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

Transcript

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

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  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
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  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: Famili'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 Colson. Kylie.
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  Speaker 1: This study I'm so excited to share. It comes from
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  Speaker 1: Deacon University in Melbourne and I want to give you
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  Speaker 1: a quick overview of where we're at. Here's the general rundown.
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  Speaker 1: Children medicated for ADHD have a lower quality of life
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  Speaker 1: than those with the condition who are unmedicated. This is
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  Speaker 1: a brand you study. Deacon University research is more than
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  Speaker 1: four thousand children from four to seventeen. The research has
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  Speaker 1: found that those taking ADHD medication like Ritlin, were struggling
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  Speaker 1: compared to children with a diagnosis who were not taking
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  Speaker 1: the medication. Direct quote from the lead author quote. Those
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  Speaker 1: taking ADHD medication in our sample experienced more severe ADHD symptoms,
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  Speaker 1: 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, the 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, you.
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  Speaker 1: Get a lot less funding. If funding an ADHD don't
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  Speaker 1: 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 roller coaster, and parents are screaming
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  Speaker 1: constantly saying I had money, it was taken away, or
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  Speaker 1: I need more money, or whatever it could be, because
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  Speaker 1: because funding is such a merry go round, and part
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  Speaker 1: of the problem is that the diagnoses keep on going up.
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  Speaker 1: So in Australia today, around one in twenty children has
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  Speaker 1: ADHD one in twenty and most are diagnosed somewhere around
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  Speaker 1: about 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: this is a direct quote talking about the study we're
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  Speaker 1: discussing here. The finding is at odds with other studies
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  Speaker 1: that have discovered that taking ADHD medication is linked to
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  Speaker 1: better outcomes for children. That's a big, fat lie And
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  Speaker 1: I want to spend a little bit of time in
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  Speaker 1: this Doctor's Desk episode talking about why it's a big
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  Speaker 1: fat lie, and it's provocative and it's really hard for
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  Speaker 1: people to hear because when your GP or your pediatrician
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  Speaker 1: is telling you, or even your child an adolescent psychiatrist
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  Speaker 1: is telling you that the drugs do work. For me
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  Speaker 1: to sit here on the podcast and say well, actually,
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  Speaker 1: the drugs don't work, it can be really, really tough
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  Speaker 1: to hear. So I want to give you some evidence
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  Speaker 1: for it. Okay, the most I would say one of
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  Speaker 1: the most famous studies on the treatment of ADHD was
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  Speaker 1: published back in the turn of the century around that
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  Speaker 1: I can't remember the exact date, and it's called the
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  Speaker 1: MTA Study. It's the Multimodal Treatment of Children with ADHD Study,
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  Speaker 1: The MTA Study Multimodal Treatment Children with ADHD. It was
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  Speaker 1: a fourteen month study. And not only was it fourteen
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  Speaker 1: months so it's nice and longer judinal, but it was
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  Speaker 1: a multi location trial, so it's not just a bunch
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  Speaker 1: of kids in Brisbane or a bunch of kids in Canberra,
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  Speaker 1: or a bunch of kids in South Australia. It's right
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  Speaker 1: across a whole lot of different locations. We've got five
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  Speaker 1: hundred and twenty seven children age seven to ten they're
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  Speaker 1: randomized to four treatment groups. So you've got a medication
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  Speaker 1: only group, you've got to behavior therapy only group, you've
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  Speaker 1: got a combined medication and behavior group, and then you've
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  Speaker 1: got routine community care, which means that there's not really
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  Speaker 1: a whole lot going on, there's just general care for
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  Speaker 1: the child. And what the author's found after fourteen months
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  Speaker 1: of treatment was that there was more reduction of ADHD
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  Speaker 1: SIMP in the medication only group and in the combined
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  Speaker 1: medication and behavior therapy groups than the behavioral therapy only which, obviously,
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  Speaker 1: as you would expect in a study like this, did
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  Speaker 1: better than the routine community care group. Essentially they were
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  Speaker 1: a control group. But if you do much more careful
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  Speaker 1: reading of this, and I'm sorry to geek out, but
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  Speaker 1: this is what is so important about these episodes, and
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  Speaker 1: more detailed reading showed that there were some genuine problems
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  Speaker 1: with the conclusion that the group reached, and the peer
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  Speaker 1: reviewed paper brought as an example, two thirds of the
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  Speaker 1: routine community care group were also prescribed stimulants. They were
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  Speaker 1: 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 apployments 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 the medication and the
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  Speaker 1: combined medication behavior therapy group because they're having regular reviews
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  Speaker 1: 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 that guides
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  Speaker 1: across a whole lot of countries. But there's so much
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  Speaker 1: more to the story, and after the break, I'm going
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  Speaker 1: to tell you what the clanger is here and why
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  Speaker 1: this shock finding here in Australia with our seven thousand
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  Speaker 1: ADHD kids is not such a shock at all. Stay
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  Speaker 1: with us. We're back with the Happy Families podcast. So
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  Speaker 1: this fourteen month MTA study the gold standard around ADHD
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  Speaker 1: and medication and this belief that giving kids medication because
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  Speaker 1: they've got ADHD is really really interesting and the reason
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  Speaker 1: that I want to share it is as follows, there
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  Speaker 1: was a study that was published at the three year
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  Speaker 1: follow up of the MTA study. There's a three year
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  Speaker 1: follow up, not just the fourteen month that I've been
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  Speaker 1: talking about. There's a three year follow up study, but
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  Speaker 1: nobody wants to know about the three year follow up
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  Speaker 1: study that 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 effectively review the paper.
