<p>It is common, even for kids diagnosed at age eight, to refuse meds at age 15. The good new is, there is no current data that shows kids on meds do any better than kids without, in the long term. And kids without may grow 2cm taller!</p>
<p>"The good new is, there is no current data that shows kids on meds do any better than kids without, in the long term. And kids without may grow 2cm taller! "</p>
<p>I bet that there is not any data that say they do not do better either. It is going to be too hard to set up control groups for this type of study to be accurate. </p>
<p>The biggest issue we faced was the low self esteem from not being able to control himself or complete work he knew he could do. The long term effects of low self esteem are pretty well documented.</p>
<p>“I bet that there is not any data that say they do not do better either.”</p>
<p>I bet there is. I will try to link it here, but that is my interpretation of the mea data, and it’s what I do. I will be going to the American Academy of Child and Adolescent Psychiatry meetings again this year, and see if there is anything new. My experience has been the meds are nothing without the motivation.</p>
<p>"The long term effects of low self esteem are pretty well documented. "</p>
<p>The long term effects of medicating? Any data?</p>
<p>I would love to see data that says meds don’t make a difference. I think that it is important to know that no one here has voiced that meds are all that is needed. There have been many ideas shared for trying to manage the ADD with, or without the meds. It is like many other diseases, medication is only one of the peices of the management plan.</p>
<p>For now, here is a link to the eight year follow up of the MTA study.</p>
<p><a href=“http://www.sciencedirect.com/science/article/pii/S0890856709600666[/url]”>http://www.sciencedirect.com/science/article/pii/S0890856709600666</a></p>
<p>"To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers (local normative comparison group; N = 261).
Method</p>
<p>Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report.
Results</p>
<p>In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested.
Conclusions</p>
<p>Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed."</p>
<p>I am not so much saying that meds don’t make a difference, as I am saying there is no proof that it does. This is meant to be reassuring to the OP. </p>
<p><strong>Note that the MTA study is of ADHD combined</strong></p>
<p>I think we know LESS about ADHD/PI (primarily inattentive)…</p>
<p>I am saying don’t sweat this particular moment in time, at least not over labels and meds. It’s about helping him see strengths and weaknesses, and what helps and what makes things worse.</p>
<p>the link did not attach…can you try again?</p>
<p>I’m guessing if the problem is such that the meds can help they will. If there is no problem other than personality, maturity or some other problem the meds won’t help. The other aspect that would be interesting is the placebo effect…do kids focus better because they are on meds or do they focus better because they took meds. I often wonder about this with college kids who covet the drugs “for exams.” Is it the drug or is it because they are actually studying and they attribute the drug. My girlfriend was complaining that her D (who was on drugs during high school) quit taking them when she went to college. She was complaining about her D’s weight gain and her drop from all As to mostly Bs. I asked her how she could presume it was all the fact that her D quit her drugs. She has her S on them also and he quit after he left home for college. He did “better” in college than high school. Every situation is unique but the treatment is definitely not one size fits all.</p>
<p>Sounds like the OP is considering all options and I wish the family best of luck going forward. These years are tough enough without the added strain of figuring out what is off and how to fix it.</p>
<p>"the link did not attach…can you try again? "</p>
<p><a href=“http://www.sciencedirect.com/science/article/pii/S0890856709600666[/url]”>http://www.sciencedirect.com/science/article/pii/S0890856709600666</a></p>
<p>Here is the title to search</p>
<p>The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study</p>
<p>Authors (all are treated with a large grain of salt if a study is industry sponsored. X, don’t think this one was,</p>
<p>Brooke S.G. Molina Ph.D.Corresponding Author Contact Information, a, E-mail The Corresponding Author, Stephen P. Hinshaw Ph.D.a, James M. Swanson Ph.D.a, L. Eugene Arnold M.D., M.Ed.a, Benedetto Vitiello M.D.a, Peter S. Jensen M.D.a, Jeffery N. Epstein Ph.D.a, Betsy Hoza Ph.D.a, Lily Hechtman M.D.a, Howard B. Abikoff Ph.D.a, Glen R. Elliott Ph.D., M.D.a, Laurence L. Greenhill M.D.a, Jeffrey H. Newcorn M.D.a, Karen C. Wells Ph.D.a, Timothy Wigal Ph.D.a, Robert D. Gibbons Ph.D.a, Kwan Hur Ph.D.a, Patricia R. Houck M.S.a and The MTA Cooperative Group</p>
<p>You may have to be an MD or subscribe to see my link. I may have a PDF somewhere I can link.</p>
<p>Shrinkrap: so the study you quote is the follow-up to this?
