View Full Version : ADHD Symptoms Persist For Most Young Children Despite Treatment


Amtram
02-19-13, 07:32 AM
A Johns Hopkins story (http://www.newswise.com/articles/adhd-symptoms-persist-for-most-young-children-despite-treatment) that I'm pretty certain will be misinterpreted pretty quickly. This is the part I think will get media attention:

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, the study found.

But later down the page, it mentions what could be a big problem with their methodology:

The investigators caution that it remains unclear whether the lack of medication effectiveness was due to suboptimal drug choice or dosage, poor adherence, medication ineffectiveness per se or some other reason.

So you're going to come out and say that medications didn't help with symptoms, really, except that you didn't really take into account whether the medications were effectively managing the symptoms? This sounds a bit slipshod to me.

ConcertaParent
02-19-13, 10:51 AM
As lead investigator Dr. Mark Riddle states, "Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better."


Conclusions (http://www.jaacap.com/article/S0890-8567(12)00993-8/abstract)
ADHD in preschoolers is a relatively stable diagnosis over a 6-year period. The course is generally chronic, with high symptom severity and impairment, in very young children with moderate-to-severe ADHD, despite treatment with medication. Development of more effective ADHD intervention strategies is needed for this age group.


I haven't been able to find the full text of the study yet, but my initial take is that, unlike autism, dyslexia and other childhood disorders, early intervention (with ADHD medication) is neither as critical nor effective in children.

ConcertaParent
02-27-13, 04:29 PM
Has anybody read the full text of "The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-Year Follow-Up"? It is very disappointing that after six years, the children taking anti-ADHD drugs had a higher percentage with significant hyperactivity, impulsivity and inattention, compared to those NOT taking drugs.

Amtram
02-27-13, 04:57 PM
This study used data collected from questionnaires filled out by parents and teachers, which is why the authors put in the disclaimer. It essentially points out something we already know - diagnosis and pharmaceutical treatment needs to be better (too many kids get Ritalin from their GPs as if it's the only thing available, and the GPs aren't qualified to diagnose and followup and advise parents about what they need to do) and we need more therapeutic interventions not only for the children, but for the parents, because the pills don't solve the problems all by themselves.

ConcertaParent
02-27-13, 05:24 PM
Another PATS finding that I was surprised about is that girls tend to have more severe symptoms than boys, especially attentiveness. Although girls showed a steeper decline in symptom severity over time compared to boys, their symptoms remained more severe than boys throughout the study period (6 years?), with the exception of hyperactivity and impulsivity in classroom settings.

The stereotype is that ADHD impairs mostly boys, but PATS shows that girls like my DD have it even worse.

mildadhd
02-27-13, 05:28 PM
This study used data collected from questionnaires filled out by parents and teachers, which is why the authors put in the disclaimer. It essentially points out something we already know - diagnosis and pharmaceutical treatment needs to be better (too many kids get Ritalin from their GPs as if it's the only thing available, and the GPs aren't qualified to diagnose and followup and advise parents about what they need to do) and we need more therapeutic interventions not only for the children, but for the parents, because the pills don't solve the problems all by themselves.

Exactly.

This is why understanding environmental topics like (abnormal, stresses, accommodations, diet,etc) and sensitive nature and how they effect emotional responses,

and other factors are all very important to address. Medication will only ever be part of the treatment.

mildadhd
02-27-13, 05:45 PM
As lead investigator Dr. Mark Riddle states, "Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better."



I haven't been able to find the full text of the study yet, but my initial take is that, unlike autism, dyslexia and other childhood disorders, early intervention (with ADHD medication) is neither as critical nor effective in children.

Thanks for this post. I never started taking medication before age of 35. I don't have enough personal expereince to comment on children taking medication.

One thing that I wish I never did as a young child/teen that I think is directly related to have ADD. Is substance abuse. I was very smart, and never got caught, but what was

driving me to use substances at such a young age? Would medication have help me avoid these mistakes? (would there have been other negative side effects I am not

considering about medication? I will never know for sure. But I am sure that a lack of chemistry was one of the reason why I did these things.

Is there other things beside medication that could have helped me avoid these "cravings"? I think there is, but I can't say they would work 100% for sure either.

Thanks for the great questions.

.

ConcertaParent
02-27-13, 06:04 PM
But PATS was the state-of-the-art clinical trial that evaluated the efficacy and long-term safety of methylphenidate in preschoolers 3 to 5 years of age with severe ADHD that was unresponsive to a 10-week psychosocial intervention. It included a complex mix of eight phases:
screening/enrollment; a 10-week, uncontrolled parent training; baseline assessment; a 1-week, open-label, safety lead-in; a 5-week, random sequence double-blind, crossover titration trial; a 4-week, optimal dose, double-blind, placebo-controlled parallel trial; a 10-month, open-label maintenance phase; and a 6-week, placebo-substitution discontinuation phase.

