

Children’s A.D.D. Drugs Don’t Work Long-Term - jhull
http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?pagewanted=all

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tomkin
As someone with A.D.D., I kinda find this piece offensive. A lot of people not
afflicted with A.D.D. like to give their armchair opinion on the effects,
classification and understanding without having spent one day with A.D.D. I
was diagnosed late in life, so I can't speak to the longer term, or even
child-related effects of Concerta or Ritalin, but I can vouch for them as a 32
year old. Since taking prescription Concerta, I have started a successful
business, become a more vocal and engaged citizen and have had much greater
relationships with people in general. I do see the benefit in other therapies
and methods of treatment, but this dialog is probably a step backward.

My larger point is this: Don't let prejudice of big pharma allow you to "throw
the baby out with the bath water". No one benefits from that mentality.

~~~
sunwooz
Granted, I'm also an armchair doctor, but... The criteria for being diagnosed
with ADD seems like it can be applied to every single human being on this
planet. Am I wrong?

~~~
astral303
Just like with depression, everyone sometimes feels sad. It's the intensity
and how much your life is affected by it that's the differentiating factor.
There also often isn't a logical reason. When you have ADD proper, you just
can't help it.

For a person with ADD, if there was a gun held to their head to stay on a
task, they will soon forget that there's a gun and become distracted. They
can't help it. Their mind is racing. The only way to stay on task is to be
constantly tapped on the head with the gun. At this point, it's the periodic
reminder that's doing the trick. This is why people with ADD often require
external structure to keep them focused.

There's a lot of positives for people with ADD, such as increased creativity
and out-of-the-box thinking. Problem is that a lot of societal institutions,
such as school, are not adapted to it.

~~~
darkarmani
> This is why people with ADD often require external structure to keep them
> focused.

It's not so much about keeping focus it's the executive function part of it:
keeping focused on the right thing. People with ADD can definitely focus, they
just can't control it. That's why parents can easily dismiss it as lack of
motivation. "he focuses just fine playing soccer" (a sport with adrenaline
that gives results like stimulants)

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mistercow
This is a _massively_ irresponsible piece, and the author should be ashamed
for having written it.

A) The drugs work in the short term, and in the absence of data, the null
hypothesis is that they continue to work in the long term. Making a strong
claim like "ADD drugs don't work in the long term" without strong evidence is
nothing short of scientific malpractice.

B) The author claims there was "a well-controlled study" that showed "very
clear" results that "medication" (which medication?) was ineffective after 8
years. Thankfully, we won't be burdened with analyzing this study for
ourselves, because the author does not give a citation or any other way of
tracking the study down.

C) The author says that you can't fix all of the problems caused by ADHD with
drugs. That's true, and any good doctor will tell you as much. Drugs are
_part_ of managing ADHD. They are not an entire solution.

D) The author claims that these drugs are habit forming. This is simply false
at the dosages used to treat ADHD. For many ADHD drugs (e.g. atomoxetine), it
is false at any dosage.

There's a more thorough destruction of the piece here:
[http://www.huffingtonpost.com/dr-harold-koplewicz/ritalin-
go...](http://www.huffingtonpost.com/dr-harold-koplewicz/ritalin-gone-
wrong_b_1244935.html)

~~~
crusso
YMMV, but as a person who has been on ADD medication and started having to
ratchet dosage up and up as my body built up tolerance, I started researching
online for more information. I found that my situation was VERY VERY common
for others taking ritalin/adderall/vyvanse-like drugs.

Very conspicuously, whenever I read "official" research on these medications,
the studies were always short term like 6 weeks, maybe 12. One of the drugs I
was prescribed had been out for years yet the only study available was for 6
weeks. Isn't that odd? Wouldn't you think that with the drug's having been on
the market for years and with lots of online accounts of decrease in
effectiveness after a few months that someone would have done a study? Doesn't
the FDA require any follow-up studies be done after a drug is released to show
a lack of side effects or continued efficacy?

