Harvard Medical School Article

Oh puh-leeze. It’s not “Harvard Medical School” article. It’s an article by a psychologist (not psychiatrist) affiliated with the med school, and apparently the opposing article, by an actual MD on the faculty at George Washington Univ., has been conveniently omitted from this website. Psychologists get very annoyed when physicians are able to prescribe medication that makes their services unnecessary. Note how this psychologist attributes ADHD-like behavior to a number of other causes, all of which would conveniemtly call for a psychologist’s services.

Actually, I think it is a pretty good assessment of the situation, and I saw nothing in it that was so extreme as to discredit either the author, or the professional integrity of psychologists in general. Being a Psyche does not make you more or less likely to be guilty of malpractice than being and MD. In fact, I believe far fewer people are injured or die each year from psycholgists’ care than do so from medical errors…

Addressing true ADHD with medication alone was found to be no more effective in remediation than was using only behavioral interventions; a much higher success rate was achieved using a combination of both medical and psychological treatment.

I would be interested in reading the opposing viewpoint. Perhaps guest #2 you would be kind enough to google it up and post it here?

(I and I really wish they would turn this guest feature off. Hard to keep track of the players in a discussion when over half of them are all “guest”. Why not pick a nickname and stick with it so that we can follow the lines of reasoning better?)

I’m the original “Guest” in this thread. What’s with all the paranoid lunacy over the drug companies? Did they one of them fire you? I don’t know what your motivations are, but clearly you’ve never dealt with the daily heartbreak that comes from raising a child with ADHD. My daughter is 12, bright, outgoing, witty. She has virtually no control over her impulses, and is constantly being thrown out of class for speaking out of turn. No punishment can deter her, because she can’t change her behavior. It pains her mightily. Her social life is quite poor, because her peers find her annoying—almost no friends at all. Stimulants have helped her incredibly (bravo to the drug companies!), but they never last very long, because she metabolizes them too fast. We envy those who can use them more successfully. We hope and pray that our beloved child will find something to enable her to become a happy, productive adult. Your posts are valueless. What do you have to offer besides your paranoia? Where do you suggest parents turn? It is no wonder that this board is so inactive compared to the others where parents truly try to help one another through their tribulations. I would love to see you, full of bluster and nonsense, handle a classroom full of ADHD kids for just one day. The sad thing is not that so many kids are diagnosed, but that so many were not diagnosed in the past and just became chronic underachievers. I can think of several kids in my small elementary school class of the mid-50’s who were so obviously either ADHD or otherwise learning disabled (I suppose you don’t believe in that diagnosis either), and were constantly in trouble and disengaged from the learning process. If only they had had the benefits of today’s health care. Now, when you get a serious illness, will you forego the medication that will help you because it is made by a big bad drug company? You make me so tired, and frankly, I’m tired enough from dealing with ADHD. Please, readers, if you are serious about finding support in raising an ADHD child, don’t waste your time here.

ADHD is a list of very subjective symptoms.

Have your daughter tested until they find out what is really wrong with her.
just because Ritalin seems to work a little bit for her that doesn’t mean it is appropriate treatment.

She has virtually no control over her impulses, and is constantly being thrown out of class for speaking out of turn. No punishment can deter her, because she can’t change her behavior.

There is a big difference between Can’t and Won’t. I too have an “ADHD” child and I found the more we talked about what he couldn’t do because of his “disability” the more he used it as a excuse. Place the responsiblity on the child, let them learn how to cope on their own and let them know there are consequences to every action. Empower them to stand on their own. In the last three weeks I have talked to my son repeatedly about his behavior in school and his sloppy work. If he wants to repeat second grade its his decision. He knows what he has to do. Tough love, maybe? I know and he knows what he is capable of, I don’t want to hear he “can’t” because we both know he CAN. Every night I put him to bed I tell him he is awesome, smart, loving and that I believe in him and that he can and will do great things. I tell my daughter the same thing. Will it be easy for them? NO. Life isn’t easy and they have to learn that. My son is extremely opinionated and outspoken, he to tends to blurt out in class and over talk his peers. Some don’t like him for it. He is slowly learning to control himself and he is liking the new found respect he gets from learning that control. He is learning on his own what annoying behaviors he has that others will not tolerate, when all his little friends refuse to play with him I don’t allow him to have a pity party for himself. I tell him (and I am sure he already knows) exactly what brought him to that point. I believe none of us like to take a cold hard look at ourselves and point out what others apparently dislike but sometimes its necessary and a great tool to learn and grow. I for one refuse to let my kids point fingers and blame at everyone but themselves.

“There is a big difference between Can’t and Won’t. I too have an “ADHD” child and I found the more we talked about what he couldn’t do because of his “disability” the more he used it as a excuse. Place the responsiblity on the child, let them learn how to cope on their own and let them know there are consequences to every action.”

You are right, there is a big difference between Can’t and Won’t. For those Won’t behaviors, responsibility lies squarely on the shoulders of the child. For the Can’t behavior, responsibility lies on the shoulders of the parent, educators, other adults in authorative positions, and then the child. We can’t expect a child that “can’t” to somehow figure it all out. It’s not going to happen. If they are punished for ‘can’t’ behaviors they will learn that they are incompetent, dumb, stupid, slow, useless, helpless, hopeless, uncapable, etc. If they are excused for ‘can’t’ behaviors, they learn that they are helpless, not good enough, dumb, slow, stupid, etc. Typically, they will learn anger, they will learn manipulation, they will learn to aviod any responsibility. They are not equipped to with experience and knowledge to do the work that gets them from ‘can’t’ behaviors to having mastered coping mechanisms, or finding compensatory skills around those ‘can’t’ behaviors. That’s where adults need to take responsibility to help the child indentify those things and implement them.

