Latest / Dr Justin Coulson's Happy Families / Rethinking ADHD: Why Medication Isn’t the Magic Fix

Transcript

Rethinking ADHD: Why Medication Isn’t the Magic Fix · Dr Justin Coulson's Happy Families

• 0:06
  Speaker 1: This is the Happy Families Podcast. I'm doctor Justin Colson.
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  Speaker 1: Every so often a study comes along that creates shock
• 0:12
  Speaker 1: waves and a brand new, comprehensive thirteen year study of
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  Speaker 1: four thousand Australian children taking ADHD medication has reached a
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  Speaker 1: conclusion that has stunned researchers. I'm going to find out
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  Speaker 1: why next. Stay with us today. This is the Happy
• 0:31
  Speaker 1: Family's podcast, Real Parenting Solutions, every single day on Australia's
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  Speaker 1: most downloaded parenting podcast. We are Justin and Kylie Coulson. Kylie,
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  Speaker 1: this study I'm so excited to share for the Doctor's Desk.
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  Speaker 1: It comes from Deacon University in Melbourne and I want
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  Speaker 1: to give you a quick overview of where we're at.
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  Speaker 1: Here's the general rundown. Children medicated for ADHD have a
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  Speaker 1: lower quality of life than those with the condition who
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  Speaker 1: are unmedicated. This is a brand new study Deacon University
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  Speaker 1: Research is more than four thousand children from four to seventeen.
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  Speaker 1: The research has found that those taking ADHD medication like Ritlin,
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  Speaker 1: were struggling compared to children with a diagnosis who were
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  Speaker 1: not taking the medication. Direct quote from the lead author quote.
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  Speaker 1: Those taking ADHD medication in our sample experienced more severe
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  Speaker 1: ADHD symptoms, which may have significantly impacted children's functioning.
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  Speaker 2: When I think about children taking medication, specifically medication that
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  Speaker 2: alter's behavior, this to me feels more like a management
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  Speaker 2: approach to behavior for the comfort of the adults in
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  Speaker 2: the room.
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  Speaker 1: Okay, so that's a really provocative statement. Here's the thing.
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  Speaker 1: This is supposedly a shock finding, but we have known,
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  Speaker 1: in for people who are doing proper research in this area,
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  Speaker 1: we've known for a couple of decades now that the
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  Speaker 1: drugs don't work. Well, let me rephrase, the drugs do work,
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  Speaker 1: but they're not.
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  Speaker 2: Actually, they're just masking the bigger issue.
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  Speaker 1: Correct, They're masking bigger issues. They're masking systemic issues, issues
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  Speaker 1: in the environment issues. Let me give you an example.
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  Speaker 1: So the data that we're talking about here tells us
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  Speaker 1: the following. This is data from the Australian Institute of
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  Speaker 1: Health and Welfare and what it shows is that children
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  Speaker 1: aged twelve to seventeen prescribed ADHD related medications has tripled
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  Speaker 1: over the last ten years. We've gone from about two
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  Speaker 1: percent of twelve to seventeen year olds to six point
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  Speaker 1: six percent.
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  Speaker 2: So how much of this comes down to the fact
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  Speaker 2: that if you have a diagnosis then there is more
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  Speaker 2: funding thrown at you. In education system.
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  Speaker 1: You get a lot less funding. If funding an ADHD
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  Speaker 1: don't tend to tie together autism definitely, ADHD not so much.
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  Speaker 1: And even that's changing. Funding is constantly. It's just a
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  Speaker 1: c sort. It's a rollercoaster, and parents are screaming constantly
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  Speaker 1: saying I had money, it was taken away, or I
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  Speaker 1: need more money, or whatever it could be, because funding
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  Speaker 1: is such a merry go round and part of the
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  Speaker 1: problem is that the diagnoses keep on going up. So
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  Speaker 1: in Australia today around one in twenty children has ADHD
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  Speaker 1: one in twenty and most are diagnosed somewhere around about
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  Speaker 1: the age of six or seven, early primary school years.
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  Speaker 1: And there is an assumption. In fact, I read a
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  Speaker 1: recent article in press in the Murder Press that said,
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  Speaker 1: insid direct quote talking about the study we're discussing here,
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  Speaker 1: the finding is at odds with other studies that have
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  Speaker 1: discovered that taking ADHD medication is linked to better outcomes
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  Speaker 1: for children. That's a big fat lie And I want
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  Speaker 1: to spend a little bit of time in this Doctor's
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  Speaker 1: Desk episode talking about why it's a big fat lie,
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  Speaker 1: and it's provocative and it's really hard for people to hear.
