In February 2010 a review of information from the Raine Study, a longitudinal study of the health and wellbeing of thousands of Western Australian children, provided the world’s first long term (8 year) data on the safety and efficacy of ADHD stimulants. It provided challenging evidence that amongst children diagnosed with ADHD those ‘medicated’ with stimulants had significantly worse outcomes than those ‘never medicated’. Specifically those ‘ADHD diagnosed and  medicated’ were 10.5 times more likely to be failing school than those ‘ADHD diagnosed and never medicated’. In addition the past use of stimulant medications was associated with permanently raised diastolic blood pressure.

Some of the authors of the ADHD data review (with a history of advocating the use of stimulants) were obviously expecting different results and tried to diminish the significance of its findings and revised their own methodology after results were in. Fortunately a robust committee process lead by a principled chairperson ensured the integrity of the review.

The Raine Study is a unique data source with the potential for further analysis. The ADHD medication review analysed the outcomes for the Raine Study children at age 14. A further six years of data (at ages 17 and  20) has now been collected. Whether this rich data source will be utilised, and who will do the analysis (and can they be trusted), are all questions that are yet to be answered.

There are literally thousands of short term, mostly pharmaceutical company sponsored studies on the effectiveness of ADHD stimulants. The majority of these studies conclude that ADHD stimulants are more effective than non-drug treatments in the short term. Aside from research bias, there are two reasons why these results are entirely predictable. Firstly, amphetamines (dexamphetamine) and near amphetamines like Ritalin alter behaviour immediately. And secondly, while the behaviour-altering effects of stimulants are almost universal (regardless of ADHD status), the effects of other forms of treatment are not. For example diet modification will be of little or no benefit if the underlying cause of behavioural problems is an undetected hearing problem.

The pharmaceutical companies exploit this by replicating short term studies and avoiding extended research that they realise may well demonstrate that in the long term amphetamines and near amphetamines are bad for growing minds and bodies. Ironically they justify this lack of long term research on ethical grounds, arguing either it is unethical to:1- experiment long term on children with pharmaceuticals or 2- deny children with a ‘neurobiological deficit’ (i.e. ADHD) access to ‘effective treatment’ (i.e. stimulants) by placing them on placebo or exposing them to unproven non-pharmaceutical treatments.

Until recently the best source of long term data on the safety and efficacy of stimulants was the three-year data from the Multimodal Treatment (MTA) Study which demonstrated no long term benefits and hinted at sustained harm (stunted growth and drug abuse). (for more information on the MTA refer to Pseudoscience Supporting ADHD)

However, published In February 2010 the Raine Study ADHD Medication Review provided the world’s first independent data on the long-term effects (eight years) of psychostimulant medication.^[1] The two most significant findings of the Raine Study ADHD Medication Review were:

1.   Long-term cardiovascular damage: ‘The most noteworthy finding in the study was the association between stimulant medication and diastolic blood pressure. Compared to not receiving medication, the consistent use of stimulant medication was associated with a significantly higher diastolic blood pressure (of over 10mmHg). This effect did not appear to be solely attributable to any short-term effects of stimulant medication, as when comparing groups who were currently receiving medication, it was found that those who had consistently received medication at all time points had a significantly higher mean diastolic blood pressure than those who had not consistently received medication in the past (difference of 7mmHg). These findings indicate there may be a lasting longer term effect of stimulant medication on diastolic blood pressure above and beyond the immediate short-term side effects.’ ^[2]

2.   School failure: ‘In children with ADHD, ever receiving stimulant medication was found to increase the odds of being identified as performing below age-level by a classroom teacher by a factor of 10.5 times.’^[3]

In addition the report indicated that there was a marginally negative outcome for both ADHD symptoms (inattention and hyperactivity) and depression with the long-term use of stimulant medication.^[4] (For more detailed information on the findings please refer to Excerpts from the Raine Study Data ADHD Long Term Drug Effect Review.)

