4 ms·

From you, >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

From you, >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. From the piece >As a psychologist who has been studying the development of troubled children for more than 40 years... From you >I was diagnosed late in life, so I can't speak to the longer term, or even child-related effects of Concerta or Ritalin From the piece >TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. The author cites numerous studies in order to discuss the effect of medications on children. You cite a personal anecdote about an adult to explain why you take offense to what I found to be an incredibly reasonable and evidence oriented article about children. -- edited to add -- The reason I'm stressing the child/adult dichotomy, and the reason I reacted tersely (and, to be honest, angrily. sorry) is that if you read the DSM IV's list of symptoms for adhd [1], they really do read like very typical behavior for children. I don't think I've ever met a 7 year old who couldn't qualify under a generous interpretation of the criteria. The vast majority of adults I've met simply wouldn't qualify. I've met adults with ADHD, and I don't doubt that it's a real disorder. But just because it's a real thing doesn't preclude the possibility that it is over-diagnosed and/or over-medicated in children. I've seen a lot of evidence that it's both. [1] https://www.msu.edu/course/cep/888/ADHD%20files/DSM-IV.htm https://www.msu.edu/course/cep/888/ADHD%20files/DSM-IV.htm They're under the heading "Diagnostic Criteria for the three subtypes..."

mistercow 14y ago
The author does not cite a single study. S/he talks about studies, but does not give us any idea how to find them and read them ourselves.
- rauljara 14y ago
  This is an editorial decision on the part of the New York Times (and most major news outlets). None of its scientific op eds include proper citations. It isn't the author trying to pull a fast one over on you. You can google "adhd bibliography" if you want to read a bunch of studies. You can tell the bibliographies that come from places that are pushing a particular therapy (medication or otherwise) because they include no articles critical of their approach.
  - mistercow 14y ago
    It doesn't matter what the author's intention was. Until you can at least see an abstract, you might as well act as if the study doesn't exist. Without knowing what study we're talking about, there's no way to discuss it. Hell, the author says "medication", but doesn't even say which medication was studied. As far as we're concerned, this is about as good as "I heard a guy on the train say..." Edit: As a side note, damn that's a stupid editorial policy. The opposite should be true; any scientific claims in an op-ed should be required to have a citation, even if it's a poor one. I guess it's just one of those places where journalistic and scientific epistemology clash. Journalists say "this is what an expert thinks!", while scientists say "here is some data!"
    - rauljara 14y ago
      Here is link to the study showing no long term benefits to adhd meds: http://www.ncbi.nlm.nih.gov/pubmed/19318991 http://www.ncbi.nlm.nih.gov/pubmed/19318991
      - mistercow 14y ago
        OK, so the elephant in the room here is this: you cannot confirm a null hypothesis (in this case: "Ritalin does not work in the long term") by failing to falsify it. This study is simply not designed such that it can provide strong evidence that ritalin is ineffective in the long term. It can only fail to provide strong evidence that it is effective in the long term. Furthermore, the author refers to it as a "well-controlled study". It's not. The original 14-month study was controlled, and it showed short-term improvement. This study is a prospective follow-up. It's not a controlled trial. It's not trying to be a controlled trial. Finally, looking at the full text, they appear to have used linear modeling. That's also a red flag. Obviously, sometimes a linear model is the right choice. But most often it is used because it is the convenient choice.
darkarmani 14y ago
The conclusions are offensive and over-broad (even if there are good points in the article). The biggest problem is that this is a child researcher and fails to understand how his statements appear to adults. > Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Illusion? Plenty of professionals in the field believe there are a number of ways to combat the symptoms of ADD. Everyone knows that the drugs combat symptoms and don't provide a cure. He is providing a straw man here. > But just because it's a real thing doesn't preclude the possibility that it is over-diagnosed and/or over-medicated in children. I've seen a lot of evidence that it's both. it's almost a tautology that it is over-diagnosed. Since it is behavior based, there are going to be more false positives than misses.
tomkin 14y ago
The goal of the piece was to dispell doubt in the medication because of its inability to resolve long-term treatment - then it backs this assertion up with...wait for it...nothing! It's offensive because the diagnosis has finally reached a milestone of acceptance and now we're shaping opinion about treatment through bullshit.
- rauljara 14y ago
  Nothing? Really? >But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits. Perhaps you are concerned about the lack of a citation (which is standard practice in op-eds, an editorial decision of the paper, and something which the author has no control over). Here is link to the study: http://www.ncbi.nlm.nih.gov/pubmed/19318991 http://www.ncbi.nlm.nih.gov/pubmed/19318991
  - darkarmani 14y ago
    Did you even read the overview of the study?? "Medication use decreased by 62% after the 14-month controlled trial" 8 years later there was no controlled study and 62% of the subjects stopped medication at 14 months! Doesn't the article sound extremely dishonest now?
    - rauljara 14y ago
      Yes I did. No, it doesn't seem dishonest, because the whole sentence reads, "Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results." Also, I would like to point out that studies cannot force the patients to take medication. If the people taking the medication are terminating their own treatment, don't you think that's a little bit of a warning sign? I've seen recordings of interviews with kids where they talk about how much they hate their adhd meds, and how the meds affect their personalities. In contrast, adults don't seem to have the same pattern of disliking the effects. To the best of my knowledge, no one's figured that one out yet.

