NZ urged to shift stress on drugs as first option

The Australian Government's move away from drugs as the first treatment for ADHD sufferers has prompted New Zealand to review its own recommendations.

New Zealand experts say lack of resources and funding makes many non-medication treatments unviable.

In the 2007-08 financial year, 12,500 Kiwis aged up to 19 were diagnosed with attention deficit hyperactivity disorder (ADHD) and on medication. More than half were under 15.

Ministry of Health child and youth health chief adviser Pat Tuohy said the ministry had no concerns about the number of children being prescribed medication for ADHD.

But after the release of draft guidelines in Australia, New Zealand's guidelines would be reviewed to ensure they were consistent with current best practice, he said. New Zealand's guidelines, released in 2001, say that as a rule "monotherapy with a stimulant drug is the first line of treatment".

"Many randomised, controlled studies show that medication is the single most useful intervention for ADHD and, optimally used, it can minimise the need for other interventions and ongoing specialist resources," they say.

The Australian Government's guidelines recommend a multi-pronged approach to treatment that could include behavioural strategies, psychosocial techniques and nutritional changes.

They say that medication should be used only when ADHD symptoms are pervasive across school and home and cause "significant impairment".

Medication should never be used as first-line treatment in preschoolers.

The chairman of ADHD support group Addvocate, Charles Harrison, said New Zealand needed to start investing in alternative ADHD treatment as drugs were not a long-term solution.

"I can't see them [the Government] doing it here. I've been trying to push for that for 15 years, but previous governments said it's too expensive," he said.

Harrison and son Nick suffer from the condition, with the family spending thousands of dollars over the years trying to manage it.

Charles Harrison said medication was effective, but parents did not want their children on it forever. Other strategies to deal with the condition took a lot of time and effort, but had worked for him and his son.

"Medication on its own will not do the trick," he said. "You need the behavioural support, educational support and possibly support for the family as well."

Without treatment, people with ADHD were more likely to commit crime, become depressed and become addicted to drugs or alcohol.

"It's so important that I truly believe that for every $1 million they spend, in the long term they will save at least $10m to $15m," Harrison said.

University of Canterbury ADHD expert Dr Julia Rucklidge said non-medical treatments for ADHD were often resource-intensive and expensive.

"It comes down to manpower – having people on the ground to offer other treatments.

"If that doesn't exist, stimulants are better than nothing, but it does show that we are not offering New Zealanders the optimal choices that are available."

Rucklidge said medication worked well in the short term but was not a cure, so once people went off it their old behaviour returned.

She was researching the role of nutrients as a possible long-term treatment.

Otago University researcher Dr Dione Healey started trials for psychosocial treatment of ADHD last May.

"Medication should always be a last resort, but the evidence is ... that stimulant medications are the most effective treatments that we have," she said.

The Press