SYDNEY—Stimulant drugs can no longer be considered the mainstay of treatment for hyperactivity disorders, warns an Australian psychiatrist who is urging doctors to review their patients' need for the controversial medications.
Sydney University Professor Joseph Rey, a specialist in child and adolescent psychiatry, said the Australian medical community should take notice of new findings from a major US study which suggest Ritalin and dexamphetamine, the drugs most commonly used to treat ADHD, are of limited use.
The study of almost 600 children revealed that while those on stimulants did better than kids on behavioural therapy or no treatment at 14 months, there was no difference between the groups after three years. It also confirmed the drugs could stunt growth.
Prof Rey said the results of the US National Institute of Mental Health (NIMH) study should change attitudes to ADHD treatment.
"While results of one study rarely justify drastic changes of practice, the findings underscore the complexity of ADHD, show that stimulant drugs are far from being a silver bullet and that there is much we do not yet know," Prof Rey wrote in the latest Medical Journal of Australia.
"This does not mean that stimulants no longer have a place in the treatment of ADHD.
"However, that place has shrunk and clinicians should be circumspect when assessing the need for ongoing treatment, (for example) through medication breaks."
Research shows up to 11 per cent of Australian children aged six to 17 have the chronic condition, which is characterised by symptoms of inattention, hyperactivity and impulsive behaviour.
Stimulant drugs are used widely, with prescribing rates increasing almost tenfold over the past decade. Rates are highest in Western Australia where almost five in every 100 children are on the medication.
Initial results from the NIMH study released in 1999 showing the short term benefits of medication were influential in driving up prescription rates.
But the results of the two-year follow-up showed children in the other treatment groups - those on tailored psychosocial treatment or routine community care - had essentially "caught up" to those on medication taken alone or combined with behavioural therapy.
Prof Rey said this leaves long term benefits in doubt and and suggests there might be a certain amount of "growing out" involved with the condition.
"Much needs to be done to clarify who benefits the most from medication, at what developmental point stimulants are most useful and for how long they should be taken," he said.
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