ADHD Drugs Don't Help Children Long Term

[Hannah Bell]

March 27, 2009

Stimulant drugs like Ritalin that are used to treat ADHD don't improve children's symptoms long term, according to new research published online in the Journal of the American Academy of Child and Adolescent Psychiatry. That may come as a surprise to parents, but ADHD researchers have been arguing for the past 10 years over the findings of the Multimodal Treatment Study of Children with ADHD. Called the MTA study, it is the largest study conducted to compare the benefits of medication to behavioral interventions.

This latest report from the MTA study tracked 485 children for eight years and found those still taking stimulant medication fared no better in the reduction of symptoms such as inattention and hyperactivity or in social functioning than those who hadn't. Most of the children who had taken medication for the first 14 months were no longer taking it. This, the researchers wrote, raises "questions about whether medication treatment beyond two years continues to be beneficial or needed at all." Earlier reports found that children taking stimulants alone or combined with behavioral treatment did better in the first year than children who got no special care or who got behavioral treatment alone.

There's more: Stimulant drugs stunt children's growth, according to another report in the journal that analyzes MTA data. Children who never took stimulants were three quarters of an inch taller and 6 pounds heavier on average than children who took medication for three years. The children don't make up for that later on.

http://www.usnews.com/health/blogs/on-parenting/2009/3/27/adhd-drugs-dont-help-children-long-term


...All of this made me wonder if Peter Jensen, who seems determined to continue to support the use of drugs to treat ADHD, might have ties to pharmaceutical companies. It took me only a few minutes to discover that he has received funding or grants from: UCB-Pharma, Cephalon, Novartis, McNeil Consumer & Specialty Pharmaceuticals, and Janssen Pharmaceutica.

I found confirmation of these ties here. Novartis and UCB-Pharma are manufacturers of ADHD drugs (Ritalin or methylphenidate), and Cephalon makes Provigil, which they attempted to promote as an ADHD drug for years until the FDA rejected it.

http://genome.fieldofscience.com/2009/03/parents-adhd-drugs-dont-work.html.



Novelty effect

The novelty effect, in the context of Human Performance, is the tendency for performance to initially improve when new technology is instituted, not because of any actual improvement in learning or achievement, but in response to increased interest in the new technology.


Hawthorne effect

The Hawthorne effect is a form of reactivity whereby subjects improve an aspect of their behavior being experimentally measured simply in response to the fact that they are being studied,<1><2> not in response to any particular experimental manipulation.

- an increase in worker productivity produced by the psychological stimulus of being singled out and made to feel important.

[lazarus]

1. you, and the people behind this study,

are welcome to try raising my daughter unmedicated for a few months. Her mother couldn't handle it and gave her to me. I was able to get her properly diagnosed and medicated. It's been like night and day.

I've been on Ritalin for 16 years. I had to go without it for two days a couple of months ago. I won't be doing that again.

This study has huge problems just from the little bit you've stated here. Small sample size and no look at the underlying diagnoses, just to start with. This reminds me of the studies that find an increased chance of suicide amongst people who take antidepressants. Well, duh, those people are depressed, and antidepressants work differently for different people. Same with Ritalin and other drugs. We tried 4 or 5 drugs before we found the right one for Kasii. I got lucky and responded favourably to methylphenidate right off, but it took six months or more to get the right dosage, and we're still adjusting it over time. So the kids studied may well have been on the wrong drug, or the drug may have needed adjusting that didn't happen, or any of a number of other things. Everybody is different, and everybody that needs medication needs a specific dosage and a specific drug, both of which can and do change, sometimes quite frequently. Did the study take this into account? Were all the kids being regularly monitored to ensure they had the proper dosage and medication? How were the symptoms assessed? Turns out, quite a few of the kids in the study weren't even still on medication, making the samle size even smaller.

ADD/ADHD are real problems that require help. Yes, some people are too quick to assume that any misbehaviour is ADD/ADHD, but that has no bearing on whether the diagnosis is real. I lived too long undiagnosed, and to this day I struggle with the learned behaviours I acquired the first 28 years of my life. Say, there's another issue with the study. A lot of these behaviours become ingrained during the unmedicated period of a person's life, and require quite a bit of behavioural therapy to overcome. Was that therapy provided to the subjects of this study? How successful was it? (Actually, I read the interview at the link, and apparently they can't build a study to determine this. Another huge hole.)

