of children with ADHD.  Yes, medication may help and it sure is quick.  Over the long-term, we may need to be considering a whole lot more than that, though.

Thanks for reading.  –Anita

Source: Sroufe, L.A. (2012 January 28). Ritalin Gone Wrong. The New York Times.  Retrieved from www.nytimes.com