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  Speaker 1: You usually don't know, although sometimes you do. You usually
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  Speaker 1: don't know who the papers by, but certainly if you
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  Speaker 1: do know who it's by, those people tend to skate
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  Speaker 1: through a lot easier because they've got the big reputations
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  Speaker 1: and nobody wants to offend them. It's a really flawed process,
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  Speaker 1: and in all of the fields that are out there,
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  Speaker 1: the process is most flawed and has been shown to
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  Speaker 1: be really hard to replicate findings in in psychology, like
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  Speaker 1: psychology is a disaster compared to most other areas. And
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  Speaker 1: that's well, there's a handful of reasons that are beyond
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  Speaker 1: the scope of our conversation today around that. But check
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  Speaker 1: this out. Five years later. It's two thousand and seven now,
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  Speaker 1: and this paper, this three year follow up paper of
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  Speaker 1: the original MTA study gets published. And unlike the original one,
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  Speaker 1: like I said, that was published in like ninety ninety nine,
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  Speaker 1: two thousand something like that, this one published now eight
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  Speaker 1: years down the track, which means that we've got eight
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  Speaker 1: years of the mental health industrial complex and the psycho
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  Speaker 1: farmceutical complex just pushing the pharmaceutical industrial complex pushing drugs
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  Speaker 1: out there because they've got this MPTA study or everyone's
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  Speaker 1: saying it's great. This paper gets hardly any press, no
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  Speaker 1: one makes any noise about it, nothing happens at all.
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  Speaker 1: And here's what they find. After fourteen months. The participants
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  Speaker 1: in that study were then free to choose what they
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  Speaker 1: did with their ongoing treatment, so it becomes this naturalistic
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  Speaker 1: study similar to what happens in everyday clinical settings. The
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  Speaker 1: three year outcomes found no support for continuing superiority of medication,
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  Speaker 1: regardless of the initial severity of ADHD symptoms. And on
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  Speaker 1: top of that, those who were on continuous medication during
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  Speaker 1: the three years were more likely to experience and deterioration
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  Speaker 1: in ADHD symptoms, They had higher rates of delinquency, and
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  Speaker 1: they were four centimeters shorter. They were literally significantly shorter
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  Speaker 1: and lighter by kilos than those who didn't take medication.
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  Speaker 1: So after fourteen months, it looks like medications working, although
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  Speaker 1: there's some big holes in that study. But then at
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  Speaker 1: three years, the gold standard study of why we're supposed
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  Speaker 1: to be medicating our ADHD kids shows that it's not
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  Speaker 1: working at all. In fact, the outcomes are worse. Those
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  Speaker 1: who continue to take it for treatment of ADHD were
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  Speaker 1: not doing any better. They were experiencing more negative effects
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  Speaker 1: than those who didn't. So when I see this headline
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  Speaker 1: and I see this study that's come out of Deacon saying, shock, horror,
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  Speaker 1: we've got this research showing that ADHD medication leads to
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  Speaker 1: lower quality of life for ADHD kids on Ritlan than
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  Speaker 1: for their non drug taking piers. Everyone's shocked by it.
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  Speaker 1: But we've had this data now for twenty years. This
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  Speaker 1: has been published data for twenty years, and we've got
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  Speaker 1: a brand new study here in Australia that is adding
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  Speaker 1: to a growing body of evidence that's saying, can we
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  Speaker 1: please stop drugging the kids now? I know if you're
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  Speaker 1: a parent whose kids are taken the medication and it's
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  Speaker 1: made all the difference, I know it's going to sound
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  Speaker 1: like I'm just being unfair and I'm being dismissive and
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  Speaker 1: I'm being invalidating. That's not what I'm getting at here.
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  Speaker 1: What I'm getting at is that the pharmaceutical companies, Big
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  Speaker 1: Farmer 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.
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  Speaker 1: It could be. Some people would argue, well, no, actually
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  Speaker 1: it's the ones who are worse off whell 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
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  Speaker 1: your kids off the drugs just because you've listened to
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  Speaker 1: this podcast, but start to read more. Go and look
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  Speaker 1: up what's going on with this MTA study and the
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  Speaker 1: three year follow up. I'll publish the links to these
• 13:02
  Speaker 1: studies in the show notes. Have a close look at it.