There's more, but it's way too late. I'm going to bed. I'll check back on this thread tomorrow.

[Hannah Bell]

4. it's the largest study ever done. the sample sizes are more than adequate.

http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml

[proud2BlibKansan]

19. You echo my thoughts exactly

Thank you.

[musette_sf]

39. + 1

[HysteryDiagnosis]

2. I wonder how long other agents could/would affect/benefit children

suffering with ADHD..

Eur Child Adolesc Psychiatry. 2006 Sep;15(6):329-35. Epub 2006 May 13.
Treatment of ADHD with French maritime pine bark extract, Pycnogenol.
Trebatická J, Kopasová S, Hradecná Z, Cinovský K, Skodácek I, Suba J, Muchová J, Zitnanová I, Waczulíková I, Rohdewald P, Duracková Z.
Dept. of Child Psychiatry, Child University Hospital, Faculty of Medicine, Comenius University, Limbová 1, 833 40 Bratislava, Slovakia.

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in children. Pycnogenol, an extract from the bark of the French maritime pine, consisting of phenolic acids, catechin, taxifolin and procyanidins, has shown improvement of ADHD in case reports and in an open study. Aim of the present study was to evaluate the effect of Pycnogenol on ADHD symptoms. Sixty-one children were supplemented with 1 mg/kg/day Pycnogenol or placebo over a period of 4 weeks in a randomised, placebo-controlled, doubleblind study. Patients were examined at start of trial, 1 month after treatment and 1 month after end of treatment period by standard questionnaires: CAP (Child Attention Problems) teacher rating scale, Conner's Teacher Rating Scale (CTRS), the Conner's Parent Rating Scale (CPRS) and a modified Wechsler Intelligence Scale for children. Results show that 1-month Pycnogenol administration caused a significant reduction of hyperactivity, improves attention and visual-motoric coordination and concentration of children with ADHD. In the placebo group no positive effects were found. One month after termination of Pycnogenol administration a relapse of symptoms was noted. Our results point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children.
PMID: 16699814
Publication Types, MeSH Terms, Substances
LinkOut - more resources

[woo me with science]

3. I don't believe they ever claimed to, Hannah.

That is one of the benefits of the original stimulants. They are out of the system in a few hours.

[trotsky]

5. The OP is on a crusade.

Don't even bother her with facts.

[Pithlet]

9. Really.

I guess we were supposed to react with "Oh noes! It's not a cure!" Oh wait. We already knew that.

[Hannah Bell]

10. the largest study ever done isn't a fact?

[HuckleB]

64. First, it's not the largest study ever done.

Second, the only fact about any study is that it's a study.

[woo me with science]

24. I know. I am a spycam veteran.

:rofl:

[Hannah Bell]

13. hardly.

Pharmacokinetics

Pharmacokinetic studies of ADDERALL XR® have been conducted in healthy adult and pediatric (6-12 yrs) subjects, and adolescent (13-17 yrs) and pediatric patients with ADHD. Both ADDERALL® (immediate-release) tablets and ADDERALL XR® capsules contain d-amphetamine and l-amphetamine salts in the ratio of 3:1.

Following administration of ADDERALL® (immediate-release), the peak plasma concentrations occurred in about 3 hours for both d-amphetamine and l-amphetamine.

The time to reach maximum plasma concentration (Tmax) for ADDERALL XR® is about 7 hours, which is about 4 hours longer compared to ADDERALL® (immediate-release). This is consistent with the extended-release nature of the product.

The mean elimination half-life for d-amphetamine is 10 hours in adults; 11 hours in adolescents aged 13-17 years and weighing less than or equal to 75 kg/165 lbs; and 9 hours in children aged 6 to 12 years. For the l-amphetamine, the mean elimination half-life in adults is 13 hours; 13 to 14 hours in adolescents; and 11 hours in children aged 6 to 12 years.



http://webcache.googleusercontent.com/search?q=cache:hp-9A4o-NHIJ:www.drugs.com/pro/adderall-xr.html+amphetamine+clearance+hours+half-life&cd=8&hl=en&ct=clnk&gl=us

[woo me with science]

22. Make an effort to learn what you are talking about, Hannah.

The "XR" means this is the extended release version, not the original drug.

