Ritalin doesn't improve ADHD after 3 years, stunts growth study finds

[latent aaaack]

I don't know what to say. Will this and/or should this affect the amount of ritalin prescriptions given to kids? Are we really giving 5-6 million children a drug that stunts their growth and doesn't have the intended effect? Seriously?

http://www.guardian.co.uk/news/2007/nov/12/uknews.health?gusrc=rss&feed=networkfront


Research released today raises questions about the long-term effectiveness of drugs used to treat attention deficit hyperactivity disorder (ADHD).

A team of American scientists conducting the Multimodal Treatment Study of Children with ADHD (MTA) has found that while drugs such as Ritalin and Concerta can work well in the short term, over a three-year period they brought about no demonstrable improvement in children's behaviour. They also found the drugs could stunt growth.

...

Research released today raises questions about the long-term effectiveness of drugs used to treat attention deficit hyperactivity disorder (ADHD).
A team of American scientists conducting the Multimodal Treatment Study of Children with ADHD (MTA) has found that while drugs such as Ritalin and Concerta can work well in the short term, over a three-year period they brought about no demonstrable improvement in children's behaviour. They also found the drugs could stunt growth.

 

[a_unique_person]

Yeah, but it's good stuff.

 

[Ivor the Engineer]

So what your saying is we're going to have a load of hyperactive and poorly educated midgets in a few years time.

 

[quixotecoyote]

So what your saying is we're going to have a load of hyperactive and poorly educated midgets in a few years time.

Good lord I hope so. Imagine the reality tv.

 

[Procida]

Ritalin was never tested in children until recently. They just presumed it "worked".

What's will really interest is whether any study will make a jack bit of difference.

No doubt someone will entone that we need at least 20 more long term studies to "confirm or deny", and by then the patent will have run out.

By then, I'm sure they will have worked out some new drug which they can flaunt for another 20 years allowing parents to also assume that one works....

 

[ponderingturtle]

Ritalin was never tested in children until recently. They just presumed it "worked".

What's will really interest is whether any study will make a jack bit of difference.

No doubt someone will entone that we need at least 20 more long term studies to "confirm or deny", and by then the patent will have run out.

By then, I'm sure they will have worked out some new drug which they can flaunt for another 20 years allowing parents to also assume that one works....

The thing is that the metric that they are using is behavior, not any sort of measured attention span or other direct way of determining the reason it is supposed to be prescribed.

 

[Procida]

True. But when you look at the excuses as to why schools ask parents to have their children assessed for ritalin, is because the child's "behaviour" is so bad that teachers want the kids drugged to make their "behaviour" acceptable in the class.

personally, I think behaviour is a bad indicator, since behaviour can often simply be an indicator of appalling parenting.

 

[Dancing David]

True. But when you look at the excuses as to why schools ask parents to have their children assessed for ritalin, is because the child's "behaviour" is so bad that teachers want the kids drugged to make their "behaviour" acceptable in the class.

personally, I think behaviour is a bad indicator, since behaviour can often simply be an indicator of appalling parenting.

How about walking around and yelling, is that good enough?(During class) Schools in Illinois can not require children to be medicated.

 

[Dancing David]

http://findarticles.com/p/search?tb=art&qt="William+E.+Pelham"

 

[Dancing David]

Funny how the title of the article reads different when it in not in the Guardian

http://www.nih.gov/news/pr/jul2007/nimh-20.htm

Improvement Following ADHD Treatment Sustained in Most Children

....
Initial advantages of medication management alone or in combination with behavioral treatment over purely behavioral or routine community care waned in the years after 14 months of controlled treatment ended. However, Peter Jensen, M.D., Columbia University, and colleagues emphasized that “it would be incorrect to conclude from these results that treatment makes no difference or is not worth pursuing.”

Their report is among four on the outcome of the MTA study published in the August, 2007 Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

“We were struck by the remarkable improvement in symptoms and functioning across all treatment groups,” explained Jensen.

After three years, 45-71 percent of the youth in the original treatment groups were taking medication. However, continuing medication treatment was no longer associated with better outcomes by the third year.

“Our results suggest that medication can make a long-term difference for some children if it’s continued with optimal intensity, and not started or added too late in a child’s clinical course,” added Jensen.


....

To understand why the initial advantage of medication wore off, the researchers examined medication use patterns that emerged after formal treatment in the study ended. They found that children who had been assigned to intensive behavioral treatment were more likely to begin taking medication, while those who had been taking medication were more likely to stop. For example, among children originally in the behavioral treatment group, the incidence of high medication use increased from 14 to 45 percent.

In a secondary analysis of the data that searched for possible explanations for the findings, in the same issue of the JAACAP, researchers led by James Swanson, Ph.D., University of California at Irvine, reported finding substantial individual variability in responses to medication. They identified three groups of children with different patterns of response. One group, about a third of the children, showed a gradual, moderate improvement; a second group, about half of the children, showed larger initial improvement, which was sustained through the third year; a third group, about 14 percent of the children, responded well initially, but then deteriorated as symptoms returned during the second and third years. Swanson and colleagues suggested “trial withdrawals” for some children to determine if they still need to take medications
....
Another report by Swanson and colleagues in the same issue of the JAACAP confirmed an earlier finding from the MTA study that taking medication slowed growth. A group of 65 children with ADHD who had never taken medication grew somewhat larger — about three-fourths of an inch and 6 pounds more, on average — than a group of 88 peers who stayed on medication over the three years. Growth rates normalized for the children on medication by the third year, but they had not made up for the earlier slowing in growth.