I’m glad for your son that he is responding well to your interventions. From the beginning I did not use my dd’s ADHD as an excuse, but as a vehicle to assistance with a goal to no longer need support. We had a stumble this year, I thought we had reached the goal by highschool, but I learned that highschool is also going to be a time for more learning- learning how to manage her ADHD- and now she is pretty much on her own, her and her teachers. I’m glad I never allowed her ADHD to be an excuse, I taught her that her ADHD just means that she might have to approach things from a different point of view, that she might need to work harder than her friends sometimes. But she never heard me say “she does that b/c she has ADHD” without following it up with, what can you do differently, how can I help you, how can your teacher help you. It’s really the same approach that I use with my non-ADHD kids. If a parent want’s to find an excuse for their child’s lack of academic skills, or bad behaviors, they’ll find one, they don’t have to be ADHD.

Good response Roxie. I approach it similar to my older child’s asthma. She is very athletic (plays hockey, softball, skates, etc.) and has never allowed her asthma to hold her back. She premedicates when necessary and takes her daily pill at night. When I talk to my younger daughter we talk about college, careers, and all the things she wants to do in her every day life. We provide the framework for support and help but having ad/hd will never be an excuse not to reach her potential. When her behavior is inappropriate it is inappropriate no matter what and we talk about it. We all have obstacles somewhere in our lives that have challenged us. If we succeed it’s because we’ve learned to live with them, overcome them and at times use them to strengthen us to our benefit.

I liked reading the last few posts - a respectful discussion at last! I have always viewed things more from SueSol’s viewpoint - the more I communicate my confidence that my kids COULD behave, the more likely that they WOULD behave. I agree that there are some things that are unreasonable to expect, based on the child’s current development. For these things, I think the adults are responsible for changing the environment so that the expectations are indeed doable. I have some question as to whether it is reasonable to ask ANY first grader (for example) to sit in a desk for 30-40 minutes at a time and do things that someone else says they have to do whether they want to or not. Kids in Kindergarten are now expected to do things (like learning to read) that used to be more expected of second graders. And when I went to school, we didn’t get letter grades until we were in 4th grade - now some schools start off in Kindergarten!

Anyway, my children (two of whom certainly would qualify for an ADHD diagnosis) always responded to my expectations of them if I kept at it long enough, though “long enough” sometimes meant weeks, months, or in some cases, even YEARS. I just never gave up, always believed in them, and they came around eventually. Of course, I was a lot smarter with my youngest than with my oldest! I used to make bets with him (he was about 4) that he couldn’t hold still for a certain period of time, which he always took me up on, because he LOVES to prove me wrong! First time, he had a hard time holding still for 30 seconds. After a couple of weeks, we were up to 5 minutes at a time without twitching or moving around! After doing this for a while, I pointed out to him that he COULD control his hyperactive behavior if he really wanted to, even though I knew he had to work at it. He has never forgotten this message. He has a friend who is older than him by 4 years, and is diagnosed ADHD. This boy often uses his diagnosis as an excuse for his misbehavior. Kevin has confronted him about this consistently, and just the other night, the boy admitted to Kevin that he could control himself, he just didn’t really like to be restricted.

I think the message we give children is vitally important, both in what we say and in what we do. In fact, they listen more to what we do than our words, anyway. If we really communicate our believe in their ability to behave appropriately, even if it is extra hard for them, sooner or later, they will come to believe the same thing. That’s where I come from, anyway. I used to tell my oldest, “Some people find math difficult. You find it really easy. Other people find it easy to get along with people. For you, that is difficult. We all have things we are naturally good at, and things we have to work on. For you, you will always have to work harder at getting along. That’s your challenge.” He is now working at a job where the main thrust is to help people get along with each other, which I never would have guessed possible when he was 8 or 9.

Believe in your kids, and eventually, they will believe in themselves!

Thank you, Steve, I couldn’t have said it better!

I constantly remind my daughter that I’m her best and tireless advocate, her #1 fan, the best “friend” she will ever have, that I have the utmost confidence in her, and I remind her when she’s afraid and doubtful, of the times when she WAS successful, so why wouldn’t she be now?

She always compares herself to her little sister, and I try so hard to discourage that. I tell her that lots of things come easy for her sister, but you are so great/talented at this, this and this!

And yep, she will try to prove me wrong if I make bets with her, too.

Steve said: <<I have some question as to whether it is reasonable to ask ANY first grader (for example) to sit in a desk for 30-40 minutes at a time and do things that someone else says they have to do whether they want to or not. >>

I’m gonna go out on a limb here, and speculate… is it reasonable to expect a 10 year old child to sit still in a desk in a classroom, and perform monotonous tasks 7 hours a day 5 days a week? In many cases, yes, certainly, but I KNOW not in all cases, even in children who do not have the ADHD dx.

[quote=”Steve”]I liked reading the last few posts - a respectful discussion at last! I have always viewed things more from SueSol’s viewpoint - the more I communicate my confidence that my kids COULD behave, the more likely that they WOULD behave. I agree that there are some things that are unreasonable to expect, based on the child’s current development. For these things, I think the adults are responsible for changing the environment so that the expectations are indeed doable. I have some question as to whether it is reasonable to ask ANY first grader (for example) to sit in a desk for 30-40 minutes at a time and do things that someone else says they have to do whether they want to or not. Kids in Kindergarten are now expected to do things (like learning to read) that used to be more expected of second graders. And when I went to school, we didn’t get letter grades until we were in 4th grade - now some schools start off in Kindergarten!

Well written!

Common sense parenting works!

