ADHD Medicine’s Value Over Time
In 1999, a group of researchers led by William Pelham released the Multimodal Treatment Study of Children with ADHD (MTA), a paper that failed to note the benefits that children receive from their medicine decline over time. The MTA ran into controversy when an academic review of the paper questioned why it played down negative effects of the drug and team members publicly stated that the report was biased in favor of drug treatment programs.
Now the latest data, released in 2007, shows that children who were medicated for 3 years showed no behavioral improvements over un-medicated peers. Interestingly, the medicated children were shown to be slightly shorter and lighter, implying that the drugs may have interfered with their natural growth processes.
Brooke Molina, also a co-author and a University of Pittsburgh associate professor of psychology and psychiatry…said the data do not “support that children who stay on medication longer than two years have better outcomes than children who don’t.”
And James Swanson, another MTA co-author and a psychologist at the University of California at Irvine said:
“If you want something for tomorrow, medication is the best, but if you want something three years from now, it does not matter,” he said. “If you take medication long-term beyond three years, I don’t think there is any evidence that medication is better than no medication.”
William Pelham, who seems to have done an about-face in regard to his original findings, now says that the primary purpose of ADHD medicine is to give parents an opportunity to get their child behavioral counseling.
A yet-to-be published study, Pelham added, found that 95 percent of parents who were told by clinicians to first try behavioral interventions for ADHD followed through on that advice. When parents were given a prescription for a drug and then told to enroll their children in behavioral intervention programs, 75 percent did not seek out the behavioral approaches.
Obviously that doesn’t bode well for the majority of children diagnosed with the disorder given the short-term nature of drug therapy. Two reason spring to mind that might explain the drop-off in parental follow-through. First, the drugs’ short-term effects may lead parents to falsely believe that their child is somehow cured and that no other action is needed on their part. Second, behavioral counseling undoubtedly takes more time and effort on the part of parents than opening a bottle of pills. Unfortunately, I think that part of the 75% is simple laziness.
You might be right, Michael. Given the number of patients, the gov’t should acti swiftly to get kids to take behavioral therapy.
As a parent who is living this, I agree with your conclusion but it’s also important to understand how extraordinarily difficult it is to do behavioral interventions effectively, and how difficult it is to find good therapists. We’re fortunate at least that my son’s school has been working very effectively with him, and I feel fortunate to have the time and resources to follow the latest research and work with him independently as well. We pretty much go through the motions with behavioral therapy because that’s what we’re supposed to do, but I honestly don’t feel that the therapists have done anything useful with him and it seems like a massive waste of time and money.
I’m sure there are parents who are lazy, or looking for an easy out with meds, or too overwhelmed with other problems in their lives to take the time to do behavioral interventions- but don’t judge that until you’ve walked in the shoes of a parent of a child that is unable to function because of a brain related problem. I’ve always thought of medicine as a last resort as well as a means of making my son available to even participate in behavioral interventions. I realize that’s not the case for many parents and school staff- but even when it is true, it’s nearly impossible to get good treatment in place.
Sympathies, Christine. I’ve worked extensively with developmentally disabled children and adults and they have a very high prevalance of ADHD. Most people have not the vaguest clue how very difficult it is for parents and caregivers to do everything “right,” no matter how well situated and suited for it they are.
The government should do something? In many areas the schools and social workers make things worse for such people, not better. (There’s absolutely nothing that a mindless grinding bureaucracy can’t make worse.)
Thanks, Tully- much appreciated. And not only is your point about the potential for schools and other bureaucrats to make things worse correct, it’s worse than that. They make the problem worse for the child while also scapegoating the parents (wish I could put my fingers on it, but there was a study a few years back which showed how the vast majority of school psychologists answered a questionnaire in such a way that every single question focused on how the families and the inherent illness of the children themselves made it impossible to fix the problems in the school setting- talk about a self fulfilling prophecy!)
As I mentioned, we’re relatively happy with our current school, so these folks represent a notable exception. But I also see very clearly how it can go the other way and have experienced the ‘blame the parent’ mode from a few individuals. More so than that, I’ve seen it when working with other families in various ways (my daughter also had some special needs which led eventually to my becoming executive director of a nonprofit for several years which, among other things, worked with families needing help with school IEPs and 504 plans.)
Praise to you! IEP’s alone are a confusing bureaucratic full-time course of study that most parents need much much help navigating, if they are not to simply give up and let the schools just write in whatever they want. And the institutional expertise at manipulating the system to suit their own agendas (and budgets and structures) is all on the side of the school system. They also have full-time legal staff, a luxury most parents can’t possibly afford.
The schools will most often serve their own systemic self-interest ahead of that of the child unless actively coerced and managed, which requires that parental expertise (and activism) on an order higher than most parents can manage, and through no fault of their own. Working effectively with these kids is hard, so the baby-sitting approach wins out all too often.
Some school systems are much better than others, and most can be acceptable IF the parents stay actively on top of the process. But only a minority of parents are capable of doing so without assistance–and the system is not geared to assisting them, but to doing the minimum it must.
Again, thanks. But we’re living proof that the IEP process can work, and work well, when all parties are properly motivated and educated. We just got my son’s latest progress report and he’s reached the criteria for mastery of 9 out of 11 benchmark/objectives! And of the remaining two, he’s at 75% accuracy (criteria for mastery is 80%) on one of them and the only remaining one where he’s falling way short of mastery is “demonstrating the ability to keep track of personal items.”
Heh, as an adult who loses car keys and sunglasses on a nearly daily basis, I assume he comes by that one naturally (though not genetically since he’s adopted.)
Hello all! I am glad to hear there are other parents out there with ADHD kids going through all we have. We are fighting the school system to obtain help with our six year old. His behavior problems intensify from noon on. It’s like he can’t deal with the day any longer. He becomes hyper, IMPULSIVE, and most of this is directed towards his peers. He is not medicated. All meds we have tried seem to have side affects that are, believe it or not, worse than having the impulsive, hyper behavior. School says he can help it, 3 different dr.’s have diagnosed him. They punish him, it seems, daily. I wish I could be there with him, I know how to deal with him, and they are not willing to bend from the criteria of the normal child. He is home with me today, alone, and guess what, heis not overstimulated! I can’t get the school to comprehend what I am trying to say. I am not a computer wiz, any help would be appreciated, please email me. (shannonmachelett@yahoo.com.) I may never be able to find this web sight again. Lol
Shannon, please continue to try getting better help for your son. If he’s having this many problems at age 6, it’s doubtfully going to get better.
Medication is not a “quick fix,” not matter what the self-medicating Internet Trolls say. It takes time and observation and dilligence.
Nutrition is important, too. Many kids with ADHD will eat only foods that are bad for them — too much sugar, starch, and dairy — because that has the highest chance of registering in their brains as “good.” So, they are often suffering a double-whammy of poor nutrition and medication that depends on nutrients in order to work. That is, we need vitamins and minerals not only to transport brain signals but also to delivery the medication effectively.
Gina Pera, author
http//www.ADHDRollerCoaster.org