mistercow 14y ago

The author does not cite a single study. S/he talks about studies, but does not give us any idea how to find them and read them ourselves.

rauljara 14y ago
This is an editorial decision on the part of the New York Times (and most major news outlets). None of its scientific op eds include proper citations. It isn't the author trying to pull a fast one over on you. You can google "adhd bibliography" if you want to read a bunch of studies. You can tell the bibliographies that come from places that are pushing a particular therapy (medication or otherwise) because they include no articles critical of their approach.
- mistercow 14y ago
  It doesn't matter what the author's intention was. Until you can at least see an abstract, you might as well act as if the study doesn't exist. Without knowing what study we're talking about, there's no way to discuss it. Hell, the author says "medication", but doesn't even say which medication was studied. As far as we're concerned, this is about as good as "I heard a guy on the train say..." Edit: As a side note, damn that's a stupid editorial policy. The opposite should be true; any scientific claims in an op-ed should be required to have a citation, even if it's a poor one. I guess it's just one of those places where journalistic and scientific epistemology clash. Journalists say "this is what an expert thinks!", while scientists say "here is some data!"
  - rauljara 14y ago
    Here is link to the study showing no long term benefits to adhd meds: http://www.ncbi.nlm.nih.gov/pubmed/19318991 http://www.ncbi.nlm.nih.gov/pubmed/19318991
    - mistercow 14y ago
      OK, so the elephant in the room here is this: you cannot confirm a null hypothesis (in this case: "Ritalin does not work in the long term") by failing to falsify it. This study is simply not designed such that it can provide strong evidence that ritalin is ineffective in the long term. It can only fail to provide strong evidence that it is effective in the long term. Furthermore, the author refers to it as a "well-controlled study". It's not. The original 14-month study was controlled, and it showed short-term improvement. This study is a prospective follow-up. It's not a controlled trial. It's not trying to be a controlled trial. Finally, looking at the full text, they appear to have used linear modeling. That's also a red flag. Obviously, sometimes a linear model is the right choice. But most often it is used because it is the convenient choice.

darkarmani 14y ago

The conclusions are offensive and over-broad (even if there are good points in the article). The biggest problem is that this is a child researcher and fails to understand how his statements appear to adults. > Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Illusion? Plenty of professionals in the field believe there are a number of ways to combat the symptoms of ADD. Everyone knows that the drugs combat symptoms and don't provide a cure. He is providing a straw man here. > But just because it's a real thing doesn't preclude the possibility that it is over-diagnosed and/or over-medicated in children. I've seen a lot of evidence that it's both. it's almost a tautology that it is over-diagnosed. Since it is behavior based, there are going to be more false positives than misses.

tomkin 14y ago

The goal of the piece was to dispell doubt in the medication because of its inability to resolve long-term treatment - then it backs this assertion up with...wait for it...nothing! It's offensive because the diagnosis has finally reached a milestone of acceptance and now we're shaping opinion about treatment through bullshit.

rauljara 14y ago
Nothing? Really? >But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits. Perhaps you are concerned about the lack of a citation (which is standard practice in op-eds, an editorial decision of the paper, and something which the author has no control over). Here is link to the study: http://www.ncbi.nlm.nih.gov/pubmed/19318991 http://www.ncbi.nlm.nih.gov/pubmed/19318991
- darkarmani 14y ago
  Did you even read the overview of the study?? "Medication use decreased by 62% after the 14-month controlled trial" 8 years later there was no controlled study and 62% of the subjects stopped medication at 14 months! Doesn't the article sound extremely dishonest now?
  - rauljara 14y ago
    Yes I did. No, it doesn't seem dishonest, because the whole sentence reads, "Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results." Also, I would like to point out that studies cannot force the patients to take medication. If the people taking the medication are terminating their own treatment, don't you think that's a little bit of a warning sign? I've seen recordings of interviews with kids where they talk about how much they hate their adhd meds, and how the meds affect their personalities. In contrast, adults don't seem to have the same pattern of disliking the effects. To the best of my knowledge, no one's figured that one out yet.