BBC OnePanorama


Page last updated at 16:03 GMT, Thursday, 15 November 2007

Shelley Jofre responds to your comments

Craig and his dad fishing

Many thanks to everyone who has posted their feedback so far.

I knew when I embarked on this programme at the start of the summer that it would provoke strong reactions, but I felt it was important for parents to know what the latest research on ADHD medication had found.

I made the point - as did Professor Pelham - that medication is effective in the short-term. However, very little research has been done on the long-term effects.

The MTA study is one of the biggest studies ever done - not just by Pelham - but by some more of the biggest names in the treatment of ADHD in North America which is why the results are so important.

It is not me but the MTA co-authors who concluded that "continuing medication treatment was no longer associated with better outcomes by the third year".

I appreciate many of you have had different experiences with medication but to see the bigger picture is why scientists do controlled clinical studies in the first place.

Some of you have complained that there were only two case studies and that the programme was generally negative about ADHD. I disagree.

The decision was taken deliberately to focus on two cases in some depth rather than have a cursory look at more cases.

This meant that with both Craig and Yaz we were able to follow their ups and downs and to explore what worked for them.

Yaz, for example, felt medication was not a long-term solution for her, but did use it to help her focus and concentrate in her exams. Her outcome was ultimately positive.

Craig's parents talked about the time when Craig attended a special school and how that made a positive impact on his behaviour.

Craig's situation at the moment is undoubtedly negative, however that is not unrepresentative of the situation for many children with ADHD, regardless of treatment.

The MTA follow-up, for example, found that "despite treatment, the children with ADHD showed significantly higher-than-normal rates of delinquency (27.1% vs 7.4%) and substance use (17.4% vs 7.8%) after three years".

A few GPs have taken issue with the statistics I used in the programme.

The reason I said GPs prescribed 55,000 children ADHD medication and 8,000 antipsychotics was because the only data available is from the GP database.

I wasn't suggesting that GPs made the original diagnosis or the original prescription; those were the only figures available to me.

Obviously, the figures in both cases would be even higher if one were to factor in prescriptions coming direct from psychiatrists and paediatricians but those figures were not available.

I was not in any way suggesting that GPs are prescribing irresponsibly.

Finally, many commented that medication should only be used in combination with other interventions and that no-one said medication alone works.

Well, the original MTA study concluded in 1999 that medication on its own WAS better than behavioural therapy alone or in combination with medication.

Those findings were hugely influential and are still quoted, for example, by the Department of Health.

A survey by ADDISS last year of 500 families found that half had never been offered any behavioural therapy nor a parenting programme and this mirrored our own research that found that many children are on medication alone with no other support.

Correction October 8 2010: Following a ruling by the BBC Trust, this report has been amended and some material removed. Details of the Trust's finding can be found here. The Panorama programme was also the subject of a ruling by the BBC's Editorial Complaints Unit, which can be found here.

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