And it doesn't matter which version you are talking about anyway; your premise is flawed. These drugs were never claimed to have long-term effects.

[Hannah Bell]

27. perhaps you'd better read the post again, woo. it wasn't just about XR.

and habitual amphetamine use has proven long-term effects.

[woo me with science]

28. And Ritalin is out of your system in 4 to 6 hours. What is your point?

My point is that the drugs are generally short-acting (even Adderall is not at an effective concentration after a few hours and is out of your system in a few days) and are not meant to cure ADHD or yield long-term effects.

Are you capable of addressing the larger point, Hannah, or is this going to be just like the spycam threads?

[Hannah Bell]

31. The OP isn't about "cures".

Methylphenidate is eliminated from the plasma with a mean half-life of 2.4 hours in children and 2.1 hours in adults.

The apparent mean systemic clearance is 10.2 and 10.5 L/hr/kg in children and adults, respectively for a 0.3 mg/kg dose.

Following oral administration of methylphenidate, 78 to 97% of the dose is excreted in the urine and 1 to 3% in the feces in the form of metabolites within 48 to 96 hours.

The main urinary metabolite is ritalinic acid (alpha-phenyl-2-piperidine acetic acid, PPAA); unchanged methylphenidate is excreted in the urine in small quantities (<1%).

Peak PPAA plasma concentrations occurred at approximately the same time as peak methylphenidate concentrations, however, levels were several-fold greater than those of the unchanged drug.

The half-life of PPAA was approximately twice that of methylphenidate.

Relative bioavailability of the Ritalin SR tablet, compared to the Ritalin tablet, measured by the urinary excretion of the methylphenidate major metabolite (PPAA), was 105% (49 to 168%) in children and 101% (85% to 152%) in adults.

The time to peak rate in children was 4.7 hours (1.3 to 8.2 hours) for the extended-release tablets and 1.9 hours (0.3 to 4.4 hours) for the regular tablets.

An average of 67% of the extended-release tablet dose was excreted in children as compared to 86% in adults.

http://www.mentalhealth.com/drug/p30-r03.html

[woo me with science]

35. So your answer to me is that, yes, this is going to be just like the spycam threads.

The typical Hannah Bell response. A cut-and-paste irrelevancy, followed by an assertion that the post "is not about" the topic at hand.

You are apparently distressed that the drugs don't have long-term effects. I point out that they were never meant to have long-term effects. True to form, you don't respond to my point at all, but blather on about irrelevant details that don't even support your argument.

Hannah, arguing with you is like arguing with a third grader. You have once again demonstrated why participating in a Hannah Bell thread is like going to Wonderland.

[Hannah Bell]

38. I believe that personal attack = a violation of DU rules.

[woo me with science]

44. I am not attacking you. I am describing the experience of arguing with you.

You do not engage in a logical argument. That is a description of your behavior, not your person.

But if you believe you are right, you are free to hit the alert button.

You still have not addressed my point.

[Hannah Bell]

46. You have failed to understand the study.

They took 579 kids diagnosed with ADHD.

They randomly assigned them to 3 treatment groups:

1. medication alone,
2. psychosocial/behavioral treatment alone,
3. a combination of both or routine community care

They studied them for 18 months in the first leg, when they found:

"the intensive medication management alone or in combination with the behavioral therapy produced better symptomatic relief for children with ADHD than just behavioral therapy or usual community care. Children who received the combination treatment fared best in other areas of functioning such as social skills and parent-child relations."


They followed up at 8 years, where they found:

"Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all."


I believe you misunderstood this point. The study followed up with kids who continued on meds & compared their symptoms/behavior/social adjustment to kids who went off.

http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml

[nonconformist]

16. +1

[hedgehog]

6. This may be a case of treating symptoms rather than the cause.

If I treat three patients with pneumonia with antibiotics and the antibiotics only cure one, does that meant that antibiotics don't cure pneumonia? What if one patient had viral pneumonia, one had bacterial pneumonia and the third had pneumonia after exposure to a chlorine?