The finding that amphetamine use may permanently raise diastolic blood pressure is of great significance. It had been previously recognised that while stimulants were in the patient’s system, heart rate and blood pressure were elevated, leading to the associated risks of heart attacks and strokes. But it was assumed that when the short-term stimulant effects wore off the cardiovascular system returned to normal.

The most startling finding was that past stimulant use increased the probability of an ADHD child falling behind at school by a massive 950 per cent. This finding completely undermines the hypothetical basis of medicating for ADHD. As stated in the review report the basis of the belief that amphetamines have long-term benefits are short-term studies, which ‘indicate that immediate management of ADHD symptoms allows children to function more effectively within a classroom. It is hypothesised that this makes children more available for learning and allows children to learn skills and concepts which are necessary to function well within a classroom in the future.’^[5] The analysis of the Raine Study data was the first time this hypothesis had been tested.

An advantage of using data from the Raine Study is that it reduces the risk of design bias as the original designers of the study had no idea the data would eventually be used to study ADHD.  In addition the body that commissioned the ADHD review, the Western Australian Ministerial Implementation Committee on ADHD (MICADHD), was an extremely diverse group. Opinions as to the safety and efficacy of stimulant medications within MICADHD were highly divergent.  This lack of consensus was a strength of the study as it limited the potential for ‘publication bias’ where there is a collective decision to bury results that are not in keeping with the consensus position of participants.

The suggestion that the Raine Study would be a possible source of long-term data on stimulant medication was first made by MICADHD members with a long history of prescribing and advocating the use of stimulants. They were obviously expecting very different results. I expected the results to show no long-term educational benefits or some adverse educational outcome from stimulants, but even I was surprised by the strength of the negative outcome. Initially, the medication proponents on MICADHD tried to claim that the outcomes for the medicated children were most probably worse than those for un-medicated children, because the medicated children had more severe ADHD. However, as a member of the MICADHD committee I insisted on a comparison of the groups at age five, which was prior to any of the children having been medicated. This analysis established that there were no statistically significant differences in developmental, behavioural and health measures before the children were medicated.

This did not prevent subsequent efforts to explain away this research using the unsupported hypothesis that differences in educational performance and the increase in blood pressure were due to pre-existing differences. Professor Ian Hickie from the Brain and Mind Research Institute dismissed the poor educational outcomes saying, ‘typically those kids who go on the medication are considerably worse to start with’.^[6] Hickie’s comment needs to be seen in the light of his commercial ties to pharmaceutical companies. His CV acknowledges receipt of $411,000 from four different pharmaceutical companies, mostly for research on psychotropic medications for depression, psychosis and bipolar disorder.^[7] Even supposing Hickie’s criticisms had been valid, and the children who had been medicated ‘were considerably worse to start with’, if amphetamines worked, they should have been performing at least as well at school as those with moderate, un-medicated ADHD.

As with all studies there are limitations with the ADHD medication review. While the sample size (131) was small, ‘it was larger than those in many short-term studies that supported the use of stimulants as a safe and effective treatment for children with ADHD’.^[8] Although the evidence now available from the Review does not prove that amphetamines cause failure at school and permanent cardiovascular damage, it is significant because there is so little other long term research to guide clinical practice.

The lack of enthusiasm for the findings of the research demonstrated by some of its authors diminished its impact when it was first published in February 2010. If not for the robustness of MICADHD Committee processes and the integrity of its chairperson, Professor Lou Landau, it challenging findings may have never been published. However, the MICADHD Committee is now dissolved. The question of if, and just as importantly who, will be conducting any future ADHD medication analysis of new Raine Study data (at age 17 and 20) is unclear.

These are important questions as the Raine Study is a unique and significant data source. The process of further ADHD medication analysis of Raine Study data must be transparent and independent of undue influence. Vigilance is required.

Appendix

What is the Raine Study and how is the data used to analyse the safety and effectiveness of ADHD stimulants?