Anyway, my children (two of whom certainly would qualify for an ADHD diagnosis) always responded to my expectations of them if I kept at it long enough, though “long enough” sometimes meant weeks, months, or in some cases, even YEARS. I just never gave up, always believed in them, and they came around eventually. Of course, I was a lot smarter with my youngest than with my oldest! I used to make bets with him (he was about 4) that he couldn’t hold still for a certain period of time, which he always took me up on, because he LOVES to prove me wrong! First time, he had a hard time holding still for 30 seconds. After a couple of weeks, we were up to 5 minutes at a time without twitching or moving around! After doing this for a while, I pointed out to him that he COULD control his hyperactive behavior if he really wanted to, even though I knew he had to work at it. He has never forgotten this message. He has a friend who is older than him by 4 years, and is diagnosed ADHD. This boy often uses his diagnosis as an excuse for his misbehavior. Kevin has confronted him about this consistently, and just the other night, the boy admitted to Kevin that he could control himself, he just didn’t really like to be restricted.

I think the message we give children is vitally important, both in what we say and in what we do. In fact, they listen more to what we do than our words, anyway. If we really communicate our believe in their ability to behave appropriately, even if it is extra hard for them, sooner or later, they will come to believe the same thing. That’s where I come from, anyway. I used to tell my oldest, “Some people find math difficult. You find it really easy. Other people find it easy to get along with people. For you, that is difficult. We all have things we are naturally good at, and things we have to work on. For you, you will always have to work harder at getting along. That’s your challenge.” He is now working at a job where the main thrust is to help people get along with each other, which I never would have guessed possible when he was 8 or 9.

Believe in your kids, and eventually, they will believe in themselves![/quote]

Thanks to both of you for yoru kind words.

Catherine, I totally agree - I think that the expectations schools set for children were devised long before anyone thought about what was appropriate at different levels of development. Sometimes it seems the whole point is to develop a tolerance for repetitive and tedious work that is of no particular personal interest. I recall the endless hours of grinding out subtraction problems with borrowing - hundreds of problems over what seemed like months to me as a second grader. And I had gotten how to do it the first day! It was agonizing. Why we think kids should have to tolerate these conditions is beyond me. Sure, it’s good to learn self-discipline, but it needs to be in a context that kids can understand. A lot of good things have happened over the last 30-40 years to make schools a little more humane, but the basic model remains unchanged from the early 1900s. And now, with the recent testing mania, there is even more pressure for EVERY kid to learn the same things earlier and earlier. It just doesn’t work for a lot of kids, ADHD or not. Sometimes it is easier to blame the kids for not adjusting rather than looking at how we do things.

A couple of interesting studies were done back in the ’70s (can provide a citaiton if anyone really wants to know) where demographically matched, ADHD-diagnosed kids were put into two classrooms, one standard, and one an open classroom with work stations where the kids could move from station to station when they felt ready to go. They had teachers identify which were the ADHD kids. In the standard classroom, the teachers were successful something like 90% of the time in identifying the ADHD kids. In the open classroom, they essentially could not tell the difference! That’s the kind of dramatic change in behavior we can see if we adjust the environment to meet the children’s needs. Yet we continue to do things as we always have done, and the kids are the ones who suffer. It’s sad.

Glad to know I’m making sense to someone. Thanks again!

“What ever happened to, “well your not [getting desert], [going out],{watching TV], [etc.], until you DO?”

Is that how you were raised? How did you respond to it? Just curious if it provided you with the fundamentals you needed to grow up into a fully functioning man.

John

That’s definitely a big part of the picture, John! “I believe you can do it” also means “you don’t get to get off without doing it”. Although the approach to designing consequences that we used is a lot more inclusive than what my parents did, the message is still the same: certain behaviors are expected, and certain ones are not acceptable. We live in a community, and we all must consider the effect of our behavior on others. The fact that it was harder for two of my three boys to learn that didn’t mean that we didn’t expect it. We just had to be a little more creative and persistent to get there. I also think I was much more fearful of authority figures when I grew up. While that helped keep me in line, it also had some negative effects that were pretty profound. So we are definitely experimenting with some new approaches that accomplish the same goals of learning socially acceptable behavior without inducing the same amount of anxiety. It’s an ongoing process, but it has really worked out pretty well. My kids are not as polite as I would like them to be some times, but other than that, they have all turned out pretty darned well!

Thanks for asking - what about you?

One thing that has actually worked out well in my house is that my LD son is well behaved (ADD-inattentive) and my more ADHD son (not diagnosed) is good at school. My older son saw all his brother’s 100s on his papers and told me that the younger one was better at school than he was. I told him that different people find different things hard–your brother has to work harder at being good than you do.

And I told the younger one that it was harder for him to control himself than other people but that school work was easier for him than some other kids.

And two weeks ago, we got a real look into how much the younger one can control himself….Our kids go to a parochial school and it was Catholic School week. We happened to sit behind our youngest’s teacher. He was such an angel in church—didn’t lay all over me as he usually does or even bug his brother. We saw that the higher expectations of his teacher made a big difference. We were tolerating too much.

And interestingly enough, he was just as good in church the next week.
Maybe he knows that we know he can do it!

Beth

DAD, I beg to disagree. The study found that intervention was better than no intervention. The best intervention included a behavioral component with medication. If you were only going to use one of these interventions, then medication was considered to be superior to behavioral treatment only.

I have read those conclusions several times, I have taught for years. Believe me, behavioral intervention alone falls short of meds. alone and meds plus behavioral mods. This study merely “proved” what those who have worked, over the years, with multiple students who have been diagnosed with ADHD and have seen all of the above in action.

Extremely ADHD people have significant difficulties functioning in our society and it is not merely about sitting still vs. being able to get up and move around. It it were that simple, then what you stated would be true. True ADHD involves much more and even impacts those who suffer from it on the job. Realize I do not speak of the mild, borderline sort of child, but the student who demonstrated significant and several ADHD issues.