Until we have a better understanding of how the brain works, all we can react to are the symptoms we can observe. I suspect that different cases of ADHD may look the same but have different causes. Some causes may be transient,(ex: a maturing brain that is out of balance for a few years) some may be permanent. Some people may need and respond to Ritalin for a brief period, others may need it forever and others may not respond at all.

[lunasun]

7. Ritalin can cause heart problems

but if you need it .....I guess you take the chances.... I work for a pediatric cardiologist

[Hannah Bell]

11. i read there was some pressure from peds docs to have kids evaluated for pre-existing

heart problems for just that reason.

[crazy_vanilla]

23. yes, and this is why I didn't put my child on stimulants

I have seen too many of these pediatric heart problems caused by stimulants prescribed as early as age 2! Before you ruin your child's health, educate yourself on the serious side effects.

I had a student who took Ritalin and was so hyped up he had to take downers at night just to go to sleep. Red circles around eyes, super skinny, it was a travesty that his parents didn't care that their child was like a zombie. What a shame ... This child was 10 at the time, now, 3 years later, heart problems (not congenital, by the way) due to accelerated heart rate for the 10 years he was on Ritalin since age 3.

There you have it, the real face of using children as cash cows for big pharma.

And yes, my son has ADHD and has always been medication free, and I am a teacher works with hyperactive students on a daily basis. I would never ever recommend they were medicated just so it made my job easier.

[madokie]

8. All I know is I have a friend who has a son who has been on adhd meds

since the first grade and he's 24 years old now and I sure wouldn't want to have to live the life that kid has to live today. And it was/is the meds too.

[anigbrowl]

12. For some extra information...

Readers might like to consult the original paper, as well as a couple of others at the same journal. One found, for example, that the same study suffered from a deficiency wherein testing found that about 25% of children were not actually taking their medication consistently, contradicting parental reports.

Go to http://www.jaacap.com/search/quick and search on "the MTA at 8" (include the quotation marks or you'll get a lot of irrelevant results). Registration is free. If you can't access all the papers, try Google Scholar with the same search terms and click on the 'cached' links.

Personally, I always prefer to read the actual papers rather than a media summary. I do think the findings are interesting, and it's only by conducting such studies that we advance science.

[Hannah Bell]

14. Results

In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes).

Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested.

[anigbrowl]

15. I'm unsure what point you're attempting to make here

You appear to be simply restating the conclusions of the study you reported in the first place. which is fine by me, but I think those can only be fully evaluated in the context of the methodology used and so forth, which is why I told people where to find the original paper in case they wished to read it.

Incidentally, the other paper I referred to discussed a discrepancy between reported and actual compliance (ie actually taking the prescribed medication) in ~25% of participants during, not after, the 14 month controlled trial. This might have implications for the reliability of the longitudinal study.

If your point is that we don't yet have a consistently reliable treatment for this problem and that anyone who thinks we do is mistaken, I agree completely. It's clear that people with ADHD have problems as a result and that models of its progression in individuals perform no better than chance.

[laughingliberal]

17. Oh, well. Don't know about long term but I'd have probably dropped out of high school without them

I was 15 when I was diagnosed and barely showing up for school, by then.

[Odin2005]

18. Oh bullshit. I've taken Ritalin since i was 6. I cannot multitask one bit without it.

[beam me up scottie]

21. Uh-oh, once again, your experience does not support one of the op's agendas.

Repeat after me:

I am a victim
I am a victim
I am a victim
I am a victim
I am a victim


What's it like to have an entire crusade trying to undermine science for your "own good", Odin?

[Odin2005]

26. Oh, given that I'm on the autism spectrum I know all about such crap, LOL!!!

:rofl:

[Hannah Bell]

29. the largest study ever done isn't science?

[woo me with science]

37. What's your point, Hannah?

You seem to be upset that the drugs don't have long-term effects.

Several people have pointed out to you that they were never meant to work that way.

You say above that this thread isn't about your expecting a cure through the drugs. Well, what did you expect from them? Why do you post this study, as though the drugs' not having long-term effects were something that should surprise us or be considered important news?

What is your point here?

[Hannah Bell]

40. The study isn't about "cures" as i've repeatedly pointed out.

The study is about the advantage of medications v. 1) behavioral therapy or 2) "usual community care," i.e. no treatment at all.