What makes it so disappointing is that despite the EARLY INTERVENTION with optimal dosing of medication, it did not seem to make much difference six years later. :confused: It seems that the medication-phobic parents who did not want to try medication may not have done their child a disfavour after all.
It essentially points out something we already know - diagnosis and pharmaceutical treatment needs to be better (too many kids get Ritalin from their GPs as if it's the only thing available, and the GPs aren't qualified to diagnose and followup and advise parents about what they need to do) and we need more therapeutic interventions not only for the children, but for the parents, because the pills don't solve the problems all by themselves.

Lunacie
02-27-13, 06:09 PM
Thanks for this post. I never started taking medication before age of 35. I don't have enough personal expereince to comment on children taking medication.

One thing that I wish I never did as a young child/teen that I think is directly related to have ADD. Is substance abuse.

I was very smart, and never got caught, but what was driving me to use substances at such a young age? Would medication have help me avoid these mistakes?

(would there have been other negative side effects I am not considering about medication? I will never know for sure. But I am sure that a lack of chemistry was one of the reason why I did these things.

Is there other things beside medication that could have helped me avoid these "cravings"? I think there is, but I can't say they would work 100% for sure either.

Thanks for the great questions.

.

Edited to put paragraph breaks after a period instead of the middle of
a sentence. That is very disconcerting to me, and difficult to read.

mildadhd
02-27-13, 06:27 PM
Edited to put paragraph breaks after a period instead of the middle of
a sentence. That is very disconcerting to me, and difficult to read.

Off topic but why not edit Amtram's posts aswell? aren't they equally as disconcerting?

Example: (from a previous post in this thread)

This study used data collected from questionnaires filled out by parents and teachers, which is why the authors put in the disclaimer. It essentially points out something we already know - diagnosis and pharmaceutical treatment needs to be better (too many kids get Ritalin from their GPs as if it's the only thing available, and the GPs aren't qualified to diagnose and followup and advise parents about what they need to do) and we need more therapeutic interventions not only for the children, but for the parents, because the pills don't solve the problems all by themselves.

I am glad you are reading my posts, just trying to figure this out.

There is other members who prefer the other way and I am trying to find middle ground.

What is the difference between my post and Amtram's?

Opinion?

Lunacie
02-27-13, 06:43 PM
Off topic but why not edit Amtram's posts aswell? aren't they equally as disconcerting?

Example: (from a previous post in this thread)


I am glad you are reading my posts, just trying to figure this out.

There is other members who prefer the other way and I am trying to find middle ground.

What is the difference between my post and Amtram's?

Opinion?

Amtram put a blank space after the end of a sentence rather than in the
middle of the sentence.

It's kinda like listening to a video where the sound track jumps or pauses
between words just long enough to lose the train of what's being said.

mildadhd
02-27-13, 07:01 PM
Amtram put a blank space after the end of a sentence rather than in the
middle of the sentence.

It's kinda like listening to a video where the sound track jumps or pauses
between words just long enough to lose the train of what's being said.

I am not sure what you mean but I will try my best, the example I posted from Amtram (post #4) has no spaces what so ever?

Anyway, back to the OP topic at hand.

mildadhd
02-27-13, 07:55 PM
But PATS was the state-of-the-art clinical trial that evaluated the efficacy and long-term safety of methylphenidate in preschoolers 3 to 5 years of age with severe ADHD that was unresponsive to a 10-week psychosocial intervention. It included a complex mix of eight phases:
screening/enrollment; a 10-week, uncontrolled parent training; baseline assessment; a 1-week, open-label, safety lead-in; a 5-week, random sequence double-blind, crossover titration trial; a 4-week, optimal dose, double-blind, placebo-controlled parallel trial; a 10-month, open-label maintenance phase; and a 6-week, placebo-substitution discontinuation phase.

What makes it so disappointing is that despite the EARLY INTERVENTION with optimal dosing of medication, it did not seem to make much difference six years later. :confused: It seems that the medication-phobic parents who did not want to try medication may not have done their child a disfavour after all.

I would always try non-medicated intervention , especially in young children, before trying medication. I never thought about parents feeling guilty for not medicating their children before.

I do think in some cases medication might be good. Anyone who says that medication is the only way, without trying non medicated treatments for ADD first, is full of it. (in my opinion)

Amtram
02-27-13, 10:39 PM
I would try non-medicated first, as well - but always be open to the idea that it might be necessary. I think the biggest problem is that too many people think that the right pill takes care of everything.

First of all, they don't know enough to know if it's the right pill.

Second, the pill doesn't teach you how to manage.

It's like you have a kid who can't walk - you give him a wheelchair, but you never take him to physical therapy to learn how to use it, get in and out of it on his own, and exercise his legs so that the muscles don't atrophy and he doesn't get pressure wounds - and then you complain that the wheelchair doesn't work!