[NIMH</a> · The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA):Questions and Answers](<a href=“http://www.nimh.nih.gov/trials/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-and-answers.shtml]NIMH”>http://www.nimh.nih.gov/trials/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-and-answers.shtml)</p>
<p>Combination treatment and medication management alone were both significantly superior to intensive behavioral treatment alone and to routine community care in reducing ADHD symptoms. The study also showed that these benefits last for as long as 14 months.</p>
<p>This is dated “Revised November 2009.” The Science article is dated May 2009. It also says kids tested were 7.0-9.9 years old- does that translate to teens embarking on meds and therapy?</p>
<p>*Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. *</p>
<p>Different way of explaining it.</p>
<p>
[NIMH</a> · Short-term Intensive Treatment Not Likely to Improve Long-term Outcomes for Children with ADHD](<a href=“http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml]NIMH”>http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml)</p>
<p>^Yes!</p>
<p>and</p>
<p>“Shrinkrap: so the study you quote is the follow-up to this?
NIMH · The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA):Questions and Answers”</p>
<p>Yes. (10 char)</p>
<p>Forgive me, but my link refers to a 14 mo study and so does Science. Aren’t we left with many questions? Couldn’t one issue be that the turnaround takes more than 14 months of attention?</p>
<p>And, how does this one fit in? 2007
[NIMH</a> · Improvement Following ADHD Treatment Sustained in Most Children](<a href=“http://www.nimh.nih.gov/science-news/2007/improvement-following-adhd-treatment-sustained-in-most-children.shtml]NIMH”>http://www.nimh.nih.gov/science-news/2007/improvement-following-adhd-treatment-sustained-in-most-children.shtml)</p>
<p>I am still confused why NIMH publishes one article in 11/09 and the Science article is 6 mo older.</p>
<p>“Aren’t we left with many questions?”</p>
<p>Yes. </p>
<p>Sorry I haven’t read each abstract today, but I believe I have read most, if not all in the past. The one I linked is a prospective study of the original kids in the original study.</p>
<p>I REALLY want to know, for both personal and professional reasons.</p>
<p>"I am still confused why NIMH publishes one article in 11/09 and the Science article is 6 mo older. "</p>
<p>I believe one is In abstract of the actual original study (Science; "Brooke S.G. Molina Ph.D.Corresponding Author Contact Information, a, E-mail The Corresponding Author, Stephen P. Hinshaw Ph.D.a, James M. Swanson Ph.D.a, L. Eugene Arnold M.D., M.Ed.a, Benedetto Vitiello M.D.a, Peter S. Jensen M.D.a, Jeffery N. Epstein Ph.D.a, Betsy Hoza Ph.D.a, Lily Hechtman M.D.a, Howard B. Abikoff Ph.D.a, Glen R. Elliott Ph.D., M.D.a, Laurence L. Greenhill M.D.a, Jeffrey H. Newcorn M.D.a, Karen C. Wells Ph.D.a, Timothy Wigal Ph.D.a, Robert D. Gibbons Ph.D.a, Kwan Hur Ph.D.a, Patricia R. Houck M.S.a and The MTA Cooperative Group</p>
<p>aThe NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) was a National Institute of Mental Health (NIMH) cooperative agreement randomized clinical trial involving six clinical sites. Collaborators from the National Institute of Mental Health: Peter Jensen, M.D. (currently at Columbia University), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Benedetto Vitiello, M.D. …) and the NIMH article is a review of the various studies.("Peter Jensen, M.D., Columbia University, and colleagues ")</p>
<p>Hi sureofsomething,</p>
<p>I am a physician and a mother of a teen with ADHD.</p>
<p>I can tell you that ADHD is real but it is also overdiagnosed.</p>
<p>Medication can be very effective in the right dose and can improve learning and social interactions. Medication + counseling or coaching works better than either alone.</p>
<p>There is no way that anyone can make your teenage son take this medicine if he doesn’t want to. He will need to first recognize that there is a problem and then be interested in working on a solution (which may or may not include medication.) </p>
<p>I may have missed this information – is your son happy? is he satisfied with his relationships and his school performance? If he sees a problem, he may want to work with someone (a therapist or a coach.)</p>
<p>Coaching might be the right modality for your son if you can pay (no insurance reimbursement.) He doesn’t have to buy into any label. I just finished reading [Amazon.com:</a> Empowering Youth with ADHD: Your Guide to Coaching Adolescents and Young Adults for Coaches, Parents, and Professionals (9781886941960): Jodi Sleeper-Triplett MCC SCAC: Books](<a href=“http://www.amazon.com/Empowering-Youth-ADHD-Adolescents-Professionals/dp/1886941963/ref=ntt_at_ep_dpt_1]Amazon.com:”>http://www.amazon.com/Empowering-Youth-ADHD-Adolescents-Professionals/dp/1886941963/ref=ntt_at_ep_dpt_1)
book on ADHD coaching and I think coaching sounds great. </p>
<p>From the author: What is Coaching? [Coaching</a> Kids, for Parents of ADHD Children](<a href=“http://www.jstcoach.com/adhd-coaching-kids-parents-adhd-children-programs-va-md-dc.html]Coaching”>http://www.jstcoach.com/adhd-coaching-kids-parents-adhd-children-programs-va-md-dc.html)</p>
<p>"ADHD coaching is a specialized type of coaching that is tailored to meet the unique needs of the client with ADHD, delivered by a coach with in-depth knowledge and understanding of ADHD and related issues.</p>