This study found no difference at 8 years follow-up.

[woo me with science]

42. What differences did you expect,

given that the drugs are short-acting for symptom relief and never claimed to cause permanent changes in children's attention?

[Hannah Bell]

47. I think you missed this part:

"Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all."

http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml

[smalll]

30. Um, people aren't SUPPOSED to be able to (ahem) "multitask" --

Read emails and have a phone conversation at the same time? You'll do both badly. Same thing with gabbing on the phone while driving. Etc. etc. Here's a link to just one recent study that helped to puncture the "multitasking" myth.

http://www.cbsnews.com/stories/2009/08/25/tech/main5264503.shtml

[Odin2005]

41. I'm talking about the broader definition of multitasking used by most people.

That is, having no problem pausing one task for a movement to do another task and then going back the the earlier task with little problem. Most people can do that, I can't.

[proud2BlibKansan]

20. Ritalin isn't a cure. There is no cure for ADD/ADHD.

And I wouldn't have dreamed of sending either of my own ADD kids to school without their meds. I grew up with 2 siblings who had ADD and neither was medicated (because they didn't commonly prescribe meds for ADD back then) and I saw their childhood as well as my own, since I had to live with them, turn into a virtual nightmare.

Both my siblings are now adults and have been on meds for many years. Both finally have functional lives because they are able to manage their hyperactivity and impulsivity, thanks to medication.

And both my own children made it through school thanks to Ritalin.

I helped start the first parent support group for those of us raising ADD/ADHD kids. It has grown into a national organization that helps tens of thousands of families. And I am proud of my involvement.

I have said the same thing a few others in this thread say. If you really believe children should not take Ritalin, I know many children I would gladly help arrange to spend the weekend with you - without their medication. If that won't turn you into a believer I don't know what would. :)

[Hannah Bell]

33. OP isn't about "cures". OP is about the largest study ever done which compared

kids on adhd meds, on meds + behavioral therapy, on BT alone, & on "usual community care," (i.e. no specific treatment).

At 8 years follow-up, there was no significant difference between any of the treatment groups for the measures studied.

Spending an off-meds weekend with kids who usually get meds = spending a weekend with kids withdrawing from their usual dose of drugs. So I'm not sure how their behavior under those conditions is relevant.

[proud2BlibKansan]

36. There is no long term effect because there is no cure

It's as simple as that. No treatment will have a long term effect as long as there is no cure.

ADD is a brain based disorder for which there is no cure. We still don't know what causes it but there is a strong genetic link in many families.

The problem I have with studies like this is they serve to discourage parents from using medication for kids with ADD. And in many cases, the medication is literally a godsend. ADD makes kids unavailable for learning. It is cruel to put these kids in classrooms and hold them accountable for tasks they are literally incapable of attending to. I have a sibling who was suicidal as a child, the frustration was that great. When prescribed appropriately, medication is the most effective treatment available.

And yes, spending time with kids off their meds will make a believer out of anyone. I do it everyday. It's no picnic. :)

[Hannah Bell]

43. The study isn't about cures. It's about the advantages of meds v. other treatments or

non-treatments.

The study found no difference at 8 years follow-up between ADHD kids:

1. on meds
2. on meds + BT
3. on BT alone
4. on no treatment whatsoever, i.e "usual community care".


And they found no difference between kids who stayed on meds & kids who went off them:

"Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all."


It has nothing to do with cures. The study doesn't discuss cures. It's a four-arm study of treatment effects, the largest of its kind ever, & the only one with long-term follow-up.

[LWolf]

25. The big question, then, is:

What IS the long-term solution for those on the extreme ends of the add/adhd continuum?

[Hannah Bell]

45. Thank you for actual discussion. I don't think any conclusions can be drawn from this study about

"extremes," because it wasn't about extreme cases.

The findings here are very general. It might be that a different result would obtain for extreme cases.

I simply wanted to post the study as it was the largest of its kind & the only one with long-term follow-up, something previously lacking.

[Initech]

32. I was on ADHD meds, I know that from experience.

Having a short attention span really fucking sucks, but I've tried pretty much every medication on the market to combat it, and they just flat-out do not work.

[HuckleB]

34. This study was published one year ago.

Why post it at DU now?

