Industry leaders in improving attention. |
|
For more information call (800) 788 - 6786 or request
a |
Does the Effectiveness of Stimulant Medication Decrease in Adolescence?
One of the concerns that many parents have about their child receiving stimulant medication is that children develop a "tolerance" for medicine, and that medication may thus not be as effective for teenagers as for pre-pubertal children. A study that was just published in the March 98 issue of the Journal of the American Academy of Child and Adolescent Psychiatry titled "Equivalent effects of stimulant treatment for ADHD during childhood and adolescence" suggests that these concerns are unwarranted.
In this study, children who attended a summer treatment program for ADHD completed careful placebo-control medication trials when they were children (i.e. 8 to 11 years old) and again when they were adolescents (i.e. 12 to 14.5 years old). Careful measures of subjects' academic performance and social behavior were obtained on each occasion, and the magnitude of medication effects were computed for each child at each time. By comparing the effect size for subjects when they were children with the effect size obtained several years later when they were teenagers, the researchers could determine whether the effectiveness of medication diminished with advancing age.
The results indicated that for most children, effect sizes for medication were judged to be in the moderate to large range, and that this was true at both assessments. Thus, there was no indication that the effect of medication diminished as subjects moved from childhood to adolescence. This was true even though the doses being administered on these two occasions were IDENTICAL. In other words, just because the subjects were bigger, a larger dose was not required to produce equivalent benefits. This is perhaps not surprising given that other research has not indicated any relation between body mass and response to different doses (see the prior issue of ADHD RESEARCH UPDATE).
Now, it certainly often seems that a child with ADHD experiences greater difficulties upon entering middle school, and a common response from treatment providers is to increase the amount of medication the teen receives. The authors of this study argue that their results indicate that stimulant medication is equally effective with children and adolescents IF they are engaged in similar activities, and suggest that a change in environmental demands may often explain why the functioning of adolescents with ADHD appears to worsen.
I think they are likely to be correct about this. Just consider how the academic demands of middle school - when students often have 5 or more different teachers - compare to the demands of elementary school, when a single teacher is generally responsible for each student. If a student appears to be struggling to a greater degree when he or she enters middle school, it is often because the demands they have to meet are greater, and not because their ADHD has gotten "worse".
This line of reasoning suggests that increasing the amount of medication the student receives rather than looking to make appropriate and necessary accommodations in the academic environment may not be the best course to pursue. Once the optimal dose of medication has been determined for an individual child using a careful medication trial procedure, treatment providers should "rigorously examine environmental causes to problems before prescribing higher doses of stimulants to adolescents with ADHD who exhibit a worsening in functioning."
In such instances, increasing the dose of medication, or perhaps changing the medication may turn out to be the answer, but it should not automatically be assumed that this is what needs to be done. When such a change is contemplated, controlled, individualized dose-response trials should be implemented to document whether the medication change is really helpful.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.