NICE recommendations are not evidence based and could expose many to unnecessary harm

doi:10.1136/bmj.a2284

Published 28 October 2008, doi:10.1136/bmj.a2284
Cite this as: BMJ 2008;337:a2284

Letters

NICE guidance on ADHD

NICE recommendations are not evidence based and could expose many to unnecessary harm

The first 150 words of the full text of this article appear below.

The National Institute for Health and Clinical Excellence’s(NICE’s) single most important recommendation is for medicationto be used as a first line treatment in "severe" attention-deficit/hyperactivitydisorder (ADHD).¹ Like other systematic reviews of ADHD medicationtreatment, NICE notes the inadequate reporting of study methodology,possible bias, limited reliability of results, and inadequatedata regarding adverse events, correctly concluding that theevidence does not support using medication as a first line treatmentfor mild or moderate ADHD. Yet NICE concludes that medicationshould be used as a first line treatment in "severe" ADHD, withonly one reference cited in support of this² (which is a reanalysisof the data from the largest trial comparing medication andbehavioural treatments), which concludes that the more severesubgroup showed a larger decrease in symptoms with medicationthan with behaviour therapy. However, these data were gathered14 months after the beginning of the study. . . . [Full text of this article]

Sami Timimi, consultant child and adolescent psychiatrist¹, Jon Jureidini, consultant child and adolescent psychiatrist², Jonathan Leo, associate professor of neuroanatomy³

¹ Lincolnshire Partnership Foundation NHS Trust, Lincoln LN4 2HN, ² Women’s and Children’s Hospital, Adelaide, Australia, ³ Lincoln Memorial University, Harrogate, USA

stimimi@talk21.com

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Diagnosis and management of attention-deficit/hyperactivity disorder in children, young people, and adults: summary of NICE guidance: Tim Kendall, Eric Taylor, Alejandra Perez, Clare Taylor on behalf of the Guideline Development Group
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