[Hannah Bell]

48. Because it's the largest study ever done, & the only one with long-term follow-up

comparing outcomes for subjects who continued with treatment to subjects who didn't?

There's no requirement to post only current research in GD.

[HuckleB]

49. The largest study?

Really? Where do you get that from?

[Hannah Bell]

50. here:

http://www.google.com/#hl=en&q=%22multimodal+treatment+study+of+children+with+adhd%22+largest&aq=f&aqi=g1&aql=&oq=&gs_rfai=&fp=3582fcc58a84fb8f


and here, start last paragraph, left column:

http://resources.metapress.com/pdf-preview.axd?code=nkv73517r7046602&size=largest

"The MTA is not only the largest clinical trial ever funded by NIMH in children & adolescents, it is also the most comprehensive in terms of scope & interventions..."

[HuckleB]

51. That doesn't indicate that it's the largest study ever done on ADHD.

[Hannah Bell]

52. look at the second reference, please.

then look at this one (linked in the first reference):

"Over the past year you may have seen preliminary reports of results from the Multimodal Treatment Study of Children with ADHD (MTA). This is the largest and most comprehensive treatment study of ADHD that has ever been conducted. Last month, the initial papers reporting the results from this study were published. This is a landmark study with a number of important implications."

then look at some of the other links.

[HuckleB]

53. "...funded by NIMH..."

That's a big caveat.

[Hannah Bell]

54. you must have missed this:

"Over the past year you may have seen preliminary reports of results from the Multimodal Treatment Study of Children with ADHD (MTA). This is the largest and most comprehensive treatment study of ADHD that has ever been conducted. Last month, the initial papers reporting the results from this study were published. This is a landmark study with a number of important implications."

http://adhd.kids.tripod.com/rabinerst.html

and this:

Get details on the largest clinical study of ADHD in children and major findings regarding the most effective ADHD treatments for children with ADHD.

1. What is the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD)? The Multimodal Treatment Study of Children with ADHD (MTA) is an ongoing, multi-site, cooperative agreement treatment study of children conducted by the National Institute of Mental Health. The first major clinical trial in history to focus on a childhood mental disorder, and the largest clinical trial ever conducted by the NIMH, the MTA has examined the leading treatments for ADHD, including various forms of behavior therapy and medications. Te study has included nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care.

http://www.healthyplace.com/adhd/nimh/nimh-multimodal-treatment-study-of-children-with-adhd/menu-id-888/

and this:


The MTA was the first major multi-site trial comparing different treatments for ADHD in childhood. The initial results of the 14-month study, in which 579 children were randomly assigned to one of three intensive treatment groups (medication alone, psychosocial/behavioral treatment alone, a combination of both) or to routine community care were published in 1999.

http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml


and this:

Abstract The multimodal treatment study of attention deficit hyperactivity disorder (MTA Study) constitutes a landmark in the history of treatment research in child psychopathology, being the largest single study of its kind ever undertaken.

http://www.springerlink.com/content/t89x171874t4r23g/

etc.

all from the first link.

[HuckleB]

55. All claims made with big caveats, or merely hyperbole.

Are you really going to stick with this claim?

[Hannah Bell]

56. It's the claim of the national institute of mental health & reputable scientific pubs. I'm not sure

what you're seeing.

Abstract:

The multimodal treatment study of attention deficit hyperactivity disorder (MTA Study) constitutes a landmark in the history of treatment research in child psychopathology, being the largest single study of its kind ever undertaken.

http://www.springerlink.com/content/t89x171874t4r23g /



I've given you multiple links from reputable sources. You want to call them "hyperbole," too bad.

I dare you to find a bigger one.

[HuckleB]

57. "...of its kind..."

Caveats are very important to pay attention to...

Here's one study that dwarfs it: http://www.scienceblog.com/community/older/2003/G/20034927.html

[Hannah Bell]

58. Yes, "of its kind" = unimportant things like randomized, with control groups & long-term follow-up.

Let's compare your study:

1. Shire Pharmaceuticals Group plc (NASDAQ: SHPGY, LSE: SHP.L, TSE: SHQ CN) announced results...
= funded by a drug company vs. funded by the NIMH

2. 7 weeks long vs. 18 months long with follow-up at 2 years & 8 years

3. subjects = 2900 children already on ADHD meds who were switched to the sponsors' product vs. about 600 kids with new diagnoses randomized into 3 research arms.