I would certainly agree in mild, borderline cases to try to use behavioral interventions first. But, when behavioral interventions improve the situation some, but the student still has many difficulties, they really do need medication if they are to have a chance to learn and get along with other people.

But remember that there is no indication that kids on medication actually LEARN MORE in the long run than those who are not. It would be interesting to see if there is any difference when “severe” cases are considered, but I’ve never seen any research on this. Our impression that kids are paying more attention doesn’t necessarily translate into more success as an adult.

[quote=”Steve”]But remember that there is no indication that kids on medication actually LEARN MORE in the long run than those who are not. It would be interesting to see if there is any difference when “severe” cases are considered, but I’ve never seen any research on this. Our impression that kids are paying more attention doesn’t necessarily translate into more success as an adult.[/quote]

Could you please point me to the research that has determined that kids don’t learn more with medication?

For goodness sake, if you are inattentive throughout your schooling, out of your seat, disrupting the class…………your learning is severely depressed. You might have a strong normal IQ and you may be several years below grade level in skills that require attention to instruction to learn.

We certainly have seen kids whose grades improved, work improved, following class lessons improved, when they started meds. I think you are splitting hairs. While I have not read enough to know if your assertion is correct, I find it highly improbable that it is. I think teachers look at much more than classroom behavior to “gauge” the effectiveness of the meds. insofar as they want to give parents feedback. We have ways of doing this: test scores, class participation, etc. When these go up, then learning is improving.

We do know that often test scores rise once medication is started and stabilized.

I know there are some people who will never accept that medication is every OK. That is sad for those whose life experience can be improved drastically with the addition of a medication. If you don’t know of the many sad cases of untreated ADHD firsthand, then you may not appreciate how bad life can be living in a SEVERELY ADHD body.

Steve is correct. It has never been demonstrated that medicated children learn better than non medicated ones.

I would like to see some proof that stims improve learning.

Guest wrote: <<Steve is correct. It has never been demonstrated that medicated children learn better than non medicated ones.

I would like to see some proof that stims improve learning.>>

I’d sure like to see some proof too.

We probably won’t find any proof but I would love to tell my son’s story anyway. At five years old he couldn’t concentrate or stay still for any length of time. Which is probably normal for a five year old but his impulsivity on top of it was incredible! He was a danger to himself and others. To make a long story short, he was way behind in kindergarten compared to other students. We know his IQ and in theory he should have been doing awesome. We started him on Concerta and honestly one month later he was reading. Three months later he was reading at a second grade level. This isn’t typical I know and proves nothing but I believe the meds. allowed his focus to improve. Is it a coincidence? Maybe, maybe not. Did the meds make him smarter? Of course not. The meds allowed him to be the student we knew he could be.

[quote=”Steve”]But remember that there is no indication that kids on medication actually LEARN MORE in the long run than those who are not. It would be interesting to see if there is any difference when “severe” cases are considered, but I’ve never seen any research on this. Our impression that kids are paying more attention doesn’t necessarily translate into more success as an adult.[/quote]

Steve,
Maybe you missed my first request, could you please provide a cite for this research? I really would like to see it. TIA!

[quote=”Tina”]We probably won’t find any proof but I would love to tell my son’s story anyway. At five years old he couldn’t concentrate or stay still for any length of time. Which is probably normal for a five year old but his impulsivity on top of it was incredible! He was a danger to himself and others. To make a long story short, he was way behind in kindergarten compared to other students. We know his IQ and in theory he should have been doing awesome. We started him on Concerta and honestly one month later he was reading. Three months later he was reading at a second grade level. This isn’t typical I know and proves nothing but I believe the meds. allowed his focus to improve. Is it a coincidence? Maybe, maybe not. Did the meds make him smarter? Of course not. The meds allowed him to be the student we knew he could be.[/quote]

If your child is so out of control how was he able to sit long enough when he was 5 to have his IQ determined?

Something sounds fishy to me.

The only fishy thing here is the need of some people to constantly attack parents for their choices and to attack the medical diagnosis of ADHD. It makes me wonder what interest group is dropping in to these boards. Steve is correct that there is little research into whether medication translates into improved academic performance. FWIW, there is equally as little research into whether alternative, non-medication methods improve school performance or learning. That is unfortunate for parents who have to deal with the problem now. I can tell you that for my child, medication has a direct, observable effect on his academic performance. Within months of beginning medication for his ADHD he went from a disinterested C student to an interested A student. Just recently, we noticed him beginning to have some difficulty with paying attention and participating in class, remembering his assignments, things like that. He has recently hit adolescence but has been taking the same amount of medication since he was 10 years old. After talking with his doctor, we increased the medication slightly and lo and behold, he was back to being attentive, participating in class, getting his work done, etc. Teachers were calling me to report on the positive changes. All of a sudden, he was interested again, instead of staring out the window and doodling. His grades are back up to As again. Obviously, for my child, medication improves academic performance. Will it do that for most children? Its impossible to say without properly done research. For us, it works. Another family might have a different experience, in which case they might choose to discontinue medicating. Really, these decisions are not written in stone. Just get the best information you can (and this board is probably not really the place for that, although it is source to consider) and make the decision that seems right to you. When you hear someone putting forth some fantastic claim about the benefits or detriments of a particular treatment, just ignore them. Chances are, their motives are suspect and their information is unreliable.

I knew I shouldn’t have replied and I agree it does sound fishy. I of course can’t prove anything but really am telling the truth. The psychologist did testing on him over a three week period. It was twice a week at one hour sessions. From what I understand you don’t have to sit for long intervals to figure out an IQ. Also, my son does better 1:1 rather than in a goup of 1:22.

Tina, please don’t hesitate to post if you feel you have something to say. Just do as I’m learning to do ( I had to learn the hard way too), and ignore the petty negative personal remarks.

I, for one, do believe you. Good luck to you and your son.

