Reply to Child with ADHD-- if you decided not to medicate, why?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]
I have two kids now in high school, both diagnosed with ADHD in elementary. We decided not to medicate because we didn’t feel the benefits were worth the risks, IN OUR SITUATION. I do believe that stimulant medications have risks and research has not shown that the benefits are clear over the long run. Again, this was our situation because our kids responded well enough to other interventions. They aren’t straight A students or even close (and I doubt they would be on meds) and they do struggle with concentration and getting assignments done but they have also had to learn some really good strategies to cope.

A couple of the studies that influenced our decision:
Medication: The smart-pill oversell. Evidence is mounting that medication for ADHD doesn’t make a lasting difference to schoolwork or achievement
http://www.nature.com/news/medication-the-smart-pill-oversell-1.14701

Large NIH longitudinal study found little benefit long term
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063150/
From the conclusions:
“Thus, although the MTA data provided strong support for the acute reduction of symptoms with intensive medication management, these long-term follow-up data fail to provide support for long-term advantage of medication treatment beyond two years for the majority of children—at least as medication is monitored in community settings. Decisions about starting, continuing, and stopping medication may have to be made on an individualized basis, avoiding untested assumptions about continuing benefit, and using periodic trial discontinuations to check for need and benefit.”
[/quote]

If you read the long term NIH study closely, it doesn't say exactly what you are saying. Their stats are complicated but essentially it is saying that initial improvements observed from treatments were sustained, but that ultimate outcomes were much more strongly predicted by other factors, one of which was the child's strength of symptom reduction from treatment. Also intensity of treatment beyond the initial trial period played a role in outcomes. Basically, this study was focused on how a one time intervention for a shorter duration of time (14 months or so) played out years later. This was not comparing continued, sustained treatments over a long period of time.

I am also the poster who mentioned the initial study that found medication to be highly effective in symptom reduction. I am a researcher at the NIH and that study was not one that was biased by funding in any way. Very difficult to publish in Pediatrics if there are concerns over financial interests![/quote]

OP here- thanks for posting studies. There are a lot of studies, varying levels of quality and rigor, and conflicting outcomes-- part of the reason I asked this question. I will read the two posted- I have a lot of respect for NiH research. It's my first stop when something seems too good to be true. PP thanks for clarifying the portion of the NIH study. These aren't easy studies to wade through without a stats background. [/quote]

I'm a mental health professional and I try to read every study that comes out regarding ADHD. It’s very confusing with lots of conflicting info. I don’t think there is enough research to be able to make any conclusive decision pro- or anti-meds based on research alone. Also, I do wonder about the long-term side effects that haven’t been researched yet, especially with the newer non-stimulant meds. I think the decision should come down to how much the meds will help your child and how much your child is struggling.  I think the quote from the NIH study is a great one:

“[b]Decisions about starting, continuing, and stopping medication may have to be made on an individualized basis, avoiding untested assumptions about continuing benefit, and using periodic trial discontinuations to check for need and benefit.” [/b]
[/quote]

While that quote is very true, the goal of any study is to look for trends at the population level. No one study result or finding will work for everyone, but the goal us to find what is significantly beneficial relative to other options. For instance, if meds help 50% (meaning half don't see a benefit) and modifications alone help 20%, then meds are "better", even though half the population is without benefit. So of course at the individual level it is trial and error. But at a population level perspective, meds are helpful in many settings.[/quote]

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