4. parents were given a "Parent Evaluation" (The Conners' 10-item Global Index Scale, Parent version) to measure improvement in ADHD symptoms: there was a statistically significant improvement in the mean CGIS-P scores at week 7.

= Ten questions to parents vs. multiple subjective & objective assessment measures.


That's it. No control group, no randomization, no follow-up. A 7 week trial of a different ADHD med, presented at a psychiatric conference, not published in a reputable journal (try to find it!), funded by a drug company & published by the drug company's PR firm.

Find me an actual *reputable* study with long-term follow-up & control groups.




About LADD.CAT

LADD.CAT was a seven-week prospective, open-label, community assessment trial that included over 2,900 children with ADHD who had previously been treated with a stable dose of ADHD medication, either methylphenidate HCl), another methylphenidate product or a mixed salts amphetamine product.

Investigators switched the patients' medication to once-daily mixed salts amphetamine product the morning after their initial LADD.CAT visit using strict criteria and calculations to approximate equivalent therapeutic potency between the previous treatment and the study drug.

At study weeks one and three, investigators could adjust, or titrate, the dose if necessary based on efficacy assessments or because of spontaneously reported adverse side effects.

The once daily mixed salts amphetamine product was generally well tolerated during LADD.CAT. The majority of treatment-emergent side effects were mild or moderate and similar to those seen in previous clinical trials of the drug. Of the 2,986 patients who enrolled in the trial, only 5.1 percent discontinued their participation because of treatment-emergent side effects.


Followed by PR about the corporation & stock info.


Shire Pharmaceuticals Group plc

Shire Pharmaceuticals Group plc (Shire) is a rapidly growing international emerging pharmaceutical company with a strategic focus on four therapeutic areas � central nervous system disorders (CNS), gastrointestinal (GI), oncology, and anti-infectives. Shire also has three platform technologies: advanced drug delivery, lead optimization for small molecules and Biologics. Shire's core strategy is based on research and development combined with in-licensing and a focus on eight key pharmaceutical markets.

The once daily mixed salts amphetamine product is distributed in the United States by Shire US Inc., the sales and marketing subsidiary of Shire Pharmaceuticals plc.

For further information on Shire, please visit the Company's website: www.shire.com; or www.adhdsupportcompany.com.

Statements included herein that are not historical facts, are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire's results could be materially affected. The risks and uncertainties include, but are not limited to, risks associated with the inherent uncertainty of pharmaceutical research, product development, manufacturing and commercialization, the impact of competitive products, including, but not limited to, the impact on Shire's Attention Deficit Hyperactivity Disorder (ADHD) franchise, patents, including but not limited to, legal challenges relating to Shire's ADHD franchise, government regulation and approval, including but not limited to the expected product approval date of lanthanum carbonate (FOSRENOL�) and METHYPATCH �, and other risks and uncertainties detailed from time to time in our filings, including the Annual Report filed on Form 10-K by Shire with the Securities and Exchange Commission.

APA Presentation Session #21,Wednesday, May 21, 2003; 11 � 12:30 PM
An Open-Label, Community Assessment Trial of Adderall XR in Children With ADHD Quality of Life Results

Medical and Health Reporters
For further information, please contact:

Mich�le Roy � Director, Corporate Communications North America
450-978-7938

Andrea L. Pellicciari � Porter Novelli
212-601-8397/201-981-2699 on-site
Marion E. Glick � Porter Novelli
212-601-8273/917-301-4206 on-site

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[HuckleB]

61. Thanks for the red herring.

[Hannah Bell]

65. whatever you say. no control group, no blinding, no randomization, funded by a drug company,

research question = is our adhd drug tolerated by users of other adhd drugs.

[HuckleB]

68. You keep telling yourself what you want to believe.

You lied. I called you on it. I gave you plenty of chances to come clean.

End of discussion.