Thanks Cathryn! I like to share that story because I think it gives parents hope that things can turn around. I do hesitate posting at this site but sometimes feel I need to. I am very happy for my son!

Sorry I missed that request! I have left my ADHD reference list at work, and I’m at home for the long weekend. Can probably give you specifics either Tuesday or Wednesday, depending on what is going on there and how busy I am.

Just to clarify, there IS evidence of short-term performance improvement on medications, in particular, higher test scores and grades, and fewer failing grades, more work completed, etc. It’s just that this localized improvement doesn’t actually appear to translate in to better long-term outcomes. So a child may learn to read a little earlier, or may be able to complete writing assignments in third grade rather than fifth grade, but when you test them in high school (like SAT scores or achievement tests) their test scores aren’t any better than the non-medicated ones who learned read later or couldn’t complete their writing assignments until two years later.

I realize this is counterintuitive, but that’s what repeated research has shown. It raises some interesting questions about the relationship of work completion and grades to ultimate acedemic attainment. It is possible that the unmedicated kids simply pick these things up at a later time (maybe a developmental age issue). The other possibility that is kind of a difficult one to swallow is that perhaps the activities that the children are being asked to participate in aren’t particularly educational, at least for the ADHD-type children. It is possible that the medication enables the children to perform certain tasks earlier that make the teachers and parents feel that they are succeeding, because they are doing as expected, but the children aren’t learning anything from those tasks that they wouldn’t already have learned in some other way. Or perhaps they have already learned the information and the tasks involved are just repetitive busywork that doesn’t add to their understanding.

My favorite example is subtraction problems with borrowing. I spent months in second grade grinding out hundreds of subtraction problems with borrowing. It took me enormous amounts of time and was exceedingly tedious, as I was not comfortable with writing, having poor fine motor skills as many second grade boys did. But I was a very compliant youngster, and I plodded away and got the job done, though I hated it so much that I can still feel the anger and frustration today. I guarantee you, even though I got excellent grades in math that year, I could have spent that time playing video games or chess or reading books or dipping girls’ pigtails in the inkwells and I would have learned no less. I understood how to do those problems the first day. The rest was a total waste of my time. So I turned in the work, I got good grades, but I was not learning a thing after the first hour or so, and I wasted probably 60 or more hours doing pointless activities that didn’t enhance my education one iota.

I could still do the problems and keep the teacher happy, and I was highly motivated to do so. Your average ADHD kid is not able or willing to do this. The medication may enable them to do what I did, but will it enhance their learning? Probably not. They might have gotten it the first day, too.

This is just an example to illustrate my point. There are a lot of reasons kids don’t pay attention or don’t complete work. I am just presenting this as a way that a child (namely me) could produce all the work asked of them and still not learn anything extra. I hope that helps folks get their arms around the concept that getting good grades and completing work doesn’t necessarily translate into more learning in the long term, even though it may appear to be productive in the immediate situation.

I am recalling one reference, which is J.M. Swanson in Exception al Children, 1993. I don’t have the exact citation. The subtitle is “A review of reviews”. I’ll try to get the specific reference, though I know I posted it some time back. There are other reviews of the literature that he reviewed, including one from Russel Barclay back in 1997 or ‘98, which I know I have the citation for. You could also go down to a medical library in your area (that’s how I got this stuff!) or look at some books that have references and a decent bibliography.

I hope this helps clarify. The research is NOT saying that some kids don’t do better in school as a result of using medication. It is saying that the fact being on medication and doing better in the teacher’s or parent’s estimation doesn’t necessarily translate into learning more in the long run than you otherwise would have. Unmedicate kids may learn later or in different ways, but by the time they grow up, the use of medication is not an important variable in determining their ultimate level of acedemic skill.

–— Steve

[quote=”Anonymous”]The only fishy thing here is the need of some people to constantly attack parents for their choices and to attack the medical diagnosis of ADHD. It makes me wonder what interest group is dropping in to these boards. Steve is correct that there is little research into whether medication translates into improved academic performance. FWIW, there is equally as little research into whether alternative, non-medication methods improve school performance or learning. That is unfortunate for parents who have to deal with the problem now. I can tell you that for my child, medication has a direct, observable effect on his academic performance. Within months of beginning medication for his ADHD he went from a disinterested C student to an interested A student. Just recently, we noticed him beginning to have some difficulty with paying attention and participating in class, remembering his assignments, things like that. He has recently hit adolescence but has been taking the same amount of medication since he was 10 years old. After talking with his doctor, we increased the medication slightly and lo and behold, he was back to being attentive, participating in class, getting his work done, etc. Teachers were calling me to report on the positive changes. All of a sudden, he was interested again, instead of staring out the window and doodling. His grades are back up to As again. Obviously, for my child, medication improves academic performance. Will it do that for most children? Its impossible to say without properly done research. For us, it works. Another family might have a different experience, in which case they might choose to discontinue medicating. Really, these decisions are not written in stone. Just get the best information you can (and this board is probably not really the place for that, although it is source to consider) and make the decision that seems right to you. When you hear someone putting forth some fantastic claim about the benefits or detriments of a particular treatment, just ignore them. Chances are, their motives are suspect and their information is unreliable.[/quote]

I would say that the CDC and major universities are unreliable. Right!

