Attention Deficit Disorder: Facing Facts : Research: Drugs don’t cure children with ADD or make them learn, according to a UCI study, commissioned by the U.S. Department of Education, to be discussed at a local seminar.
UC Irvine’s Child Development Center, commissioned to review how effective drugs are in helping children with attention deficit disorder, is about to publish its conclusions, and they are not going to please those who have routinely prescribed drugs in the past.
Does medication help children to calm down and learn? Yes, but no, researchers say.
“These drugs have some beneficial effect in the short term,” says James M. Swanson, director of the center. “They also have some effect on associated features--aggression and noncompliance. The effect is very dramatic and happens within one hour.
“But the effect is gone in three hours, and there’s no effect on learning to speak of and no long-term effects. It’s essentially negligible. It’s very perplexing.”
Perplexing, he says, because the drugs and their effects have been known since 1937. There is no disagreement on what the drugs can and cannot do. Yet the assumption persists, especially among educators, that physicians and medication are the answer, Swanson says. “It’s surprising to me that people don’t know this already,” he says. “I thought everyone would be somewhat knowledgeable about it. But most don’t know the limitations of medication. This is going to be a surprise to many people.”
Children with attention deficit disorder (ADD), who used to be known as hyperactive, have great difficulty concentrating for more than very short periods. They fidget and can’t sit still. They are easily distracted, their attention bouncing from one thing to another. They seldom focus on one task long enough to complete it. They are impulsive, acting before they think.
Drugs that in higher doses act as stimulants have been given to ADD children in lower doses, and the effect usually has been calming.
Swanson says schools in the past have considered such children discipline problems and reacted only by advising parents to seek medical help.
But parents last fall succeeded in pressuring federal authorities to include such children on the list of pupils who must be given special attention at schools. “But I think it will take several years for schools to get prepared,” Swanson says.
To help them, the federal Department of Education commissioned UCI and three other institutions to review 50 years of published research on the topic and summarize what is known and unknown.
To discuss their findings, Swanson and Fiore will address a conference in Laguna Hills May 21 and 22, organized by the UCI Child Development Center. The Friday evening session will be open only to medical and education professionals and to parents of ADD children. The Saturday afternoon and evening sessions will be open to the public.
Information is available at (714) 856-8737.
In the study, UCI concentrated on medication and concluded that while medication can temporarily calm an ADD child’s behavior, it cannot cure the condition, nor can it by itself improve the child’s learning.
He equated administering medication to giving a child glasses to improve vision, then expecting the child to spontaneously begin reading. “You still have to teach them to read,” Swanson says.
“This has led to questions about the use of medication, how widespread use of medications should be. Should they be used in every case or should we be trying something else first? Some are speculating that only a third of those receiving medication are actually benefiting from it.
“What we don’t know is what happens with intensive intervention in the classroom in combination with medication. Almost every study said what you should do is combine these treatments--a common-sense approach. But there are no studies on whether that’s actually effective. We expect it will be, but we don’t know.”
Reviewing research on treatment techniques other than medication fell to the Research Triangle Institute near Raleigh, N.C. The institute is affiliated with Duke University, North Carolina State University and the University of North Carolina.
Tom Fiore, senior research scientist, said much past research was in clinic and hospital settings with techniques that may not be effective in schools. “What’s really needed is more research by educators in classrooms,” he says.
But the most important finding is the consensus among past research that “behavior therapy”--using reminders, incentives and punishments to encourage and discourage behavior patterns--has some effect on ADD children.
Do something right and you get a “positive reinforcer,” some candy or some points or tokens you can cash in for goodies at the end of the day. Do something wrong and some of your rewards are taken back.
The wandering attention of an ADD child may be redirected by means as simple as pointing at the book the child is supposed to be reading.
Researchers are less confident that “cognitive behavioral therapies” are effective. These are, in effect, teaching aggressive or impulsive children “to count to 10,” Fiore says. “You teach kids how to think about problem situations. You’re trying to get them to stop and think it through. You teach them to say to themselves, ‘Stop, think, what should I do?’ ”
Some researchers say this technique simply doesn’t work with ADD children, who seem to lack the brain process that wants a look before it leaps. Other researchers are reserving judgment. “But no one says current research shows it works,” Fiore says.
Fiore says he finds “correspondence therapy” promising. With this technique you reward a child for promising to behave a certain way, then again when he succeeds and again when he accurately appraises his performance.
There is some evidence, though it is inconclusive, that training parents to use these successful strategies is useful, Fiore says.
Perhaps the most promising research is into making classroom materials maximally stimulating for ADD children. “By working on issues like rate of presentation and use of color, some researchers have had some success in improving academic performance, at least on rote tasks,” Fiore says. “But research in the area is in the developmental stage.”
It stems from a change in attitude in the field, Fiore says.
“Not too many years ago, the basis for a lot of the interventions was to minimize stimulation--put them in sterile classrooms working in cubicles to minimize distractions.
“The more recent work has recognized that, if anything, these kids are under stimulated. People need to know that. A lot of teachers and parents still have the old idea that these kids need to be isolated and protected from stimulation,” Fiore says.
“They need focused stimulation, probably more than other kids do. Because they’re distractible and impulsive, they need it to be focused. If we put them in sterile environments, they tend to create their own. And some of the problem behaviors come from that.”