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  Speaker 1: Because when your GP or your pediatrician is telling you,
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  Speaker 1: or even your child an adolescent psychiatrist is telling you
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  Speaker 1: that the drugs do work. For me to sit here
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  Speaker 1: on the podcast in a Doctor's Desk episode of and
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  Speaker 1: say well, actually, the drugs don't work, it can be really,
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  Speaker 1: really tough to hear. So I want to give you
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  Speaker 1: some evidence for it. Okay, the most I would say
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  Speaker 1: one of the most famous studies on the treatment of
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  Speaker 1: ADHD was published back in the turn of the century
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  Speaker 1: around that I can't remember the exact date, and it's
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  Speaker 1: called the MTA Study. It's the Multimodal Treatment of Children
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  Speaker 1: with ADHD Study, the MTA Study Multimodal Treatment Children with ADHD.
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  Speaker 1: It was a fourteen month study. And not only was
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  Speaker 1: it fourteen months so it's nice and longer itudinal, but
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  Speaker 1: it was a multi location trial. So it's not just
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  Speaker 1: a bunch of kids in Brisbane or a bunch of
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  Speaker 1: kids in Canberra, or a bunch of kids in South Australia.
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  Speaker 1: It's right across a whole lot of different locations. We've
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  Speaker 1: got five hundred and twenty seven children age seven to ten.
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  Speaker 1: They're randomized to four treatment groups. So you've got a
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  Speaker 1: medication only group, you've got to behavior therapy only group,
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  Speaker 1: you've got a combined medication and behavior group, and then
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  Speaker 1: you've got routine community care, which means that there's not
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  Speaker 1: really a whole lot going on, there's just general care
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  Speaker 1: for the child. And what the author's found after fourteen
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  Speaker 1: months of treatment was that there was more reduction of
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  Speaker 1: ADHD symptoms in the medication only group and in the
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  Speaker 1: combined medication and behavior therapy groups than the behavioral therapy
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  Speaker 1: only which, obviously, as you would expect in a study
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  Speaker 1: like this, did better than the routine community care group. Essentially,
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  Speaker 1: they were a control group. But if you do much
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  Speaker 1: more careful reading of this and I'm sorry to geek out,
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  Speaker 1: this is why you fall asleep in doctor's desk episodes,
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  Speaker 1: but this is what is so important about these episodes,
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  Speaker 1: and more detailed reading showed that there were some genuine
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  Speaker 1: problems with the conclusion that the group reached, and the
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  Speaker 1: peer reviewed paper brought as an example, two thirds of
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  Speaker 1: the routine community care group were also prescribed stimulants. They
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  Speaker 1: were also given drugs, though just part of the community care,
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  Speaker 1: and so the control group wasn't a true control group.
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  Speaker 1: They were receiving care from a GP or from whoever
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  Speaker 1: the parents could get help from, and two thirds of
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  Speaker 1: them ended up getting drugs during the trial anyway, but
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  Speaker 1: they had the poorest outcomes of all. Also, the behavioral
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  Speaker 1: treatment group, so they definitely didn't have any drugs that
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  Speaker 1: consisted of an intensive six week course and that could
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  Speaker 1: be completed at any time during the fourteen months. So
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  Speaker 1: by the time of the fourteen month evaluation, some of
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  Speaker 1: the families receiving that behavioral therapy intervention they completed it
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  Speaker 1: maybe nine months ten months before the final assessments, and
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  Speaker 1: others had only just done it. Whereas the medication group
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  Speaker 1: they had regular appointments throughout the study period and soil
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  Speaker 1: all of this raises the possibility of placebo effects being
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  Speaker 1: the main reason for better outcomes of the medication and
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  Speaker 1: the combined medication behavior therapy group because they're having regular
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  Speaker 1: reviews through the fourteen months versus the other two groups. Anyway,
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  Speaker 1: that's a long way of saying there's some really big
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  Speaker 1: flaws with what became the most literally this became the
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  Speaker 1: most quoted study for ADHD treatments. It's been consistently referred
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  Speaker 1: to as the gold standard study in treatment guides across
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  Speaker 1: a whole lot of countries. But there's so much more
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  Speaker 1: to the story, and after the break, I'm going to
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  Speaker 1: tell you what the clanger is here and why this
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  Speaker 1: shock finding here in Australia with our seven thousand ADHD
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  Speaker 1: kids is not such a shock at all. Stay with us.