‘The Western Australian Pregnancy Birth Cohort (Raine) Study is an ongoing longitudinal study following 2,868 children. The study began in 1989 as a pregnancy cohort of women enrolled at or before the 18th week of gestation from the public antenatal clinic at the principal obstetric hospital in Perth, Western Australia or nearby private practices. Since 1989, data has been collected from the participants (both the mother and her child) at regular intervals including when the child turned 1, 2, 3, 5, 8, 10, 14 and 17 years old.’^[9]

Across the globe there are other similar long term, large scale, studies into children’s health and wellbeing, however, the Raine Study is the only one in a location which has had high rates of ADHD stimulant child prescribing. This unique potential data source was recognised by the Western Australian Ministerial Committee on ADHD (MICADHD) who commissioned a review of the Raine Study data in response to a 2004 Western Australian Parliamentary Inquiry that recommended “research into the safety and efficacy of the long run use of psychostimulant medication”.^[10] ,^[11]

By age fourteen ‘of the 1785 adolescents in the sample, 131 (7.3%) had received a diagnosis of ADHD.’^[12] At age five none of the 131 had taken ADHD stimulants. The comparison of the groups at age five showed there were no statistically significant differences in symptom severity or health measures. The statistically significant differences that existed at age 14 occurred between age five and fourteen, after some of the children were medicated. To the extent that (non statistically significant differences) existed at age 5 these were ‘controlled for by using the ‘propensity for medication’ score, the symptom severity before commencement of medication treatment, and a number of sociodemographic measures.’^[13]

The data for the 131 ADHD diagnosed children was grouped for analysis in two different ways:

The first was by ‘Current Use of Medication’. At age fourteen, “21 (16.0%) were using medication… and had used it consistently since being diagnosed with ADHD; 40 (30.5%) were using medication.. but had not consistently used it in the past; 41 (31.3%) had used medication in the past be were not using it at age 14, and; 29 (22.1%) had not reported using stimulant medication.”^[14]

The second was by ‘Ever Use of Medication’. Of the 131 children, “21 (16.0%) reported the use of stimulant medication at all three follow-up points (8, 10, 14 years), 42 (32.1%) at two follow-up points, and 39 (29.8%) at one of the follow-up points. 29 (22.1%) reported no use of stimulant medication at any of the follow-up points.”^[15]

These two measures gave the capacity to analyse the differences attributable to differences resulting from 1- residual effects of medication, 2- current effects of medication, 3- effects of extended duration of medication.

http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf

[4] ibid., p. 5

http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf

[5] ibid., p. 30

http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf

; The short term studies referred to in the Raine Study are Howard B. Abikoff, et al., ‘Methylphenidate effects on Functional Outcomes in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS)’, Journal of Child and Adolescent Psychopharmacology, 17(5), 2007, pp. 581–92; C. L. Carlson & M. R. Bunner, ‘Effects of Methylphenidate on the Academic Performance of Children with Attention-Deficit Hyperactivity Disorder and Learning Disabilities’, School Psychology Review, 22(2), 1993, pp. 184–98; Irene M. Loe & Heidi M. Feldman, ‘Academic and educational outcomes
of children with ADHD’, Journal of Pediatric Psychology, 32(6), 2007, pp. 643–54.

[6] Interview with Professor Ian Hickie on ABC PM program with Mark Colvin, ‘New Research Reignites Debate over ADHD’, 17 February 2002. Available at http://www.abc.net.au/pm/content/2010/s2822748.htm (accessed 15 March 2010).

[7] Professor Ian Hickie received the following grants totalling $411,000 from pharmaceutical companies: $10,000 from Roche Pharmaceuticals (1992); $30,000 from Bristol-Myers Squibb (1997); $40,000 from Bristol-Myers Squibb (1998–1999); $250,000 from Pfizer Australia (2009); $81,000 from Pfizer Australia (n.d.). Cited in Ian Hickie, Curriculum Vitae, last updated 23 August 2009.

