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Opinion: medication the tip of the ADHD treatment iceberg

ADHD is the most common neurodevelopmental disorder of childhood, with a prevalence of approximately 5 per cent. It is more common in boys. Most children with ADHD first show symptoms in the early primary school years. The challenges of an increasingly complex environment, both in the classroom and playground, often expose weaknesses in sustained attention and impulse control, the core features of ADHD.

There has been a lot of research into causes of and treatments for ADHD. That’s why we established the Children’s Attention Project (CAP), in 2011. Based at the Murdoch Childrens Research Institute in Melbourne, its Australia’s first longitudinal ADHD study. A multidisciplinary investigative team from Melbourne, Sydney and Perth recruited 491 grade 1 children, with and without ADHD, from 43 Melbourne schools. We collected data about the children, their families, their schools and their ADHD treatment to try to work out the elements leading to success. Once identified, we will be able to develop more effective, individualised ADHD management.

CAP has shown ADHD isn’t trivial. In grade 1, children with ADHD already had significantly poorer academic, mental health and social outcomes. These appeared to last until at least age 10. Outcomes were similar for boys and girls. Medication status did not affect outcomes, even when taking initial ADHD severity into account.

One striking finding from CAP was that at age 7, only 17 per cent of the children identified with ADHD had been clinically diagnosed (and 13 per cent prescribed mediation), and at age 10, only 38 per cent had been diagnosed (with 26 per cent prescribed medication). This means that many of these children were missing out on the opportunity for effective treatment.

The neuroimaging component of our CAP study commenced in 2014. We are studying children at three time points: at ages 9.5, 11, and 12.5. We are looking at how brain structure and function changes from late childhood to early adolescence, and whether these changes predict different outcomes.

What we know so far is that while medication can effectively reduce many ADHD symptoms, treatment of the condition is relatively generic. Also, medication does not appear to influence broader outcomes like academic and mental health functioning.

Insights gained from CAP will hopefully lead to better, targeted ADHD intervention. This, in turn, could improve outcomes for people with ADHD, from childhood to adulthood.

Dr Daryl Efron is a senior research fellow at the Murdoch Childrens Research Institute, and a paediatrician at the Royal Children’s Hospital, Melbourne. 

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