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Controversial Treatments for Children With Attention-Deficit/Hyperactivity Disorder

Although parents of children with AD/HD want the very best treatment for their children, not all AD/HD therapies meet scientific standards. Learn what works -- and what not to waste your time and money on.

By Sam Goldstein, Ph.D.

Introduction

In the past decade there has been a tremendous upsurge of scientific and public interest in Attention-Deficit Hyperactivity Disorder. The interest is reflected not only in the number of scientific articles but in the explosion of books for parents and teachers. Great strides have been made in understanding and managing this common childhood disorder. Children with AD/HD who would have gone unrecognized and untreated only a few short years ago are now being helped, often with dramatic, positive results.

It is critical for parents to seek the best in evaluation, as well as the best in treatment. Evaluations that consist of a single checklist or ten minute discussions, will likely run the risk of mis-diagnosis of the disorder or in fact a misunderstanding of co- occurring problems that often present for children with AD/HD. Symptoms of inattention, restlessness, impulsivity, social and academic difficulties, can reflect a variety of childhood disorders. It is essential to obtain a thorough understanding of problems before attempting to intervene, especially since many children with AD/HD also experience co-existing learning and behavior problems. A good treatment plan follows logically from a thorough evaluation.

There continues to be many questions in need of answers concerning the developmental course, outcome, and treatment of AD/HD. Although there are a number of effective treatments, they may not be equally effective with all children experiencing AD/HD. In their efforts to seek effective help for their children, parents may become desperate. In their desperation, and confused by misinformation in the marketplace, parents may turn to treatments which claim to be useful but which have not been demonstrated to be truly effective in accordance with standards held by the scientific community. We refer to such treatments as controversial. That is, they are marketed beyond their proven worth.

Unfortunately, most parents, no matter how intelligent or well-educated, do not have the training nor expertise necessary to identify and evaluate relevant scientific findings concerning the effectiveness of various treatment which have not as yet met scientific standards for effectiveness. Some of these treatments merit continued research, others do not. We do not recommend these as proven treatments. We know that parents need to be informed about them because they may be offered as proven and accepted approaches to the treatment of AD/HD, which they are not.

How Are New Treatments Evaluated?

The road by which a particular treatment is shown to be effective can be long and arduous. The process begins with the formulation of a hypothesis or idea. This hypothesis is usually based upon an existing body of knowledge. The second step is the development of a protocol to evaluate the effectiveness of the proposed treatment. The treatment itself and the way in which it will be implemented must be carefully defined. The researcher must also specify the way in which the effectiveness of the treatment will be evaluated. Care must be taken to be certain that the effects of the treatment are not simply due to placebo. It has been well documented in scientific research that people respond to all sorts of ineffective treatments as long as they believe that the treatment has the power to help them. Placebo effects can be more dramatic than most people realize.

The researcher must also take care that all who participate, researchers and research subjects alike, are blind or unaware, whether they receive the active treatment or the placebo. Otherwise the expectancies of either party could influence the findings. Appropriate measurement techniques and statistical tests must be built in so that the entire scientific community can evaluate the findings. Finally, the results must be subjected to the scrutiny of this group, published and substantiated by others attempting to replicate the findings.

Sam Goldstein, Ph.D. is a Clinical Professor of Psychiatry at the University of Utah, a Research Professor of Psychology at George Mason University and Director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah. He is Editor-in-Chief of the Journal of Attention Disorders, author, co-author or editor of 26 books and dozens of book chapters and peer reviewed research articles.

This article originally appeared on Dr. Sam Goldstein's website in 2000, samgoldstein.com, and is reprinted here with permission.


Comments from GreatSchools.org readers

08/11/2009:
"When did Goldstein write this? His information about the Feingold diet is inaccurate and out of date. For example,the double-blind Rowe & Rowe (1994) study found a dose-response effect for tartrazine (Yellow #5), and there is the 2007 McCann study that found that even normal children react to a modest amount of food dyes with increased activity and decreased attention span. There is the landmark 2006 Lau study in which he tested additives in combination and found that the combinations were many times more powerfully toxic to developing nerve tissue. Actually, every single study done since 1987 has shown clearly that the diet works - often dramatically. Some tested a more restrictive diet called an oligoantigenic (few foods) diet, but they got the same results. These studies have been replicated over and over with similar results. Most recent literature reviews agree that the diet is effective to treat ADHD. The 2004 Schab meta-analysis agrees as well. The American Academy of Pediatrics published an article in their 2008 Grand Rounds that admitted that after 30 years of saying the diet doesn’t work they “may have been wrong.� They now say, “. . . a trial of a preservative-free, food coloring–free diet is a reasonable intervention.� The British Medical Journal, in May 2008, said a “trial of eliminating colourings and preservatives should be part of standard treatment . . .� "
11/17/2008:
"Thank you so much for this artical on questionable ADD Treatments. I was wondering if you had another artical with Treaments that have proven success and how to get them? I am a desperate parent trying to help my son hear and understand me when I am talking to him. Thanks "
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