ADHD drug debate

In the short run, children with attention-deficit hyperactivity disorder benefit from drug therapy, researchers say.  They do much better than kids treated with talk therapy alone or routine medical care.  In the long run — more than two years — ADHD drugs lose effectiveness. And kids who take the drugs for three years or more end up shorter than those who quit earlier.  Some scientists accuse others of downplaying the long-term trend, reports the Washington Post:

One principal scientist in the study, psychologist William Pelham, said that the most obvious interpretation of the data is that the medications are useful in the short term but ineffective over longer periods but added that his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of medication. When their explanations failed to hold up, they reached for new ones, Pelham said.

. . . Pelham, who has conducted many drug therapy studies, said the drugs have a valuable role: They buy parents and clinicians time to teach youngsters behavioral strategies to combat inattention and hyperactivity. Over the long term, he said, parents need to rely on those skills.

Nearly all parents will try behavioral strategies — if they’re offered before the family doctor suggests drugs, Pelham said.  If drugs are offered first, most parents won’t go on to try behavioral approaches.

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  1. From my own, purely anecdotal, experience, that sounds about right to me.

  2. Margo/Mom says:

    “Nearly all parents will try behavioral strategies — if they’re offered before the family doctor suggests drugs, Pelham said. If drugs are offered first, most parents won’t go on to try behavioral approaches.”

    Not quite so simple. Many kids are first diagnosed when they start school and have difficulties with the regimen and expectations there. Some school employees urge parents to have their child evaluated so that they can be put on medication. Behavioral approaches really require consistency between the adults–difficult enough to achieve between two parents, but when you toss in an array of teachers and other school personnel it gets really difficult. Docs who prescribe really should be working together with someone who can provide assistance with behavioral strategies–something that most docs lack either training or time to do effectively.

  3. Anonymous says:

    This is my hot button right now. As a teacher, I am disgusted at the HUGE amount of children, especially boys, who are being medicated. And I’m tired of watching school personnel push drugs on families of children who are perceived to have ADHD. (Notice I say perceived. You can’t tell me that the percentage of American children on these drugs are all abnormal to the point of requiring medication.) It’s disgraceful. As many of 30% of the boys in my classes have either been on psychotropic drugs or their parents have been pushed to put them on drugs. I’m ready to leave public education, because I’m not sure how much longer I can be a part of this.

    Here’s an interesting article:

  4. The Post article is certainly interesting, but the actual study has to be looked at carefully before drawing any conclusions, especially considering the history of sensationalistic articles about much-exaggerated studies.

  5. Margo/Mom says:

    Hey, Anon,

    Hang in there–we need skeptics like you!. I think the msnbc article finds a good balance.

    I recall the school “specialist” who told me, following a meeting regarding my son’s behavior at school telling me cryptically that I should take my son to the doctor for a “complete evaluation.” While I wasn’t born yesterday and knew exactly what she was trying to tell me (nudge, nudge, wink, wink), I really resented the implication that there was nothing that the school could or should change to be more supportive of my son. From the benefit of hindsight, I can attest that ADD was not an appropriate diagnosis, although he does have a condition for which he is medicated. Although medication brings his emotional state (and therefore behaviors) into a “normal” range, his learning has scarcely improved, nor has he ever been welcomed as a “normal” kid.

    When I worked extensively with kids, it was in an environment that resisted labelling, and while we knew that many of our kids received medication, our focus was on providing an environment in which they could learn to make appropriate behavioral choices. This frequently required developing a sensitivity to physical and creature comforts. Some things go better just after lunch or snack. Long sedentary activities are best broken up by at least a stretch, if not some singing or running around. So much “bad” behavior is preventable, and it is so easy to exacerbate “bad” situations. It helps to pare down the things that make things worse–then the kids are much more likely to be able to “control” themselves.

  6. I take Adderall, and I wish I’d had it in school or at least college. Since it’s genetically linked, my kids also have ADD–no H component. They usually take weekends and vacation breaks off the meds, which is approved by our Dr. I think it’s just common sense. Neither of my kids are short or particularly thin, but then, since parents are all worried about obesity, what’s a mother to do?

