Study: Pharmaceutical Treatment of Pre-School ADHD is Ineffective - Mothering Forums

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#1 of 9 Old 03-10-2013, 01:19 PM - Thread Starter
 
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Researchers found that 9 out of 10 young children with moderate to severe attention-deficit/hyperactivity disorder (ADHD) continue to experience serious to severe symptoms and impairment long after their original diagnoses and treatment.

 

 

http://psychcentral.com/news/2013/03/10/pharmaceutical-treatment-of-pre-school-adhd-is-ineffective/52346.html


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#2 of 9 Old 03-11-2013, 07:09 AM
 
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I read the article and I see some problems with the methodology.

 

First, I think it is faulty to ever compare groups of kids on ADHD meds to groups of kids with ADHD who aren't on meds. Although some people believe this is a case of a parental choice, I suspect that those people have never been around a kid with severe ADHD. I believe that kids on ADHD meds are far more likely to have severe symptoms than unmedicated kids, such that any comparison of the two groups is inappropriate.

 

Second, kids on meds will still have symptoms -- especially when it is getting time for their next dose, and after the next dose is administered but before it has time to take effect. That could easily be an hour and half total, and for a kid with severe ADHD, they could easily rack up enough inappropriate behaviors in that short time to equal to the total number of inappropriate behaviors that an unmedicated child with moderate ADHD will have for the entire day. It doesn't mean that the meds aren't working, but rather, we cannot medicate kids enough to make ALL their symptoms go away.

 

Thirds, kids with severe ADHD are still sensitive to triggers such as lack of sleep, too much sugar, etc. -- things that effect ALL small children. Even though they are on meds, meds aren't strong enough to keep their behavior under control if those other things happen. Again, not a case of the meds not working, but simple that meds aren't the whole answer.

 

My view on ADHD meds has changed a great deal since January when I started working as a TA in a public school. One of my little guys needs extra support at school because of severe ADHD. Severe. Off the charts. I suspect that most people have never seen a kid with severe ADHD, and if they had, the whole conversation about ADHD would be different. (And yes, he is on meds!)


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#3 of 9 Old 03-11-2013, 07:40 AM - Thread Starter
 
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Originally Posted by Linda on the move View Post

 

My view on ADHD meds has changed a great deal since January when I started working as a TA in a public school. One of my little guys needs extra support at school because of severe ADHD. Severe. Off the charts. I suspect that most people have never seen a kid with severe ADHD, and if they had, the whole conversation about ADHD would be different. (And yes, he is on meds!)

So does that child really have ADHD or something else? 

 

http://www.cdc.gov/ncbddd/adhd/diagnosis.html

 

I have seen a kid with severe ADHD, according to his parents*, and he displayed several neurological symptoms - low muscle tone, slurred speech, mental retardation. I have a child with ADD and her symptoms were entirely focus related and only impacted her school work.

 

* Before they told me what his diagnosis was I assumed he was relatively high functioning autistic.


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#4 of 9 Old 03-11-2013, 01:15 PM
 
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I'm curious why you ask if he has ADHD. His meds work so well for him that one can easily tell when it is getting time for the next dose, and then tell when that does kicks in. The meds aren't a cure all, but the help to a tremendous degree.

 

He does have some sensory issues (he does best wearing a compression vest all day at school). He also does best being given something to do with his hands during group instruction time (I find therapaputty works GREAT for him). He is extremely social and very kind to others. No problems with eye contact. When medicated, he really tries with his school work. He always has a deep desire to be part of what the group is doing and to be helpful with others. However, he can only follow through on that desire when medicated. For him, not medicating would just be mean.

 

Although I've never seen him outside of school, I'm with him in a variety of context at school -- recess, lunch, PE, etc. His ADHD impacts his ability to interact with his peers and behave in appropriate ways in every context. I'm sure it shows up at home, at a store, etc.

 

He also does best with extra  adult support. The school can't give a child a one-on-one for ADHD, so he is placed in a room with a child who does get a one-on-one. (although I'm classified as a one-on-one, I'm really more of a one-on-five)
 


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#5 of 9 Old 03-11-2013, 02:28 PM
 
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I guess I am kind of confused by your opinion of the study Linda on the move.  I got from the article that they were seeing little significant change in medication helping about 2/3rds of the kids being treated with it.  That means that there is still 1/3 of the kids that they see improvement, but that seems like a low number.  It should bring into light that they need to reevaluate the efficacy of the medications and how they are being used as treatment.  The numbers between the kids that are medicated and unmedicated are similar, so that is also a concern.  

