# Placebo Effects in Caregivers May Change Behavior of Children with ADHD



## Nik (Jun 29, 2009)

Placebo Effects in Caregivers May Change Behavior of Children with ADHD
Placebo Effects in Caregivers May Change Behavior of Children with ADHD

quote:
Stimulant medications, such as Ritalin and Adderall, are the accepted treatment to stem hyperactivity in children with attention deficit-hyperactive disorder (ADHD) and improve their behavior. 

Now a recent review of research by University at Buffalo pediatric psychologists suggests that such medication, or the assumption of medication, may produce a placebo effect -- not in the children, but in their teachers, parents or other adults who evaluate them.

A placebo effect is a positive change in symptoms or behavior after a patient receives a "fake" medication or procedure; in other words, the belief can become the medicine. In this case, the review suggested that when caregivers believed their ADHD patients were receiving ADHD medication, they tended to view those children more favorably and treat them more positively, whether or not medication was actually involved.
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## The Judge (Jun 30, 2009)

Interesting - but I don't know that the facts as shown in the report justify the headline, really.  There are an awful lot of 'may's and 'could's and no evidence at all.

Frankly it doesn't surprise me if parents etc treat the children differently when thinking they are receiving helpful medication.  Label a boy as a problem child and everything he does is wrong.  The same actions/behaviour coming from a 'good' boy will be perceived in a different way.  eg high spirits in a few tipsy college leavers -v- drunken shouting from a mob from the local sink estate.  The headline might as well be 'Give a dog a bad name...'

So if a parent thinks the problem is being medically treated and that the behaviour must be improving, then yes I can understand that even if there is no actual difference in conduct it may be perceived as being improved.  It would be interesting to know the figures though - ie what percentage of parents think this.  But what I have more difficulty in accepting is that because the parents think the child is behaving better, a child with ADHD does behave better - ie a true placebo effect.  

That is, I of course accept that a difference in behaviour towards a child will result in different behaviour from that child.  But if a child has been given a medical diagnosis of ADHD I would have hoped that there was a medical condition underlying the problem - that the diagnosis wasn't given simply because the child was being too much for the parents to handle.  Can a medical condition be improved just by more sympathetic behaviour towards the suffererer?  I have no doubt that cancer patients can have a better quality of life, but I've never heard of reliable evidence that shows the conduct of those surrounding them can make the tumour go away. 

Having said that, I'm far from an expert on ADHD.  What worries me though is that it is used as a catch all term for all kinds of conduct and that some children are being given a label, and more worryingly medication, when it is not appropriate.  So in a sense, even though this study seems lacking in evidential value I'm pleased that it's out there.  It might prevent some child being given a chemical cosh simply because his parents have had enough.

J

PS Just to make it clear, I'm not saying that every diagnosis of ADHD is inappropriate or that drugs should not be given to those who need them.


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## Werewoman (Jun 30, 2009)

_• By producing changes in how caregivers perceive children with ADHD when they think they are on medication -- The researchers determined the studies suggested that this may be a viable mechanism for the __placebo effect__._
_• By producing changes in how caregivers behave toward children with ADHD who they think are on medication, which in turn, could produce changes in the child -- The analysis supported this hypothesis._

I can see the logic here, and I've probably been a part of the system long enough to have seen it without knowing. 

More often than not, a child receives a diagnosis of ADHD because of behaivor at school. The teacher tells the parent/caregiver that the child exhibits ADHD behaviors and is very disruptive in class and recommends that the child be seen by a doctor. The parent, wanting their child to perform better in school, tells the doctor the child has ADHD, the doctor will ask all the appropriate questions - there is no difinitive test - agree with the teacher's assessment, prescribes a stimulant medication, and when the teacher is informed the child is being treated, changes his/her attitude towards the child, which the child recognizes, and their behaviour changes as a result of no longer being 'expected' to act out. 

A child acts out for many reasons, ADHD being only one. The sad part is that it's easier to pop a pill than it is to get to the root of the problem. Many children are mis-diagnosed, and teachers have no business advising parents about medical issues. However, the educational system itself does not allow for those who fall outside the 'norm', and medicating behaviour is more efficient. 

I jokingly refer to myself as the 'adult ADHD poster child' because I have no doubt I have ADHD and I have tried the medications. It amazed me how much people's attitudes changed towards me when I was taking the meds. The funny thing is, I stopped because of the horrific side effects and didn't tell everyone, yet their attitudes toward me remained the same as if I were. 

Now my personal joke is, why should I take medication for something that only drives other people crazy? It doesn't bother me....

Actually, I find behavior management to be just as effective, and I get to keep my apetite to boot. 

Besides, there are more _advantages_ to having ADHD than there are liabilities, IMHO.


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## the smiling weirwood (Jul 1, 2009)

I kind of don't believe that ADD/ADHD is real. I think some children are just misbehaving.


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## Werewoman (Jul 3, 2009)

But don't all children misbehave? 

There's a book by Thom Hartmann called 'The Edison Gene and the Gift of the Hunter Child'. In it, he explains a theory he came up with in the 1970's that since has been proven correct through genetics. 

In very basic terms, his theory is that some 20,000 years ago, people started changing from a hunter/gatherer society to agriculture. I won't go into his reasons, but suffice it to say, not all people adapted well to the new lifestyle. These people are genetically different and approx. 5% of today's population still carry the gene.

