Thursday, February 20, 2014

Medication for ADHD: Short Term Gains, Little Long Term Impact

Give some kids Adderall, and they seem transformed. Formerly fidgety or lost in daydreams, they seem to focus and pay attention. Surely this ought to have a huge impact on their lives, or at least their careers in school. But no:
For most people with ADHD, these medications — typically formulations of methylphenidate or amphetamine — quickly calm them down and increase their ability to concentrate. Although these behavioural changes make the drugs useful, a growing body of evidence suggests that the benefits mainly stop there. Studies indicate that the improvements seen with medication do not translate into better academic achievement or even social adjustment in the long term: people who were medicated as children show no improvements in antisocial behaviour, substance abuse or arrest rates later in life, for example.
Many studies have shown that stimulants help students with ADHD for a year or so, helping them do more work and get better grades, but then the effect fades:
In the early 1990s, as rates of stimulant prescriptions were beginning to climb, the National Institute of Mental Health in Bethesda, Maryland, funded a study to compare different treatments for the disorder. Known as the Multimodal Treatment Study of Children with ADHD, or MTA, the study randomized 579 children aged between seven and ten with ADHD to receive one of four treatments: stimulant medication, behaviour therapy, medication and behaviour therapy combined or whatever care they had already been receiving.

After 14 months, the groups treated with medication alone and medication plus behaviour therapy showed greater improvements in core ADHD symptoms than the other two groups. For academic achievement, only the group receiving medication and behaviour therapy combined outperformed the group receiving regular care. By three years in, the four groups had become indistinguishable on every measure. Treatment conferred no lasting benefit in terms of grades, test scores or social adjustment. Eight years later, it was the same story. “Nothing we did could tease out and say there's a long-term effect,” says Swanson, who was one of the lead investigators on the MTA.
Katherine Sharpe has an interesting essay exploring why that might be. Some people think the cause is inadequate medical follow-up; kids stop taking the drugs or don't get the right dose or what have you. But another explanation is that while it looks like kids are learning more, they really are not:
In the 1970s, two researchers, Russell Barkley and Charles Cunningham, noted that when children with ADHD took stimulants, parents and teachers rated their academic performance as vastly improved. But objective measurements showed that the quality of their work hadn't changed.
This is more evidence that the real problem is not the students, but the strange expectation that 7-year-old boys will sit still all day.

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