[8] Government of Western Australia, Department of Health, Study raises questions about long-term effect of ADHD medication, Media Release, 17 February 2010.

[9]  Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p14

[10] Education and Health Standing Committee: Annual Report 2003-2004, Legislative Assembly, Parliament of Western Australia, Perth, October 2004 recommendation 2, page 42

[11] Western Australian Ministerial Implementation Committee for Attention Deficit Hyperactivity Disorder, Raine Attention Deficit Hyperactivity Disorder Study, September 2009

[12] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p25

[13] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p56

[14] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p26.

[15] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p26

Press Release – Embargoed until Wednesday 17 February 2010

The world’s first long term data review revealed that ADHD diagnosed children who had used stimulants (amphetamine based drugs like dexamphetamine and Ritalin) were 10.5 times more likely to fail to reach an age appropriate educational standard than children diagnosed with ADHD but never medicated.

“This completely destroys the basis of ADHD child drugging. The ADHD industries claim that without medication ADHD children risk academic failure has been shown to be complete BS. It is not just that ADHD drugs don’t improve long term school performance, the evidence is they drag kids down.”

“Parents will be furious they have been conned into giving their children taxpayer subsidised amphetamines. No responsible parent would knowingly increase their child’s chances of academic failure.”

The finding that past stimulant use was associated with sigificantly and permanently increased diastolic blood pressure which increases the risks of future heart attacks and strokes is of even greater concern. “Failing school is bad enough but increasing the risk of an early death from a heart attack or a stroke is something else.”

“The short term behavior modifying effects of amphetamines can fool parents into believing they are helping their child particularly when a doctor is telling them the ‘medication’ is safe and effective. Now this information is available no responsible doctor will prescribe for ADHD. Even if some quack wants to, I doubt they will be able to get any malpractice liability insurance.”

Mr Whitely will write to every medical malpractice insurer to make sure they are aware of this groundbreaking world first long term research. “I will also be writing to Kevin Rudd to implore him to stop funding ADHD drugs via the Pharmaceutical Benefits Scheme. The money saved subsidising school failure and cardiovascular damage must be diverted the into things that help kids like speech therapy, occupational therapy and extra in class support.”

Prior to this review hundreds of pharmaceutical industry funded studies, lasting weeks or months, were used to support the claim that stimulants are safe and effective. These studies provided the ‘scientific basis’ for ADHD child drugging. Pharmaceutical companies chose the researchers, designed the studies, interpreted the results and controlled what was published.

In contrast the original data used in this long term (9 year) review came from the internationally respected Raine Study conducted by the Telethon Institute. The Western Australian Ministerial Implementation Committee on ADHD, who commissioned the review of the Raine Study data, was comprised of members with very different views as to the safety and efficacy of stimulant medications. “Some of the people who designed and initiated this data review have had very different views to me. But they can’t ignore this evidence, can they?”

Full report available here.

Highlights

Significance – The longitudinal and comprehensive nature of the Raine study provides a unique opportunity to examine the long-term outcomes associated with the use of stimulant medication during childhood.^[1] The 9 year data (ages 5 to 14) available from the Raine study is the only comprehensive educational, social, and health long term data source on the effect of stimulant medication available worldwide.

Permanent cardiovascular damage from medication – The most noteworthy finding in the study was the association between stimulant medication and diastolic blood pressure. Compared to not receiving medication the consistent use of stimulant medication was associated with a significantly higher diastolic blood pressure (of over 10mmHg) This effect did not appear to be solely attributable to any short-term effects of stimulant medication, as when comparing groups who were currently receiving medication, it was found that those who had consistently received medication at all time points had a significantly higher mean diastolic blood pressure than those who had not consistently received medication in the past (difference of 7mmHg).These findings indicate there may be a lasting longer-term effect of stimulant medication on diastolic blood pressure above and beyond the immediate short-term side-effects.^[2]