    My dad self-medicated by smoking a couple of packs a day. I’ll go for the pills.

    But in families that are already confused, disorganized, or distracted (and that’s the ADD family modus operandi), the medication can mean a difference between a kid passing a grade and not.

  7. patricia says:

    Margo/Mom, what I find interesting about the strategies you used with your students is that they are the same ones I (and every parent I know) use with my own children. Neurotypical or not, small kids benefit when the adults who structure their days have sensitivity to the kids’ physical and creature comforts. Every parent of a three year old knows that certain things aren’t attempted unless a snack is involved, or without a break for some exercise. Elementary school kids aren’t so different in that regard, whether they have behavioral challenges or not.

    That would seem to be common sense, and I wonder that elementary school teachers don’t incorporate those kinds of strategies into the design of their days. (Maybe they do? My kids aren’t school age yet.) But assuming they don’t, maybe we would see less pushing for medicaation of children, and fewer ADHD diagnoses?

  8. We have to be careful about passing judgments on families when they opt for medication. For every kid we suspect is wrongly put on medication, there’s another one that desperately needs a diagnosis and isn’t getting one for fear of being regarded as too quick to medicate.

    And Kate is right: Medication can mean the difference in a passing grade or not. It can mean the difference between learning or not. It can also mean the difference between having friends or not.

    Even with an IEP and behavioral strategies in place, some kids are severe enough to need more help. A good pediatrician will chart the growth of the child (the short thing has been around for years.)

    Unfortunately, there are doctors who will write a prescription without a thorough checkup by a psychologist or psychiatrist. My own pediatrician reported to me that, yes, he does get pressured by parents at times to just write out something to control the “problem.”

    Anecdotally, I was very anti-drug until a good child psychiatrist convinced me that my son was not a borderline case. I still didn’t believe it.

    Since my child’s problems were mostly around focus, he was not the problem hyper kid that most of us think of as classically ADHD. He was quiet and sweet and unable to follow any teacher for more than a few seconds.

    I remember on the first day that I gave him a pill he looked at me and said a complete sentence. I had never noticed that he never completed his sentences. He usually got stuck midway and trailed off, losing track of his words. It was a shock to realize what I had dismissed as normal.

    I was also very worried that my son’s growth was being affected. He always seemed a bit short, even though my husband and I are tall. Then, pubery hit and now he’s taller than me with more growth spurts to come.

    This is a complicated issue that has to be looked at case by case. My advice would be to never take a hard stance in either direction and do a lot of research.

  9. Margo/Mom says:


    I applaud your good sense. The importance of an appropriate diagnosis is extremely important. I would also suggest that their are other diagnoses that fit ADD-like symptoms (eg: bipolar, attachment disorder) and sometimes it is very difficult to “get it right.” For my son, I found that I had to do a lot of reading on my own. I worked with very competent professionals–but none of them were with my son for the amount of time that I was. When I began to suspect that his behaviors better fit a different diagnosis, I approached the clinician who was prescribing for him and we were able to take him to a facility that was doing a lot work in diagnosing kids with his particular disorder. Working together, they changed his meds to something more appropriate. Sometimes meds can aggravate a problem when the diagnosis is off (and this was actually a key to making his diagnosis). We have been very lucky with regard to getting him stabilized medically–I know other folks who have had far more difficulty, particularly when their kids approach adolescence.

    My biggest regret is that the school system continually remained out of the loop with regard to the things that were going on medically. The really sad thing is that even with medication, kids have good and bad days (don’t all kids?). A poorly managed bad day, however, always has the possibility of snowballing into worse behavior, followed by days of punishment and isolation, followed by pressure to catch up, ostracism, etc. I recall a speaker I heard once who said that some day, your kid will have a good day–get everything right–and be punished for the rest of their life for that good day, because it proved he could really “do it.”

    Out of all my kid’s teachers only a very small handful “got it” with regard to understanding the impact of physical condition, environment AND choice on behavior. Of those, a smaller number were willing to work within the general population of students (the rest preferred to be rescuers in separate classes that protected their kids from the rest of the school). It’s not all about medication, nor is it all about strategies/environment. It’s really gotta be both. Of the two, sad to say, medication is the easier to obtain.