Steve, I’ll ask this in the most respectful way possible, because I KNOW so many parents are at their wits end, and then the meds do help in some cases, and appear to be a Godsend. But are there any studies on the LONG-TERM effects these very strong medicines have on the developing child’s young brain, their health, and long-term growth and well-being? And when the medication is taken away in a few years, are they “cured”? What happens to them then? Or do they have to take this for the rest of their lives? And isn’t it true they can become “dependent” on these meds? I’ve read the horror stories about “kiddie cocaine”.

http://www.adhd-biofeedback.com/ritalin.html

http://www.geocities.com/stnektarios/STRATERRA.html

Quote “Just to clarify, there IS evidence of short-term performance improvement on medications, in particular, higher test scores and grades, and fewer failing grades, more work completed, etc. It’s just that this localized improvement doesn’t actually appear to translate in to better long-term outcomes. So a child may learn to read a little earlier, or may be able to complete writing assignments in third grade rather than fifth grade, but when you test them in high school (like SAT scores or achievement tests) their test scores aren’t any better than the non-medicated ones who learned read later or couldn’t complete their writing assignments until two years later. ”

You went on to say that it is counterintuitive, but really it’s not. Are we medicating our ADHDer’s so that they are super-students? Are we medicating them b/c we think it will mean a higher than average ACT or SAT? or are we medicating to put them on a level playing field allowing them to reach their potential, their average potentional? I know I did it for the latter.
I’m wondering, do you know if gaps in knowlege were addressed in this research? In our experience, our dd did have significant gaps that probably weren’t so noticable until 1/2 way through middle school. I also believe that anyone that thinks that medication is the answer to solving and ADHDer’s challenges is going to be greatly disappointed. IMHO, it’s a rare case where meds are the only intervention needed, and when it comes to academic challenges, that probably only happens with truely gifted students. Also, does the research take into account the significant % of ADHDer’s with comorbid LD’s. Those will certainly not be impacted by medication at all. LD’s can certainly limit a child’s success on testing, especially when they are not accomodated for. I also have to wonder, how do they know, that if a child goes unmedicated and has academic challenges due to their ADHD that treating the ADHD symptoms and allowing them successes in their lives in the short term, has not had an effect on the long term, even in the simplest terms as a child having the confidence to even take and complete the test? Don’t the short term successes and accomplishments translate into long term success, even if it’s not measurably success above their peers? They could be testing well below their peers, right?

No improvement No proof

[quote=”Anonymous”]No improvement No proof[/quote]

Well then, I guess I have proof then. If only for my child, I have the proof that adding medication to the already established behavioral interventions = consistent improvement, and improvement that has lasted over the years, not improvement with limitations as we saw prior to using medication.
I’d still like to know more about Steve’s information though. At least we have something to discuss there and we can learn from the discussion.

Steve,

I sure would like to read those studies you refer to in your message. is there a place I can read them online?

Here are some references to recent research concerning long-term safety and effectiveness of ADHD medication. You might have to register to view some of the articles, but it is free.

http://mentalhealth.about.com/gi/dynamic/offsite.htm?site=http://www.medscape.com/viewarticle/458811%5F1

http://www.apa.org/monitor/may01/stimulants.html

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9294377&dopt=Abstract

[quote=”Anonymous”]Here are some references to recent research concerning long-term safety and effectiveness of ADHD medication. You might have to register to view some of the articles, but it is free.

http://mentalhealth.about.com/gi/dynamic/offsite.htm?site=http://www.medscape.com/viewarticle/458811%5F1

http://www.apa.org/monitor/may01/stimulants.html

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9294377&dopt=Abstract[/quote]

As a parent I really resent you trying to keep me from being uninformed.

Sorry, been gone a while. I did try to post on Sunday but had no luck.

I’m sorry, but I haven’t been able to find an on-line link to these studies - they mostly are in journals that were published pre-internet. Most of the seminal studies on ADHD and medication were done back in the 70’s or 80’s. You will have to find them the old fashioned way, just like I did - go to the nearest medical library. I did a search on “ADHD, Ritalin, long-term outcomes” or some combination like that. Found a ton of stuff, but I focused my attention on the long-term outcome question, both for stimulants and alternative interventions.

I have on occasion been able to find more recent articles on the issue, but haven’t been making a log of them. The most recent was in about 1999, and verified the same conclusions Swanson drew. I really think people stopped researching the question much after ‘92 because Swanson’s “Review of Reviews” pretty much nailed the question down - we can’t expect big changes in long-term outcomes based on the use of medication on a broad scale. There appear to be other factors that are more important in the long run. This is not to minimize the short-term effects, which can be pronounced, nor to imply that NO child will do better long-term on stimulants. It’s just that we can’t really assume that the stimulants will make a difference over the course of years.

For clarification, the studies involved comparisons of kids diagnosed with ADHD, some medicated and some not. These are not comparisons with “normal” students. Most of the studies supported that ADHD-diagnosed kids did do more poorly on the average in school and social outcomes than non-ADHD kids. It’s just that whether the child was on medication or not didn’t really change the picture - both groups of ADHD-diagnosed kids did worse than “normals” regardless of medication status.

Wish I could find some links. I can post some literature references if you want to look them up. I will try and find time to search some on-line med libraries for more recent stuff, but the older stuff is just not available on line. Geez, how inconvenient! I love having stuff at my fingertips, but we get spoiled that way. Oh, well - some times we have to roll up the old sleeves and do some digging!

Abstracts of the studies Steve mentioned ought to be available on medline. (Try webmd.com for a link.) Often there is a link for obtaining the full text of the study, but the abstracts are often quite informative.

[quote=”Anonymous”]Abstracts of the studies Steve mentioned ought to be available on medline. (Try webmd.com for a link.) Often there is a link for obtaining the full text of the study, but the abstracts are often quite informative.[/quote]

This may clear things up a little. This is a list of the DSM-IV ADHD Diagnostic criteria.