Significant long term impairment of educational performance from medication – In children with ADHD, ever receiving stimulant medication was found to increase the odds of being identified as performing below age-level by a classroom teacher by a factor of 10.5 times (compared to never receiving stimulant medication).^[3]…The finding that stimulant medication-use increased the odds of below-age-level academic achievement by a factor of 10 times strongly suggests that medication may not result in any long-term academic gains (as rated by a classroom teacher). And, at worst, may result in poorer teacher-rated academic performance.^[4]

ADHD symptoms (inattention and hyperactivity) and depression marginally worse with long term use of medication - …externalising behaviour and attentional problems did not appear to improve or worsen significantly between the ages of 5 and 14 in children with ADHD, regardless of medication use. Where an effect was noted, this was in the direction of symptoms worsening with the use of ADHD medication (however, this effect was small and not statistically significant). The results seem to indicate that there is little long-term benefit of stimulant medication in the core symptoms of ADHD.^[5]

Whilst no statistically significant results were noted, a trend toward slightly higher depression scores was noted with the use of medication.^[6]

Why is this analysis so significant?

The longitudinal and comprehensive nature of the Raine study provides a unique opportunity to examine the long-term outcomes associated with the use of stimulant medication during childhood.^[7] The 9 year data (ages 5 to 14) available from the Raine study is the only comprehensive educational, social, and health long term data source on the effect of stimulant medication available worldwide.

Whilst there are thousands of mostly industry funded studies that claim to show ADHD stimulants are relatively safe and effective in the short term, “there is a paucity of evidence on the long term effects of psychostimulants on childen.”^[8] Whilst the greater part of the literature provides consistent evidence for the effects of stimulant medication in the management of ADHD symptoms, it is noted that a strong ‘publication bias’ (i.e. the likelihood of positive findings being published over ‘null’ findings) is present within the ADHD treatment literature (Schachter et al., 2001).^[9] Prior to the Raine Study review the longest relevant comprehensive study was the 3 year data from the Multimodal Treatment Study for Attention Deficit Hyperactivity Disorder (The MTA Study). ^[10] The MTA Study indicated the longer you look at the performance of ADHD medicated children the worse the results become.^[11] However, 3 years data can only at best be described as a medium term study.

Another advantage of the original Raine study data is that it reduces the risk of design bias as the original designers of the study had no idea the data would eventually be used to study ADHD. In addition the commissioning body, the Western Australian Ministerial Implementation Committee on ADHD (MICADHD), was a extremely diverse group. Opinions as to the safety and efficacy of stimulant medications within MICADHD are highly divergent. This lack of consensus should be seen as a strength of the study as it limited the potential for ‘publication bias’ where there is a collective decision to bury results that are not in keeping with the consensus position of participants.

What is the Raine Study and how is the data used to analyse the safety and effectiveness of ADHD stimulants?

The Western Australian Pregnancy Birth Cohort (Raine) Study is an ongoing longitudinal study following 2,868 children. The study began in 1989 as a pregnancy cohort of women enrolled at or before the 18th week of gestation from the public antenatal clinic at the principal obstetric hospital in Perth, Western Australia or nearby private practices. Since 1989, data has been collected from the participants (both the mother and her child) at regular intervals including when the child turned 1, 2, 3, 5, 8, 10, 14 and 17 years old.^[12]

Across the globe there are other similar long term, large scale, studies into children’s health and wellbeing, however, they are in locations with historically low rates of ADHD prescribing. The Raine Study is unique, in that it was conducted in a location which has had high rates of ADHD stimulant child prescribing. This unique potential data source was recognised by the Western Australian Ministerial Committee on ADHD (MICADHD) who commissioned a review of the Raine Study data in response to a 2004 Western Australian Parliamentary Inquiry that recommended “research into the safety and efficacy of the long run use of psychostimulant medication”.^[13],[14]