[Hannah Bell]

72. keep telling yourself what you want to believe. post 48

"Because it's the largest study ever done, & the only one with long-term follow-up comparing outcomes for subjects who continued with treatment to subjects who didn't?"

research question: how do kids on drugs do compared to kids on behavioral therapy or community treatment over 18 months, at two years, and at 8 years?


i repeat: you linked a drug-funded study of subjects already on meds who were switched to another med & assessed for tolerance: no comparison or control group, no randomization, no blinding.

research question: will kids currently on drug X do as well or better on OUR drug over 7 weeks?


now, what were we talking about in this thread? were we talking about whether medicine x is better than medicine Y?

no, we were not. we were talking about whether kids on meds show long term benefit v. other treatments (i.e. we were talking about the study i posted).



sure, *i* "lied".

any bogus excuse to ignore the findings of the largest, most comprehensive study ever done comparing different treatment modalities.

whatever, i'm sure long-term amphetamine use is very healthy.

smoking, now -- that's bad. bad, bad, bad. especially that second-hand smoke.

but chronic amphetamine use - is grand.

unless they're illegal amphetamines -- that's completely different. then you lose your teeth, become psychotic & murder grandma.

[Hannah Bell]

59. oh, & i forgot to compare the principal investigators:

Paul J. Ambrosini, M.D., Professor of Psychiatry at MCP Hahnemann University.

"After Tenet Healthcare acquired the holdings of the Allegheny Health Education and Research Foundation it created the MCP Hahnemann University and arranged for Drexel University to assume its operation.<3> In 2002 Tenet Healthcare agreed to a 20 year merger between MCP Hahnemann University and Drexel University, as well as an affiliation between the Drexel University College of Medicine and Tenet's teaching hospitals in the Philadelphia area."

i.e. "MCP Hanhnemann U." = the recent creation of Tenet Healthcare, a publicly-traded for-profit healthcare corp.

http://google.brand.edgar-online.com/PeopleFilingResults.aspx?PersonID=3465255&PersonName=PAUL%20J.%20AMBROSINI




v. publicly funded NIHM principal investigators:

Principal investigators and coinvestigators from the 6 sites are as follows:

Stephen P. Hinshaw, Ph.D. (Department of Psychology, University of California, Berkeley),

Glen R. Elliott, M.D., Ph.D. (Department of Psychiatry, University of California, San Francisco);

Duke University: C. Keith Conners, Ph.D., Karen C. Wells, Ph.D., John March, M.D., M.P.H. (Department of Psychiatry & Behavioral Sciences);

James Swanson, Ph.D. (Department of Pediatrics and Cognitive Science, University of California, Irvine),

Timothy Wigal, Ph.D. (Department of Pediatrics, University of California, Irvine);

Howard B. Abikoff, Ph.D. (Department of Psychiatry, New York University School of Medicine),

Lily Hechtman, M.D. (Department of Psychiatry, McGill University);

Laurence L. Greenhill, M.D. (Department of Psychiatry, Columbia University),

Jeffrey H. Newcorn, M.D. (Department of Psychiatry, Mount Sinai School of Medicine);

William E. Pelham, Ph.D. (Department of Psychology, State University of New York at Buffalo),

Betsy Hoza, Ph.D. (Department of Psychological Sciences, Purdue University).

Helena C. Kraemer, Ph.D. (Stanford University, Department of Psychiatry & Behavioral Science)

[HuckleB]

62. And another red herring.

You proved to be incredibly dishonest on this matter, and that makes your motivation for pushing this, while ignoring other evidence, and ignoring the problems with the MTA study, incredibly unpersuasive.

[Hannah Bell]

66. "dishonest" = lol. "other evidence" - you presented no other evidence.

the drug-funded study you posted doesn't even address the same questions.

"the problems with the mta study" = you didn't discuss any.

[HuckleB]

69. Thanks you for proving my point again.

[Hannah Bell]

71. & thanks for proving mine. you put up a piece of crap pharma-funded study with

no control group. if the kids didn't do worse on the new med than their old one - success!!

that's what passes for unbiased research at DU.

[Grand Taurean]

60. Ritalin has done more harm to society than marijuana.

[HuckleB]

63. First, hogwash. Second, nice red herring.

[Grand Taurean]

67. Truth. It has become a substitute for parenting.

[HuckleB]

70. Thanks for the baseless cliche.

[Hannah Bell]

73. thanks for the free-floating hostility.

[Odin2005]

74. Bullshit.