––––––––––––––––––––––––––—

Diagnostic Criteria
Either (1) or (2):
six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
often has difficulty sustaining attention in tasks or play activities
often does not seem to listen when spoken to directly
often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
often has difficulty organizing tasks and activities
often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
is often easily distracted by extraneous stimuli
is often forgetful in daily activities
six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity

often fidgets with hands or feet or squirms in seat
often leaves seat in classroom or in other situations in which remaining seated is expected
often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
often has difficulty playing or engaging in leisure activities quietly
is often “on the go” or often acts as if “driven by a motor”
often talks excessively
Impulsivity

often blurts out answers before questions have been completed
often has difficulty awaiting turn
often interrupts or intrudes on others (e.g., butts into conversations or games)
Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Specify Type:
Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months
Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months
Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months
Note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.

Stieve,

I’ve been wanting to follow up on your post, but I just started a job and don’t find the time to do any type of research and digging as I used to, so this will be short. You wrote:

[quote=”Steve”]
I’m sorry, but I haven’t been able to find an on-line link to these studies - they mostly are in journals that were published pre-internet. Most of the seminal studies on ADHD and medication were done back in the 70’s or 80’s. “”

Considering how informed you seemed to be, I am surprised that you are hanging your hat on research from the 70’s or 80’s regarding the effectiveness of medication for ADHD. Pharmacotherapy for ADHD has changed dramatically in the last 20-30 years. Meds are used more effectively because of the studies you have noted. 20-30 years ago it was pretty much “conventional wisdom” that all kids outgrew ADHD at puberty. We still see today how some insurance companies are about paying for Adult ADHD treatments. There are new meds. Twenty to Thirty years ago it was Ritalin, Dexedrine or Cylert. Today we understand 1st, 2nd, and 3rd tier med use. Along with combination therapy. We also understand better the etiology of ADHD and how it often travels with other disorders, so that when meds are not successful, Docs that keek current are looking for other problems.

“”I have on occasion been able to find more recent articles on the issue, but haven’t been making a log of them. The most recent was in about 1999, and verified the same conclusions Swanson drew. I really think people stopped researching the question much after ‘92 because Swanson’s “Review of Reviews” pretty much nailed the question down - we can’t expect big changes in long-term outcomes based on the use of medication on a broad scale. There appear to be other factors that are more important in the long run. This is not to minimize the short-term effects, which can be pronounced, nor to imply that NO child will do better long-term on stimulants. It’s just that we can’t really assume that the stimulants will make a difference over the course of years. “”

I would have to disagree with you that the research has stopped on the effectiveness of medication for ADHD. Also, in my very short dig for information, I would have to say that I did indeed find information that disputes the notion that medication has no long term effect. I think the most important recent research tells us that medication alone is not the most effective, but it didn’t say that medication didn’t have an impact at all.

My thoughts on this interesting, ( and civil !) thread.

I agree that children will live up to our expectations. We have made it clear that we expect our son will read for pleasure some day. That he will go to college and have a successful career. We expect him to do the work necessary to make it happen. But having high expectations isn’t the whole story. You also have to accept who your child is. Simply telling ds to read isn’t going to make it happen. He can’t do it on his own. Its not a question of won’t - its a question of can’t. Its my responsibility as his parent to figure out what tools he needs so he can then do his part which is learn to read.

I view the attention issue in much the same way. Its my job to figure out what he needs in terms of help. And he does need help — his inattention is involuntary.

This thread also doesn’t address the role of self esteem.

My son may learn eventually, later , or in different ways without medication. But at what cost? This is also a factor in our (current and ongoing) decision about medication. This kid feels concerned that he misses information in class. In a class of 6 children. Maybe, just maybe, the short term academic benefit he *might* gain from medication would give him some self confidence, and give him a window, some breathing room , so he can learn better self monitoring skills. That would be my goal if we go in that direction. Then the long term learning can be a little less difficult, with or without medication.[/u][/code]

[quote=”KarenN”]My thoughts on this interesting, ( and civil !) thread.

I agree that children will live up to our expectations. We have made it clear that we expect our son will read for pleasure some day. That he will go to college and have a successful career. We expect him to do the work necessary to make it happen. But having high expectations isn’t the whole story. You also have to accept who your child is. Simply telling ds to read isn’t going to make it happen. He can’t do it on his own. Its not a question of won’t - its a question of can’t. Its my responsibility as his parent to figure out what tools he needs so he can then do his part which is learn to read.

I view the attention issue in much the same way. Its my job to figure out what he needs in terms of help. And he does need help — his inattention is involuntary.

This thread also doesn’t address the role of self esteem.

My son may learn eventually, later , or in different ways without medication. But at what cost? This is also a factor in our (current and ongoing) decision about medication. This kid feels concerned that he misses information in class. In a class of 6 children. Maybe, just maybe, the short term academic benefit he *might* gain from medication would give him some self confidence, and give him a window, some breathing room , so he can learn better self monitoring skills. That would be my goal if we go in that direction. Then the long term learning can be a little less difficult, with or without medication.[/u][/code][/quote]

The medication will only have a negative effect. Instead of looking at his attention difficultie as a problem look at them like a challenge. It is a whole lot easier to concentrate on things he likes. That would be a place to start.

I am glad to read that you accept him as is. He need to do the same. He needs to know that he is OK.

[quote=”Anonymous”]

The medication will only have a negative effect. Instead of looking at his attention difficultie as a problem look at them like a challenge. It is a whole lot easier to concentrate on things he likes. That would be a place to start.

I am glad to read that you accept him as is. He need to do the same. He needs to know that he is OK.[/quote]

It is your bias that medication will only have a negative side effect, there is simply too much literature out there that says differently.

Yes, it is a lot easier to concentrate on things that a person likes, that is true of anyone, not just ADHDer’s. The difference is, a non-ADHDer can concentrate even when they are disinterested, when they decide to. However, an ADHDer cannot, at least not for a length of time.