 

Mizram, I agree that some symptoms between various disorders overlap, which can make dx hard, and there are many kids with more than one condition.  On this, I speak from experience because ds has adhd, dyslexia, and epilepsy.  We have had a very difficult time deciphering inattention from seizures as they look almost identical in ds.  Plus, some of the meds he took for the seizures, amplified the adhd behaviors like impulsivity and inattention.  

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#6 of 9 Old 03-12-2013, 06:07 AM
 
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My problem is with how they set up the study.

 

Because ADHD is such a continuum and severe ADHD looks very different than moderate ADHD, I believe it is inappropriate to lump children together and then decide anything based on the averages. After all, the more severe the ADHD, the more likely the child is to be on meds and the more likely the child is to still have problems while on meds.

 

In this quote, "Specifically, 62 percent of children taking anti-ADHD drugs had clinically significant hyperactivity and impulsivity, compared with 58 percent of those not taking medicines" the article tells us that the majority of the children on meds still had problems, but it isn't quantifying if they are having *fewer* problems than they would without meds. It doesn't prove that the meds didn't bring about a massive improvement for the children for 62% of the children, it just documents that it isn't the whole answer.   

 

Meds don't "cure" ADHD. They cause  symptoms of ADHD to dissipate while they are in the system, but they quickly wear off. This quote:

 

"researchers found that 9 out of 10 young children with moderate to severe attention-deficit/hyperactivity disorder (ADHD) continue to experience serious to severe symptoms and impairment long after their original diagnoses and treatment."

 

Because we don't have meds or treatments that *cure* ADHD, what else would they find? All we can do right now is treat the symptoms for today, which is an excellent point and something it would be great for scientist to work on, but it doesn't mean that our currently available medications don't work. They do relieve symptoms for many, many children. And the article seems to be saying the opposite -- saying that meds aren't helpful for most kids with severe ADHD.


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#7 of 9 Old 03-12-2013, 07:34 AM
 
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This is just an article about the study and am not drawing the conclusions about lumping the continuum of adhd together.  What I got from the article was that in the findings, that after following the kids whether on medication or not, the vast majority still had symptoms.  They are comparing the child to themselves over a 6 year span not to each other.  This study identified a problem and is not looking for a solution.  It is really showing a short coming with current treatment.  Of course meds don't cure it, but the idea of putting a child on meds is done with the understanding that they will be better able to function than without.  Most of these meds come with various side effects that can be just as problematic as the original adhd, so it is a give and take of what you are willing to put up with to find a balance.  

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#8 of 9 Old 03-12-2013, 06:52 PM
 
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I read the article and it does not look like they are comparing medicated kids to non-medicated kids, but looking at changes in behavior of individual kids over a period of time:

 

"The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis; children taking ADHD medication had just as severe symptoms as those who were medication-free."

 

Linda, I read that you were speculating that perhaps the kids on meds had more severe ADHD.  We do not really know that - the article does not say that - we only know the 186 kids that were followed were listed as moderate-severe.  

 

ETA:  I am thinking that the decision to medicate is based on much more than severity of symptoms.  This paper looks at medication rates per state -and it ranges from 78% of kids with a diagnosis of ADHD being medicated in Iowa, to a low of 33% of those with a diagnosis in Nevada, so we know some of the decision to medicate is regional.  http://www.addrc.org/demographic-variation-in-parent-reported-medication-rates/


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#9 of 9 Old 03-13-2013, 04:35 PM
 
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Kathymuggle, thanks for the link.  We are in Iowa, and I am just not surprised IA is at the top of the list.  We had meds offered at various times for ds, and I am glad we had to decline.  Some kids certainly need them, but they are not right for all situations.  I feel we have a shortage of specialized doctors.  In my town, which is a college town, we have maybe 3 child psychologists, 1-2 child psychiatrist and pediatric neurologist (one of only 2 in the whole state that is also a pediatric epitologist).  It is so hard to get in to see any with out a wait; I could see how many would just go talk to their pediatricians to get a dx/meds instead.  

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