<p>For coaches working with those who have ADHD, there is a belief that all clients are naturally creative and resourceful, with, at times, a need for a different approach than would be used in traditional life coaching and an understanding by the coach of how a person with ADHD may struggle in certain life areas.</p>
<p>The ADHD coaching process offers clients support, structure, and accountability for their actions, leading to a greater level of success in all areas of life, including those negatively impacted by ADHD, learning disabilities, or other coexisting conditions.</p>
<p>The Institute for the Advancement of ADHD Coaching defines ADHD coaching as a designed partnership that combines coaching skills with knowledge of Attention Deficit Disorder, a neurobiological condition. The coaching process enhances quality of life, improves performance and supports growth and change. The purpose of ADHD coaching is to provide support, structure and accountability. Coach and client collaboratively explore strengths, talents, tools and new learning to increase self-awareness and personal empowerment. Together they design strategies and actions and monitor progress by creating accountability in line with goals and aspirations.</p>
<p>ADHD coaches help individuals to set goals, acknowledge strengths, accept limitations, develop social skills, and create strategies that enable them to be more effective in managing their day-to-day lives. ADHD coaches do this by establishing a pattern of frequent communication with clients to make sure they are focused and working steadily toward their goals."</p>
<p>CHADD is a good resource. So is ADDitude Magazine <a href=“http://www.additudemag.com/[/url]”>http://www.additudemag.com/</a></p>
<p>Good luck!</p>
<p>Milkweed, thanks for posting those books! I have been considering coaching for my son, and I am sure those will help. Another CC parent gave me some info on ADHD coaching as well.</p>
<p>OP, since you mentioned some social issues with teachers, I want to make sure you know that there are places that have social skills training. I know Jewish Social Services does it some places-- and it doesn’t matter whether you are Jewish. </p>
<p>ADHD is such a catch-all that I really think it can include very different kids with very different issues. You need to address the behaviors that are a problem. If it were my child, I would start with a counselor so that he cooperates with whatever intervention is applied. I would then write a letter to the school requesting a 504 meeting. Read up before you go in and have a list of possible interventions. Ideas for your son’s afternoon problem include asking whether they can give him preferential scheduling (so his more important academics are in the morning), have testing in morning only OR schedule some sort of study period right after lunch that will help him regroup and get organized. </p>
<p>I woud second a coach or, if there is none in your area, an “organizational tutor.” Ask around. You don’t want anyone who takes over and spoonfeeds your son; you want someone who teaches your son how to organize himself.</p>
<p>2ccollegewego, great idea about the schedule! As far as teachers, it’s not so much social skill problems. It is really that he is a disicipline problem for them, and he gets in trouuble. He see this as “they don’t like me.” </p>
<p>Someone asked is he is happy with his performance. I would say no, he is not satisfied, but he dosen’t really think it is a “problem” just the way he is. He certianly doesen’t like that he is always forgetting something, and always getting in trouble. And he dosen’t enjoy his Mom always reminding and nagging him about something! On the other hand, he is certianly not thinking there is something wrong with me, I need some sort of assistance.</p>
<p>Because he is getting tired, inattentive, and a behavioral problem after lunch, I would definitely recommend getting him checked out for blood sugar issues and observe what he eats to see if there’s a difference according to behavior and moods. You’ve just described someone with physical problems that are causing mental issues.</p>
<p>I second the omega-3’s that someone else suggested too.</p>
<p>I’m on the side of try everything else first, then use meds when necessary. The only problem is that the person has to admit there’s a problem and want to change. My thought on that is that if he can agree to make some changes and get some medical testing to help figure out what the problem is, he might find that he feels better, and he’ll suddenly see there’s a difference. He has no idea what “normal” feels like. He’s trying to think through a haze - it must be very difficult and frustrating, causing him to act out.</p>
<p>Thanks to Shrinkrap and others who helped sort some of the info from their medical perspectives.</p>
<p>If your son doesn’t want to take pharmaceutical drugs, perhaps he would consider taking nutritional or homeopathic supplements instead. There are many out there for ADD, several of which seem to get good results. I’ve heard a change in diet can help a lot as well.</p>
<p>It might be a good idea to look at both alternatives. Here’s a link to more info if you’re interested:</p>
<p><a href=“http://www.oneaddplace.com/[/url]”>http://www.oneaddplace.com/</a></p>