A new meta-study from Italy, published in the Archives of Disease in Childhood (April, 2014) has found that few research studies have evaluated the long term safety of drugs typically used to treat ADHD. Reviewing six studies that evaluated the incidence of negative side effects, the researchers concluded that there is a large gap in our understanding of what the long term effects of the medicines might be. Typical drugs prescribed for ADHD are Ritalin, Adderall, and Strattera.

With 6.4 million American children diagnosed with ADHD and two thirds of them taking medications, this gap in long term studies on the side effects of ADHD drugs is a public health concern.

The researchers found that the very few studies on the side effects of these drugs were funded by pharmaceutical companies. Not surprisingly, the studies concluded that ADHD drugs were safe in the long term carrying with them only mild side effects. The most common side effects found were decreased appetite, insomnia, headaches, and stomach pain. The authors of the Italian study pointed out that the pharma-funded studies may have ommitted more unusual side effects like suicidal thinking and long lasting erections. Because data were ommitted from the drug company-funded studies, the safety profile of ADHD drugs is not fully transparent.

In 2005, the U. S. Food and Drug Administration (FDA) found an increased risk of suicidal thinking in children and adolescents taking atomoxetine, known as Strattera, and ordered a "black box" warning on the drug. The FDA's decision was based on findings from research showing that atomoxetine is associated with a significantly higher incidence of suicidal ideation than placebo.

A 2011 study by Danish researchers pointed out that not only do drug manufactorers fund almost all of the studies on ADHD drugs, but also a majority of the researchers in these studies received contributions from the pharmaceutical companies producing the medications. The conclusions of studies by pharma-hired researchers could scarcely be free of bias. Like the Italian researchers, the Danish scientists call for more objective long term research on ADHD drugs funded by independent agencies.

Lately, I am seeing more and more parents looking at dietary changes as alternatives to medication for children who can't sit still at school and have trouble finishing their homework. Changing a child's diet can do wonders, at least for some kids. Some parents have found that removing artificial food dyes, artificial preservatives, sugar, and gluten from their children's diets can have a spectacular effect on the child's behavior and ability to focus. One mother found that after eliminating sugar, artificial colors and gluten from her son's diet, his facial tics disappeared and he became calmer at school. 

Of course, changes in diet are not always the whole story for calming down jumpy kids. Making sure that children have plenty of physical exercise, limiting time on electronic screens to one hour a day, having a calm home environment, seeing that a child gets enough sleep at night, and getting a tutor for a child who is struggling at school are effective interventions as well. 

 UPDATE: On May 13, 2014, a new research study on the long-term effects of Ritalin on the brains of youth was published in Frontiers in Systems Neuroscience.  Researchers from the University of Delaware and Drexel University College of Medicine reviewed the latest research on the effects of "smart drugs" and discovered smart drug use is not as benign as we might think.They found that though Ritalin can boost mental performance in the short term, longer term use can "adversely impact the brain’s plasticity, interfering with people’s ability to plan ahead, switch between tasks and be overall flexible in their behaviors." this gives parents all the more reason to look at alternatives to drug treatment of ADHD--like dietary changes and family therapy.

Copyright © Marilyn Wedge, Ph.D.  

Marilyn Wedge is the author of Pills are not for Preschoolers: A Non-Drug Approach for Troubled Kids and a forthcoming book on ADHD in America and abroad: A Disease Called Childhood

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