It's really not surprising to me that now that medical practitioners are
gaining years of experience prescribing these drugs that this long-term
efficacy issue is going to become more of a subject of discussion.

~~~
mistercow
There is certainly a potential to build a tolerance to stimulants, and that's
one possible reason to switch drugs. As you said, it varies from person to
person. For drugs with minimal withdrawal symptoms, like ritalin, it is also
possible to mitigate tolerance effects by taking regular vacations from the
medication.

Out of curiosity, have you had to increase your dosage significantly as an
adult? It is common for people to need to increase their dosage during
adolescence because their bodies change, and that's not necessarily indicative
of a tolerance effect.

------
ericcumbee
I was diagnosed with ADD in the third grade. I think i was probably one of the
last to be properly diagnosed as A.D.D before it became the catch all
diagnosis. I spent a day worth of testing at my doctors office, and probably a
week worth of testing over the next month at school taking different tests.

I took Ritalin or Concerta (a long release form of Ritalin) from 3rd grade to
most of the way through college. And i can say for a fact that i would not
have made it through high school with out it.

When i got to college im not sure what happened, i either outgrew the ADD, or
adapted, i stopped taking it around the end of my 2nd year.

~~~
TechNewb
You didn't out grow it, I think the general high school education system is
broken. Our society would like to think it's a children's medical problem, why
students can't pay attention in class, when in reality it's the broken public
education system.

We need to rethink public education before we start drugging everyone to fit a
broken system. The way that college is taught is much more humane.

Good Noam Chomsky interview on the topic of education:
<http://www.youtube.com/watch?v=DdNAUJWJN08>

~~~
josephlord
> You didn't out grow it

Stated with such certainty. What evidence do you have that the commenter here
in particular didn't develop in some way as they grew up?

This doesn't take away from your views that there may be problems with the
education system but to declare that there are no cases of real medical issues
in this area seems a bit presumptive.

~~~
TechNewb
>Stated with such certainty. What evidence do you have that the commenter here
in particular didn't develop in some way as they grew up?

No evidence, speaking from personal experience and the belief that ADD is over
diagnosed.

I don't find it hard to believe there are millions of students unable to focus
in public school. What I find hard to believe is that medication is the
answer. Sure its an easy answer for those teachers to have their students sit
quietly in the classroom for 50-90 minutes with little interruption and be
expected to focus on subjects that relate little to their life with little or
no control over what and how they study. I was diagnosed with ADD, and I had
these views about 12 years ago to when I was diagnosed. I'll stick to cabbage,
green tea, and the occasional meditation to help with my so called add.

~~~
josephlord
I'm glad that worked for you. And medication is probably not the answer for
millions of students although there maybe tens or even hundreds of thousands
for whom it is necessary and life changing.

"I therefore all" is clearly a fallacy although a very popular one. It is
really a form of anecdote and deserves no more weight than any other
particular anecdote.

------
lancefisher
My 5-yo son has a hard time behaving at pre-school. I think it has a lot to do
with being bored, since he is far ahead of the other students. They are
tracing letters, while he likes to write short stories. They are learning to
count to 10, while he can multiply and divide.

Nevertheless, we had him tested by a neurobehavioral specialist who believes
he has ADD. The doctor recommended either drugs or neurofeedback.
<http://en.wikipedia.org/wiki/Neurofeedback>

I'm very hesitant to give my 5-yo any medication, but we are considering
neurofeedback. I'm curious if anyone here has any knowledge or experience with
it.

~~~
pixie_
I had a hard time concentrating in school as well. Always in the principal's
office, and got C's in conduct all the way through 6th grade. I thank god my
parents never had me 'diagnosed' because I was guaranteed to be labeled 'ADD'
and been prescribed medication for this truly bullshit condition concocted by
the modern age.

~~~
DanBC2
> prescribed medication for this truly bullshit condition concocted by the
> modern age.

Ritalin is nearly 60 years old.

~~~
pixie_
Sorry I meant the condition is concocted, not the drug.

~~~
DanBC2
The drug has been used to treat the condition for nearly 60 years.

------
jstalin
I genuinely wonder how much of these sorts of behavior problems can be traced
to external factors such as too much sugar in the diet, lack of exercise, and
the over-stimulation (or under, depending how you look at it) of watching
hours and hours of TV. I don't want to sound like a luddite curmudgeon, but it
seems like so much of the ADD realm is about using drugs to "correct" problems
but little attention is paid to other factors. The author of this article does
say that socio-economic status plays a part (or at least is correlated), but
no mention of diet or activity.

Is anyone aware of any studies of ADD and related conditions that control for
these factors?