• 13:05
  Speaker 1: Talk to your pediatrician, talk to your child an adolescent
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  Speaker 1: psychologists or psychiatrists. Talk to your gp and figure out
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  Speaker 1: if there are other ways that we can do this
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  Speaker 1: because your child doesn't have a problem. Thinking that your
• 13:17
  Speaker 1: child has a problem is often the bigger problem. But
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  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,
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  Speaker 1: rather than my child is a problem. Let's work with
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  Speaker 1: our children. We can amend and adjust our environments, ideally
• 13:34
  Speaker 1: in ways that are going to be positive for them
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  Speaker 1: and helpful for them. If they're struggling at school, it
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  Speaker 1: doesn't mean it's your child. It could be the school environment.
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  Speaker 1: Like schools are not necessarily great places for every child,
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  Speaker 1: as we've discovered in our own family. Kyle, you've been
• 13:46
  Speaker 1: really quiet. I've had a lot to say. I've been
• 13:48
  Speaker 1: geeking out on the science. I appreciate that your eyes
• 13:50
  Speaker 1: are still open and that you're still awake. Is there
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  Speaker 1: anything that pops into your head as we wrap up
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  Speaker 1: this pod that you want to raise?
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  Speaker 2: I think for me, the standout is just reiterating is
• 14:00
  Speaker 2: not the problem. They really aren't. And one of the
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  Speaker 2: main reasons we pulled our daughter out of school was
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  Speaker 2: because she was seen as a problem. And the change
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  Speaker 2: that we saw in her when she came home to
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  Speaker 2: a safe environment that she felt comfortable in. It's chalk
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  Speaker 2: and cheese. Predictability, consistency, and calm place such a huge
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  Speaker 2: part in our children being able to navigate this world.
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  Speaker 1: Okay, heavy conversation, Thanks for listening, hopefully. I mean, here's
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  Speaker 1: the thing. We're not trying to change your mind. We're
• 14:39
  Speaker 1: not trying to convince you that everything that you've been
• 14:41
  Speaker 1: doing and everything you've been told is wrong. The purpose
• 14:43
  Speaker 1: of these conversations is to provoke thinking and to increase intentionality.
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  Speaker 1: There's so much value in being willing to rethink your assumptions.
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  Speaker 2: The challenge for the average mum or dad is that
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  Speaker 2: we go and see specialists. We go and see people
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  Speaker 2: who are experts in their field, trusting that and we
• 15:00
  Speaker 2: trust that they know what's best, and we take for
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  Speaker 2: granted that they just know what they know.
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  Speaker 1: Yeah, you can feel so helpless. I'm hearing you say that.
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  Speaker 1: It's like we've sat there with medical professionals with our
• 15:14
  Speaker 1: own kids and just gone, well, we're not the expert here.
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  Speaker 1: We were just trusting you that you've gone deep into
• 15:20
  Speaker 1: the answers so that you can tell us where to go.
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  Speaker 2: And I just think as individuals we need to recognize
• 15:27
  Speaker 2: that everybody is giving the best information they have with
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  Speaker 2: what they have, but they don't have everything.
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  Speaker 1: Yeah, give yourself some grace, give your kids some grace,
• 15:35
  Speaker 1: and potentially even give your GP or your psychologists some grace.
• 15:39
  Speaker 1: But also, if you know something new, investigate it, learn
• 15:43
  Speaker 1: about it, and have the conversation because it could actually
• 15:46
  Speaker 1: make a change for the better for you.
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  Speaker 2: And I think you've got to follow your gut. I honestly,
• 15:52
  Speaker 2: so many times I've sat in rooms with professionals and
• 15:57
  Speaker 2: have just not felt like what they're sharing is best
• 16:00
  Speaker 2: for me or my family.
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  Speaker 1: Yeah, they're getting it wrong.
• 16:02
  Speaker 2: Yeah, and that's okay. It doesn't make them a bad person,
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  Speaker 2: but it's not right for me. And having I guess
• 16:09
  Speaker 2: the I don't know guts to say that. I really
• 16:14
  Speaker 2: appreciate your advice. I think I'm going to go looking
• 16:16
  Speaker 2: elsewhere because this doesn't sit right with me right now.
• 16:19
  Speaker 1: Links to the studies are in the show notes. The
• 16:20
  Speaker 1: Happy Families podcast is produced by Justin Ruland from Bridge Media.
• 16:23
  Speaker 1: Mimhamonds provides additional research, having in another support. If you'd
• 16:26
  Speaker 1: like more info about how you can guide your children
• 16:28
  Speaker 1: through their tricky situations, especially if you're raising neurodivergent kids,
• 16:32
  Speaker 1: check out The Parenting Revolution. You'll get so much from it.
• 16:35
  Speaker 1: That and a whole lot of other resources are available
• 16:37
  Speaker 1: at Happy families dot com dot au. I'll and check
• 16:40
  Speaker 1: out my ADHD course Game Changer right there.