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  Speaker 1: We're back with the Happy Families podcasts. So this fourteen
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  Speaker 1: month MTA study the gold standard around ADHD and medication,
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  Speaker 1: and this belief that giving kids medication because they've got
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  Speaker 1: ADHD is really really interesting. And the reason that I
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  Speaker 1: want to share it is as follows. There was a
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  Speaker 1: study that was published at the three year follow up
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  Speaker 1: of the MTA study. There's a three year follow up,
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  Speaker 1: not just the fourteen month that I've been talking about.
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  Speaker 1: There's a three year follow up study, But nobody wants
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  Speaker 1: to know about the three year follow up study that
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  Speaker 1: was published.
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  Speaker 2: I'm really curious about this. So you've suggested that number one,
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  Speaker 2: this has become the gold standard in research. Number two,
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  Speaker 2: it's been peer reviewed. And my understanding with research is
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  Speaker 2: that peer reviews are there actually doesn't fall through the
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  Speaker 2: cracks stomp this out.
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  Speaker 1: Exactly, And unfortunately it does. And I think there's a
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  Speaker 1: handful of reasons for it. Number one, because a lot
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  Speaker 1: of people who are doing reviews are tired and cranky,
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  Speaker 1: and so long as they're seeing what they want to
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  Speaker 1: see or what they expect to see in the data,
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  Speaker 1: they just push it through. They've got their own publication loads,
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  Speaker 1: and they've got the university teaching loads, and they've got
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  Speaker 1: their own problems to deal with. And you don't get
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  Speaker 1: paid as a peer reviewer. You end up on an
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  Speaker 1: editorial board for a journal, or you literally so when
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  Speaker 1: I was an academic, I had a couple of papers
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  Speaker 1: sent to me by editors of journals and they just said,
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  Speaker 1: justin we know that this is an error of specialty
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  Speaker 1: for you. Would you please be a peer reviewer? And
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  Speaker 1: so you don't get paid for it. You just get
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  Speaker 1: a random email from somebody saying can you please review
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  Speaker 1: this because we think that you're an expert, And then
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  Speaker 1: you review the paper and they assume that you know
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  Speaker 1: everything that you need to know to us to effectively
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  Speaker 1: review the paper. You usually don't know, although sometimes you do.
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  Speaker 1: You usually don't know who the papers by, but certainly
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  Speaker 1: if you do know who it's by, those people tend
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  Speaker 1: to skatee through a lot easier because they've got the
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  Speaker 1: big reputations and nobody wants to offend them. It's a
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  Speaker 1: really flawed process, and in all of the fields that
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  Speaker 1: are out there, the process is most flawed and has
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  Speaker 1: been shown to be really hard to replicate findings in
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  Speaker 1: in psychology, like psychology is a disaster compared to most
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  Speaker 1: other areas. And that's well, there's a handful of reasons
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  Speaker 1: that are beyond the scope of our conversation today around that.
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  Speaker 1: But check this out. Five years later. It's two thousand
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  Speaker 1: and seven now, and this paper, this three year follow
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  Speaker 1: up paper of the original MTA study gets published. And
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  Speaker 1: unlike the original one, like I said, it was published
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  Speaker 1: in like ninety ninety nine, two thousand something like that,
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  Speaker 1: this one published now eight years down the track, which
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  Speaker 1: means that we've got eight years of the mental health
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  Speaker 1: industrial complex and the psychopharmaceutical complex just pushing the pharmaceutical
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  Speaker 1: industrial complex pushing drugs out there because they've got this
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  Speaker 1: MPTA study where everyone's saying it's great. This paper gets
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  Speaker 1: hardly any press, no one makes any noise about it.