Wanting your child to have successes, to meet his or her potential, is not not accepting them as they are. If I was to have accepted my child as she presented in 1st and 2nd grade, I’d have a depressed, frustrated, overwhelmed child with absolutely no sense of self esteem at all, and she wouldn’t feel this b/c she was failing, she would, and did, feel this because she wasn’t learning and she knew she could. She knew she understood completely when the teacher explained addition, etc in the classroom, but… every day like, every evening, it was like it was never taught. She knew that she shouldn’t be so aware of the sights and more so, sounds around her, yet the harder she tried to filter those and keep the focus on the teacher, she only became more and more frustrated, her peers could obviously do it, why not her? She knew something was wrong when all she could remember was the beginning of what the teacher started to say, and then the ending when books were being closed or papers shuffled, and this happened even when she was interested. She has always loved science and history, yet this still is a problem at times, just SIGNIFICANTLY less so with medication. She knew, and knows that I love her the same, always. But she also knew that something was wrong. What message would I have sent if I had not done EVERYTHING I could to help her achieve what she knew she was capable? An animal has to “accept” things as they are, as humans we have free will and choice. We have the ability to change our own destiny, for the worse or for the better.

Roxie, of course you understood my point about acceptance so I don’t need to beat that one to death.

I accept my son’s issues, and I accept that he needs help.

“guest”, if my son is only taught things he is interested in , at his age, isn’t that awfully limiting? Don’t we all need as well rounded an education as possible so we can have as many opportunities as possible. Its simply not OK for him to not read, given his intellectual potential.

I don’t accept a blanket statement that medication will have a negative effect. The consensus is that there is positive short term effects of improving a child’s attention. I believe for my child that will have long term benefits of improved self esteem. Of course there could be undesirable side effects - a risk I take very seriously. If it were risk free I doubt we’d be debating medication much.

Roxie,

I want to tell you something, something that I thought I’d never think or say, much less post on a publis message board. I’m sure I’ll get blasted for this, but what the heck.

Tuesday night, when my daughter was feeling very, very low, I was at a loss, I didn’t know what to do. It was so bad, she was so down, I went to the bathroom, took all the meds, I mean all of them, mine, the over the counter stuff, everything, and hid them. I didn’t know what she was capable of doing, if you catch my drift. It terrified me.

I did a great deal of thinking. The thought crossed my mind, that, if necessary, I would do anything, and I mean ANYTHING, to take away her pain. Even meds, if it comes to that. I hope to God it doesn’t come to that, but I understand now that one cannot sit in judgment of a desperate parent, who loves and is trying to help their child. A parent doesn’t know what they themselves would do in a serious situation involving their child, until they are faced with that situation.

Cathryn, I certainly hope that nobody will blast/flame you for saying what you did. Most of us have been there at one time or another. None of us know where we will be tomorrow. If anybody sinks that low please don’t be offended or even bother to respond.

If you felt that concerned about your daughter you most certainly did the right thing. Is this something you could mention to the therapist?

Anyone who comes to this board has a kid who is ‘not usual’, to say the least…I HATE callling it ‘disordered’ cuz in some cases that amounts to calling a PERFECTLY FINE engineer/architect a ‘broken lawyer’, but suffice it to say we are all here cuz our kids DON’T FIT where they are ‘supposed to’.

I have watched close friends go through severe ADHD combined with tourettes — they FOUGHT against meds for a couple of years and finally HAD TO TRY IT…many of you will be nodding your heads and saying, ‘YUP, that was US’ even if your child is not the same dx…but this is what is so important that all participants agree and understand: YES, you will, if pushed to the wall, do ANYTHING, TRY anything that will help or MIGHT help your child…and NO, NOBODY should ever question your right to do so!

BTW, YES, the meds helped…allowed child to function while gaining maturity, which continues by leaps and bounds. Will he ever be med free? Maybe not — we just don’t know. Will he be a happy, productive adult with a good chance for a successful life? YES, we are now CERTAIN of that!
(Bet those same folks are nodding again and agreeing with this, too!)

‘Nuf said…this is why anyone ‘against’ meds for anyone other than THEIR OWN CHILD should just be ignored…!

[quote=”KarenN”]
I believe for my child that will have long term benefits of improved self esteem. .[/quote]

And that is something that no one will ever be able to measure, but parents can see and feel in our hearts. Whether we choose to treat with medication, and I think that that is the goal of all parents- meds or not- we aren’t worried that jr is keeping up with his peers, or that Sally is a straight A student. We want our kids to be happy, well adjusted individuals that feel good about themselves when they look in the mirror.

Cathryn
I am concerned that you felt the need to hide all the medication that you had in the house. If you haven’t talked to her therapist about this, please do asap. I know that you must be scared that the therapist is going to want her hospitalized, and that may be true. But if she is having suicidal ideation, that means having suicidal thoughts, but no plan to act on it, it is time to step up therapy, or consider something inpatient. If it was just that she was so low it scared you, her therapist needs to know so she can approach it and decide just where things are at. I need to go out again, time to pick up from dance. How are things now? Are they better?

Roxie,

I hid all the medication as a precaution, because she was so-o-o down, and I really didn’t know what she was capable of doing. I’ve never seen her like this before in her life.

She seemed to be somewhat better today. Not like she used to be, but better than Tuesday night! I did talk to her teacher for over an hour today, I talked and she listened, and it went OK. I will post about that in more detail when I have time, maybe later tonight or tomorrow.

My daughter has a therapy session tomorrow afternoon, and yes, I will definitely be bringing up all that occurred this week with Alisha.

My daughter was so low that it scared the wits out of me, Roxie. No, I don’t want her hospitalized, but I definitely think the therapy needs to be stepped up. I talked to my daughter tonight, and I asked her to please, please stop pretending that everything is fine in her therapy sessions with Alisha, because Alisha can’t help her if she hides things. My daughter is a very good actress, by the way. Last week, Alisha told me she wasn’t sure anymore that my daughter was even depressed at all! That scared me too, because I know better.