By age fourteen ‘of the 1785 adolescents in the sample, 131 (7.3%) had received a diagnosis of ADHD.’^[15] At age five none of the 131 had taken ADHD stimulants. The comparison of the groups at age five showed there were no statistically significant differences in symptom severity or health measures. The statistically significant differences that existed at age 14 occurred between age five and fourteen, after some of the children were medicated. To the extent that (non statistically significant differences) existed at age 5 these were ‘controlled for by using the ‘propensity for medication’ score, the symptom severity before commencement of medication treatment, and a number of sociodemographic measures.’^[16]

The data for the 131 ADHD diagnosed children was grouped for analysis in two different ways:

The first was by ‘Current Use of Medication’. At age fourteen, “21 (16.0%) were using medication… and had used it consistently since being diagnosed with ADHD; 40 (30.5%) were using medication.. but had not consistently used it in the past; 41 (31.3%) had used medication in the past be were not using it at age 14, and; 29 (22.1%) had not reported using stimulant medication.”^[17]

The second was by ‘Ever Use of Medication’. Of the 131 children, “21 (16.0%) reported the use of stimulant medication at all three follow-up points (8, 10, 14 years), 42 (32.1%) at two follow-up points, and 39 (29.8%) at one of the follow-up points. 29 (22.1%) reported no use of stimulant medication at any of the follow-up points.”^[18]

These two measures gave the capacity to analyse the differences attributable to differences resulting from 1- residual effects of medication, 2- current effects of medication, 3- effects of extended duration of medication.

What did the Analysis find?

The 9 year data from the Raine Study confirmed the trend evident from the 3 year data from the MTA study; that is, in the long term ADHD drugs are of no benefit and cause harm.^[19]

The major findings were:

Educational Achievement

‘In children with ADHD, ever receiving stimulant medication was found to increase the odds of being identified as performing below age-level by a classroom teacher by a factor of 10.5 times (compared to never receiving stimulant medication).’^[20] This findinding undermines the very basis of ADHD child stimulant prescribing as‘it is hypothesised that this (the treatment of ADHD with stimulants) makes children more available for learning and allows children to learn skills and concepts which are necessary to function well within a classroom in the future. Thus, children who have received stimulant medication at any time point should observe some long-term school-related benefits as a result’ (Carlson & Bunner, 1993).^[21]

Therefore ‘it would be expected that any stimulant medication-use would reduce short-term attentional and behavioural problems for the period in which it was used, thus allowing a child to learn the necessary information on which new information can be built upon in the future (Carlson & Bunner, 1993). The finding that stimulant medication-use increased the odds of below-age-level academic achievement by a factor of 10 times is in direct contrast to this hypothesis; indicating that ‘any’ use of stimulant medication is not associated with improved academic performance.’^[22]

…’The finding that stimulant medication-use increased the odds of below-age-level academic achievement by a factor of 10 times strongly suggests that medication may not result in any long-term academic gains (as rated by a classroom teacher). And, at worst, may result in poorer teacher-rated academic performance.’

Cardiovascular Function

Diastolic Blood Pressure

The most noteworthy finding in the study was the association between stimulant medication and diastolic blood pressure. Compared to not receiving medication the consistent use of stimulant medication was associated with a significantly higher diastolic blood pressure (of over 10mmHg) This effect did not appear to be solely attributable to any short-term effects of stimulant medication, as when comparing groups who were currently receiving medication, it was found that those who had consistently received medication at all time points had a significantly higher mean diastolic blood pressure than those who had not consistently received medication in the past (difference of 7mmHg).These findings indicate there may be a lasting longer-term effect of stimulant medication on diastolic blood pressure above and beyond the immediate short-term side-effects.^[23]