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  Speaker 1: Nothing happens at all, And here's what they find. After
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  Speaker 1: fourteen months. The participants in that study were then free
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  Speaker 1: to choose what they did with their ongoing treatment, so
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  Speaker 1: it becomes this naturalistic study similar to what happens in
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  Speaker 1: everyday clinical settings. The three year outcomes found no support
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  Speaker 1: for continuing superiority of medication, regardless of the initial severity
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  Speaker 1: of ADHD symptoms. And on top of that, those who
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  Speaker 1: are on continuous medication during the three years were more
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  Speaker 1: likely to experience and deterioration in ADHD symptoms, They had
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  Speaker 1: higher rates of delinquency, and they were four centimeters shorter.
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  Speaker 1: They were literally significantly shorter and lighter by three kilos
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  Speaker 1: than those who didn't take medication. So after fourteen months,
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  Speaker 1: it looks like medications working, although there's some big holes
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  Speaker 1: in that study. But then at three years, the gold
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  Speaker 1: standard study of why we're supposed to be medicating our
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  Speaker 1: ADHD kids shows that it's not working at all. In fact,
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  Speaker 1: the outcomes are worse. Those who continued to take it
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  Speaker 1: for treatment of ADHD were not doing any better. They
• 11:31
  Speaker 1: were experiencing more negative effects than those who didn't. So
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  Speaker 1: when I see this headline and I see this study
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  Speaker 1: that's come out of Deacon saying, shock horror, We've got
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  Speaker 1: this research showing that ADHD medication leads to lower quality
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  Speaker 1: of life for ADHD kids on Ritlin than for their
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  Speaker 1: non drug taking peers. Everyone's shocked by it. But we've
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  Speaker 1: had this data now for twenty years. This has been
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  Speaker 1: published data for twenty years. And we've got a brand
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  Speaker 1: new study here in Australia that is just adding to
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  Speaker 1: a growing body of evidence that's saying can we please
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  Speaker 1: stop drugging the kids now? I know if you're a
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  Speaker 1: parent whose kids are taking the medication and it's made
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  Speaker 1: all the difference, I know it's going to sound like
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  Speaker 1: I'm just being unfair and I'm being dismissive and I'm
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  Speaker 1: being invalidating. That's not what I'm getting at here. What
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  Speaker 1: I'm getting at is that the pharmaceutical companies, Big Farmer
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  Speaker 1: and the mental health industrial complex have bought shoddy science,
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  Speaker 1: probably paid for shoddy science realistically, and it's affecting our kids.
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  Speaker 1: Now we've got a brand new Australian study that is
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  Speaker 1: drawing a line in the sound and saying we've got
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  Speaker 1: the data four thousand Australian kids and the ones who
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  Speaker 1: are taking the medication are the ones that are worse off. Now,
• 12:45
  Speaker 1: it could be some people would argue, well, actually it's
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  Speaker 1: the ones who are worse off feel taken the medication.
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  Speaker 1: But that's not what study after study and now starting
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  Speaker 1: to point to. Here's the take home message. Don't pull
• 12:57
  Speaker 1: your kids off the drugs just because you've listened to
• 12:59
  Speaker 1: this podcast, but start to read more. Go and look
• 13:02
  Speaker 1: up what's going on with this MTA study and the
• 13:05
  Speaker 1: three year follow up. I'll publish the links to these
• 13:07
  Speaker 1: studies in the show notes. Have a close look at it.
• 13:10
  Speaker 1: Talk to your pediatrician, talk to your child an adolescent
• 13:12
  Speaker 1: psychologists or psychiatrists. Talk to your gp and figure out
• 13:16
  Speaker 1: if there are other ways that we can do this
• 13:18
  Speaker 1: because your child doesn't have a problem. Thinking that your
• 13:23
  Speaker 1: child has a problem is often the bigger problem. But
• 13:26
  Speaker 1: if we can work with the challenges that our children
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  Speaker 1: are having and say no, my child is struggling with something,
• 13:33
  Speaker 1: rather than my child is a problem. Let's work with
• 13:36
  Speaker 1: our children. We can amend and adjust our environments, ideally
• 13:39
  Speaker 1: in ways that are going to be positive for them.
• 13:41
  Speaker 1: And helpful for them. If they're struggling at school, it
• 13:44
  Speaker 1: doesn't mean it's your child. It could be the school environment.