Yup that is what the precise says, not what the Gaurdian reported Pelham said.

here is what Swanson says
http://lib.bioinfo.pl/pmid:17667479

RESULTS:: All five propensity subgroups showed initial advantage of medication that disappeared by the 36-month assessment. GMM analyses identified heterogeneity of trajectories over time and three classes: class 1 (34% of the MTA sample) with initial small improvement followed by gradual improvement that produced significant medication effects; class 2 (52%) with initial large improvement maintained for 3 years and overrepresentation of cases treated with the MTA Medication Algorithm; and class 3 (14%) with initial large improvement followed by deterioration. CONCLUSIONS:: We failed to confirm the self-selection hypothesis. We found suggestive evidence of residual but not current benefits of assigned medication in class 2 and small current benefits of actual treatment with medication in class 1.

http://www.jaacap.com/pt/re/jaacap/...Gs1JXrJtyjgS5kQn!-368808804!181195628!8091!-1

Conclusions: By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.

It is imporatant to note what the researchers actually said.

 

[Jeff Corey]

The thing is that the metric that they are using is behavior, not any sort of measured attention span or other direct way of determining the reason it is supposed to be prescribed.

I don't understand this. How is "measuring attention span or other direct way" not behavior?

 

[ponderingturtle]

I don't understand this. How is "measuring attention span other direct way" not behavior?

There is software to measure how well people can pay attention to such things. By measuring changes in response time. You can measure attention span in much more direct fashions than looking at how much they act out.

 

[Jeff Corey]

There is software to measure how well people can pay attention to such things. By measuring changes in response time. You can measure attention span in much more direct fashions than looking at how much they act out.

I'm well aware of that and have measured attention spans. That's why I said they were a measure of behavior.
That's what behaviorists do, measure behavior.

 

[Dancing David]

I think that people are using behavior to denore acting out and disruptive behaviors in a classroom.

JC is of course pointing out that such issues and paying attention are all behaviors.

 

[andyandy]

That's what behaviorists do, measure behavior.

i thought they just argued with cognitivists

 

[ponderingturtle]

I think that people are using behavior to denore acting out and disruptive behaviors in a classroom.

That was my impression from the article as well.

Why would someone think that "over a three-year period they brought about no demonstrable improvement in children's behaviour." would be specific to measured attention span? Especially when used in a lay publication.

 

[latent aaaack]

To understand why the initial advantage of medication wore off, the researchers examined medication use patterns that emerged after formal treatment in the study ended. They found that children who had been assigned to intensive behavioral treatment were more likely to begin taking medication, while those who had been taking medication were more likely to stop. For example, among children originally in the behavioral treatment group, the incidence of high medication use increased from 14 to 45 percent.

I don't understand how the fact that 'those children who had been taking medication were more likely to stop' answers the question of why the initial advantage of medication wore off.

And what do they mean by "They found that children who had been assigned to intensive behavioral treatment were more likely to begin taking medication."? That the behavioral treatment was what caused the children to not need or benefit from ritalin after three years?

What the guardian article is talking about must be this part:

In a fourth article, Brooke Molina, Ph.D., University of Pittsburgh, and colleagues reported that, despite treatment, the children with ADHD showed significantly higher-than-normal rates of delinquency (27.1 percent vs. 7.4 percent) and substance use (17.4 percent vs. 7.8 percent) after three years. Earlier evidence of lower substance use rates among children who had received intensive behavioral therapy had lessened by the third year. “These findings underscore the point that ADHD treatment for one year does not prevent serious problems from emerging later,” noted Molina.

But they don't give the percentage of behavioral problems of ADHD children who aren't taking ritalin, so it's not clear if they're still less prone to deliquency because of ritalin.

 

[shadron]

The quoted article seems to be saying that they have proved that Ritalin is not a cure, but a symptom suppressant. It had always been my impression that Ritalin has always been prescribed as a symptom reliever, never as a cure. So this is startling news?

“These findings underscore the point that ADHD treatment for one year does not prevent serious problems from emerging later,” noted Molina.

Indeed. I had two children who were diagnosed with mild ADHD symptoms. In a bit of off-the-cuff research, I kept a record of how their practice archery scores changed with use or non-use of Ritalin over a two year period, and there was a definite, significant correlation.

Ah, I should also note that Ritalin is banned by the US Anti-doping Agency; at the time, use of the drug would disqualify the users from medals and placement within the National Archery Association, as well as keep such a child from entering the US Air Force officer candidacy. Beware.....

 

[Ivor the Engineer]

<snip>

Ah, I should also note that Ritalin is banned by the US Anti-doping Agency; at the time, use of the drug would disqualify the users from medals and placement within the National Archery Association, as well as keep such a child from entering the US Air Force officer candidacy. Beware.....

Wouldn't they be too small to fly a plane?

 

[shadron]

Wouldn't they be too small to fly a plane?

They want them small enough to fit in the cockpit...

Seriously, when my daughter went into ROTC at Colorado U they warned her that she probably wouldn't pass the physical on those grounds, even though she'd been away from it for four years.