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Importance of Conducting a Careful Medication Trial
A case study that appeared in the July 1998 issue of the Australia Family Physician (pages 103-105) highlights the importance and, in my opinion, necessity of conducting a careful trial for children with ADHD who are started on medication. Although this isn't really a research article, per se, I wanted to include it in the newsletter to highlight this important issue.
The subject of this case study was a 16 year old boy with learning and attention problems whose parents were convinced required medication. The child's physician was not so sure, so a double blind, placebo controlled medication trial was conducted. During the trial the child received either medication or a placebo over a period of several weeks, and ratings were obtained from the child's teacher concerning his behavior and academic performance during each condition. Because this subject was a teenager, he also completed self-ratings of his ability to concentrate during the medication and placebo conditions.
The results of this trial showed that this subject received no objective benefit from the medication. In other words, teacher ratings of behavior and school work and the subject's own ratings of his ability to concentrate were not appreciably different during the medication and placebo weeks. As a result, the subject did not go on to take medication for an extended period when there was apparently no real benefit from doing so.
For all these reasons, conducting the type of individual trial described in this article is important to do. Conducting such a trial is really extremely easy and provides the benefit of giving you and your child's doctor objective information to use in making long term decisions about the use of medication. Unfortunately, this type of trial is rarely done. As a result, there are many children who may be taking medication regularly who are deriving no objective benefit from it. Many more are probably receiving a dose or medication that is not really optimal for them.
If you are considering the use of medication for your child, I would recommend that you speak with your child's doctor about conducting this type of careful trial. I have developed a set of materials for conducting medication trials that make this quite easy and straight forward to do. I am pleased that a number of physicians in my state have started to use this program routinely. Please feel free to get in touch with me about this if you are interested. If you are a physician looking for a more rigorous and objective way to evaluate your patients' response to stimulant medication that you prescribe, this program would be quite helpful to you as well.
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.