~~~
Mz
I have seen such info. Dietary changes and nutritional supplements have a
better track record than allopathic drugs. I don't have any links at my
fingertips. It has been a few years since I hung out in places where that type
thing was regularly discussed. But I know it works. I have two ASD sons and
diet makes a big difference for them.

~~~
illuminate
"Dietary changes and nutritional supplements have a better track record than
allopathic drugs. I don't have any links at my fingertips."

There's a reason for that. "My kid has celiac" is the new fad, but the fad
doesn't "cure" ADD.

~~~
Mz
It is more complicated than that. And I did not say it was a "cure".

------
tokenadult
It's an opinion article, not news reporting. The New York Times is annoying in
how often these days its brand is diluted by publishing opinion pieces on
medical issues that don't have to meet journalistic reporting standards.

Worse, the author of this piece is a known axe-grinder on the issues he writes
about, and doesn't even have the respect of many of his colleagues in the
Department of Psychology (he himself is in the Department of Child
Development) at the University of Minnesota, where I attend the behavior
genetics seminar most weeks during the school year. He is still stuck in the
old days of child development theories that have since been abandoned.

On the other hand, I will agree with the author, relating both to ADD and to
other diagnoses, that most human behaviors have to be influenced by treatments
that focus on the specific behaviors in addition to prescribed medicines. A
both-and approach of supportive help for the behavior as well as the best
validated medical treatment works better than merely taking the medicines.
Learning to focus and direct attention appropriately is not easy, especially
when many immediate relatives of the child, perhaps including both parents,
may have many of the same issues. Slow and steady wins this race.

------
mitchi
Anyone with A.D.D who's taken drugs here? Do you remember what it feels like?
I haven't taken any, how do they make life different? I will say this however,
I've found that a moderate dose of alcohol (1 pint of beer) usually makes me
focus better/more discipline and I'm able to resume working on my master
thesis. Usually, I cannot work on it because it's almost over(in my head it's
over) and I want to do something else.

I am currently pursuing an academic career but I really feel that I would have
been better at doing something simpler, like sports. Short tasks, competition,
and recognition are very important for me.

~~~
cube13
This reddit post is a great description of what it's like:

[http://www.reddit.com/r/explainlikeimfive/comments/16joxj/pe...](http://www.reddit.com/r/explainlikeimfive/comments/16joxj/people_with_adhd_what_adhd_is_like_how_does/c7wnp37)

~~~
mitchi
"Normal people have like a mental secretary" So jealous

------
dmix
Could this not be solved by switching between different stimulants to offset
tolerance?

~~~
betterunix
That would probably be dangerous. The drugs prescribed for ADD can induce
psychotic episodes, and cause mood swings, and otherwise have negative
psychological effects. Switching between different stimulants could amplify
the risk of such episodes, or complicate treatment should such a patient have
such an episode.

I would be a bigger fan of _moderating_ the drugs. Don't use the drugs on
weekends or holidays; use lower doses on days where it is OK to goof off a bit
or days where the workload is light. I suspect that doing this with children
would be a good lesson in and of itself, in that they can see that work and
play can be separated and that the withdrawal symptoms from a drug can be
overcome (this could also serve as a way to identify people who have some
innate problem with drug dependence before they get into trouble).

Of course, there is also the matter of school being so boring and so
undesirable that children need to have pristine focus just to survive. Perhaps
it would be best to solve that problem first, before using drugs to keep
children focused on "busy work."

~~~
darkarmani
> Of course, there is also the matter of school being so boring and so
> undesirable that children need to have pristine focus just to survive.
> Perhaps it would be best to solve that problem first, before using drugs to
> keep children focused on "busy work."

You do know that ADD is much more than focus issues, right? It's more of an
executive function disorder. They can't focus on the right things when the
want to. I'm betting most if not all can hyperfocus and lose track of time
when doing something that engages them. What they can't do is manage
priorities and turn that focus on and off when they want to.

------
malkia
It could be that we are doing LEARNING the wrong way. It's only the last 2-3
centuries that kids were put under such stress.