An elevation in diastolic blood pressure of 7 to 10mmHg does not necessarily represent a movement outside of the ‘normal’ range. This was mirrored by the fact that none of the children in the ADHD-diagnosed sample recorded a diastolic blood pressure that fell above the cut-off for the 95^th percentile (i.e. 79mmHg). However it should be noted that a meta-analysis examining cardiovascular function in adults found that elevated diastolic blood pressure, even falling within the ‘normal range’, significantly increases the risk of stroke and coronary heart disease. Prolonged elevation in diastolic blood pressure of 7.5 to 10mmHg was associated with 46% to 56% more stroke and 29% to 37% more coronary heart disease (MacMahon et al., 1990). However, whether similar long-term effects are associated with elevated blood pressure during childhood has not yet been studied.^[24]

Table 12. Estimated marginal means for diastolic blood pressure by current stimulant medication use (adjusting for gender, propensity, CBCL-E, CBCL-A, mother’s age, family structure, family income).^[25]

Resting Heart Rate

Whilst the results were not statistically significant, it is worth noting that there is a non-significant trend toward a higher resting heart rate in children who had consistently received medication (as compared to all other stimulant medication-use categories).^[26]

Systolic Blood Pressure

The pattern for Systolic Blood Pressure was similar to that for Diastolic Blood Pressure although increases in Diastolic Pressure are considered to be more important as they are more directly associated with adverse outcomes like heart attacks and strokes.

Table 11. Estimated marginal means for systolic blood pressure by current stimulant medication use (adjusting for gender, propensity, CBCL-E, CBCL-A, mother’s age, family structure, family income).^[27]

Change in Key ADHD Symptoms

‘Externalising behaviour and attentional problems did not appear to improve or worsen significantly between the ages of 5 and 14 in children with ADHD, regardless of medication use. Where an effect was noted, this was in the direction of symptoms worsening with the use of ADHD medication (however, this effect was small and not statistically significant). The results seem to indicate that there is little long-term benefit of stimulant medication in the core symptoms of ADHD.^[28]

Emotional Outcomes (Depression)

Whilst no statistically significant results were noted, a trend toward slightly higher depression scores was noted with the use of medication.^[29]

[1] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p14

[2] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p56

[3] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p5

[4] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): pp34-35

[5] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p6

[6] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p5

[7] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p14

[8] Finding 13 Western Australia Legislative Assembly, Attention Deficit Hyperactivity Disorder in Western Australia, Education and Health Standing Committee, Report No. 8, (2004): p42

[9] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p10

[10] KC Wells, WE Pelham, et al, ‘Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation’, (abstract), Journal of Abnormal Child Psychology, 28; 6 (2000) Available here. (accessed 7 February 2008)

[11] Peter S Jensen, L. Eugene Arnold, James M. Swanson et al, “3-Year Follow-up of the NIMH MTA Study”, Journal of the American Academy of Child & Adolescent Psychiatry, Vol 46: 8; August 2007: pp989-1002

[12] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p14

[13] Education and Health Standing Committee: Annual Report 2003-2004, Legislative Assembly, Parliament of Western Australia, Perth, October 2004 recommendation 2, page 42

[14] Western Australian Ministerial Implementation Committee for Attention Deficit Hyperactivity Disorder, Raine Attention Deficit Hyperactivity Disorder Study, September 2009

[15] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p25

[16] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p56

[17] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p26

[18] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p26

[19]The MTA’s co-author University of Buffalo, Professor William Pelham, was describing the MTA’s 3 year results analyzing the benefits of stimulant medication when he said “There were no beneficial effects – none. 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.” Allegra Stratton, ‘Questions raised about drugs as treatment for ADHD sufferers’, The Guardian, November 12th, 2007. Available here. (accessed 26 March 2008)

[20] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p5

[21] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p31

[22] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p34

[23] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p56

[24] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p48

[25] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p44

[26] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p46

[27] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p43

[28] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p6

[29] Draft: Long-term outcomes associated with stimulant medication in the treatment of ADHD in children, Perth, Telethon Institute for Child Health Research (January 2010): p5

(The video can be viewed by following the links located on the right hand side of the transcript article)