• 13:46
  Speaker 1: Like schools are not necessarily great places for every child,
• 13:49
  Speaker 1: as we've discovered in our own family. Kyle, you've been
• 13:52
  Speaker 1: really quiet. I've had a lot to say. I've been
• 13:53
  Speaker 1: geeking out on the science. I appreciate that your eyes
• 13:55
  Speaker 1: are still open and you're still awake. Is there anything
• 13:58
  Speaker 1: that pops into your head as we wrap up this
• 13:59
  Speaker 1: pod you want to raise?
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  Speaker 2: I think for me, the standout is just reiterating your
• 14:05
  Speaker 2: child is not the problem. They really aren't. And one
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  Speaker 2: of the main reasons we pulled our daughter out of
• 14:12
  Speaker 2: school was because she was seen as a problem. And
• 14:16
  Speaker 2: the change that we saw in her when she came
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  Speaker 2: home to a safe environment that she felt comfortable in.
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  Speaker 2: It's chalk and cheese. Predictability, consistency, and calm place such
• 14:33
  Speaker 2: a huge part in our children being able to navigate
• 14:36
  Speaker 2: this world.
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  Speaker 1: Okay, heavy conversation, Thanks for listening, hopefully. I mean, here's
• 14:41
  Speaker 1: the thing. We're not trying to change your mind. We're
• 14:44
  Speaker 1: not trying to convince you that everything that you've been
• 14:46
  Speaker 1: doing and everything you've been told is wrong. The purpose
• 14:49
  Speaker 1: of these conversations is to provoke thinking and to increase intentionality.
• 14:54
  Speaker 1: There's so much value in being willing to rethink your assumptions.
• 14:58
  Speaker 2: The challenge for the average mumal dad is that we
• 15:00
  Speaker 2: go and see specialists. We go and see people who
• 15:03
  Speaker 2: are experts in their field, trusting and we trust that
• 15:06
  Speaker 2: they know what's best, and we take for granted that
• 15:12
  Speaker 2: they just know what they know.
• 15:14
  Speaker 1: Yeah, you can feel so helpless hearing you say that.
• 15:17
  Speaker 1: It's like we've sat there with medical professionals with our
• 15:20
  Speaker 1: own kids and just gone, well, we're not the expert here.
• 15:22
  Speaker 1: We were just trusting you that you've gone deep into
• 15:26
  Speaker 1: the answers so that you can tell us where to go.
• 15:28
  Speaker 2: And I just think as individuals we need to recognize
• 15:33
  Speaker 2: that everybody is giving the best information they have with
• 15:37
  Speaker 2: what they have, but they don't have everything.
• 15:38
  Speaker 1: Yeah, give yourself some grace, give your kids some grace,
• 15:41
  Speaker 1: and potentially even give your GP or your psychologists some grace.
• 15:45
  Speaker 1: But also, if you know something new, investigate it, learn
• 15:49
  Speaker 1: about it, and have the conversation because it could actually
• 15:51
  Speaker 1: make a change for the better for you.
• 15:54
  Speaker 2: And I think you've got to follow your gut like
• 15:56
  Speaker 2: I honestly, so many times I've sat in rooms with
• 16:01
  Speaker 2: professionals and have just not felt like what they're sharing
• 16:05
  Speaker 2: is best for me or my family.
• 16:06
  Speaker 1: Yeah they'reetting it wrong, Yeah, and that's okay.
• 16:09
  Speaker 2: It doesn't make them a bad person, but it's not
• 16:12
  Speaker 2: right for me and having I guess the I don't
• 16:16
  Speaker 2: know guts to say that, I really appreciate your advice.
• 16:20
  Speaker 2: I think I'm going to go looking elsewhere because this
• 16:22
  Speaker 2: doesn't sit right with me right now.
• 16:24
  Speaker 1: Links to the studies are in the show notes. The
• 16:26
  Speaker 1: Happy Families podcast is produced by Justin Roland from Bridge Media.
• 16:29
  Speaker 1: Mimhammonds provides additional research, amen and other support. If you'd
• 16:32
  Speaker 1: like more info about how you can guide your children
• 16:34
  Speaker 1: through their tricky situations, especially if you're raising neurodivergent kids,
• 16:37
  Speaker 1: check out The Parenting Revolution. You'll get so much from it.
• 16:41
  Speaker 1: That and a whole lot of other resources are available
• 16:43
  Speaker 1: at Happy families dot com dot a u Oh, and
• 16:46
  Speaker 1: check out my ADHD course Game Changer right there.