This gene is called the hunter gene. People like me who are labeled ADHD are simply better adapted to be hunter/gatherers. We only operate in two modes, either we can't stay focused on one thing for very long, or we are hyperfocused - to the exclusion of all else. 

Now, think about the skills needed in order to be a successful hunter. A good example is: Meat is scarce and you are tracking a rabbit to feed your family that day. When hunting the rabbit, you have to focus on your current prey while scanning for bigger prey. Suddenly, something moves just outside your peripheral vision and though you don't dare take your eyes off of the rabbit, you immediately know that the movement was caused by a deer. In a split second, you make the decision to abandon the hunt for the rabbit and shift your focus to the deer. After all, a deer will feed your family for weeks. Now you must hyperfocus on the deer in order to be successful and your aim must be true regardless of what weapon you are using (say, a spear or a bow and arrow).

Again, I am oversimplifying, I know, but hopefully, you get the idea. 

Take those hunting behaviors and apply them to modern life. A child is expected to stay focused on what is happening in the classroom to the exclusion of all else. A hunter child has difficulty doing this. He is too easily distracted by anything just outside his peripheral vision. Because of his heightened curiosity, he quickly scans and if he finds something more interesting than what is in front of him (say, a math paper with 20 problems on it), he forgets about the paper in front of him and wants to explore what now holds his interest. He gets up from his seat and the teacher admonishes him for disrupting the class. Now he's frustrated because his curiosity is not satisfied. Frustration leads to anger. Anger leads to acting out. His behaviour becomes unbearable for everyone, including himself. 

Amphetamines work because they help the hunter child stay focused on what's in front of him and diminishes his vigilance and curiosity. 

The gene is referred to as the Edison Gene because when Thomas Edison was a child, he exhibited all the behaviours I just described and was punished harshly for it. His mother recognized that he was not equipped to learn in a conventional school environment, and therefore chose to teach him at home. He was conducting experiments and developing inventions by the time he was 13. 

Regardless of whether ADHD is real or not, I believe that all children do not learn the same way, and until our education system recognizes that, and accomodates these children, more and more of them will be needlessly medicated because educators are desperate to meet the benchmarks mandated.


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## dustinzgirl (Jul 3, 2009)

I am vehemently against giving any child any form of medication that is behavior controlling. 

Learn how to parent. Provide alternative education. 

Me, my brother, and my son have all been diagnosed with ADHD. I absolutely refuse to let my child be dumbed down.

PS: Hyperfocusing is also a disorder that I have been classified with. That must be why I'm such a good hunter.


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## Dave (Jul 3, 2009)

It was suggested only a few weeks ago that Ritalin be given to all A' Level students to help them concentrate. That would seem a complete waste of money if it really has no effect.

It does have an effect, and it is a very strong drug. My wife teaches many children who have it prescribed. Their parents often forget, or just decide to stop giving it. The effects that result are not in her head. It isn't a case of them "misbehaving". You can't educate a child if it can't sit down.

However, I'd be completely against giving such strong medication in such a broad way to all students, and I would agree that it is probably over-prescribed. Then I think all drugs are over prescribed. When my mother went into hospital recently, the nurses couldn't believe she had no tablets - they soon sorted that little anomaly out before she went home. I think my father and father-in-law actually rattle with the number of pills they take.


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## dustinzgirl (Jul 3, 2009)

My grandfather that died last year at 89 years old never took any medication other than antibiotics when necessary, Tylenol, and vitamins. He drank Ensure like it was going out of style tho.

And on another note, some kids just can't sit still, like my oldest. His gradeschool teachers would get really frustrated with me because I refused to medicate him. I had to explain repeatedly that if they let him doodle and kept his seat separated from the other kids (distractions) that he would be just fine. They didn't catch on until about fourth grade, and that teacher (who also had my other two kids) understood and had almost no problems with him.


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## The Procrastinator (Jul 3, 2009)

On yet another note, I have no doubt some kids really do have ADHD but there would be a fair few have Coke overdose or some other sugar-loaded hit drink overdose. Or sugar loaded hit food. Do people really think all that crap they let their kids have has no effect on them? No wonder they can't sit still, indeed. 

The hunter thing is interesting. The hyperfocus thing also applies to another group who are a little outmoded today - the Artisan.


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## Werewoman (Jul 3, 2009)

Dave said:


> It was suggested only a few weeks ago that Ritalin be given to all A' Level students to help them concentrate. That would seem a complete waste of money if it really has no effect.
> 
> It does have an effect, and it is a very strong drug. My wife teaches many children who have it prescribed. Their parents often forget, or just decide to stop giving it. The effects that result are not in her head. It isn't a case of them "misbehaving". You can't educate a child if it can't sit down.


 
Why is it that children can only learn sitting down? I have been very successful using alternative methods to teach. Give children the proper resources, teach them how to use them, and then let them explore and discover for themselves. A team approach works, as well. Put them in groups, give each group an assignment to research, and then have each group present their findings to the rest of the class. There are many other methods as well. Lecturing is no longer considered an effective teaching method. Learning by rote is not learning, it's memorizing. With today's technology, lecture and memorizing have gone the way of the dinosaur. 

BTW, I'm not implying your wife's teaching methods are archaic or anything like that. I'm speaking in general terms only. 



dustinzgirl said:


> Me, my brother, and my son have all been diagnosed with ADHD. I absolutely refuse to let my child be dumbed down.
> 
> PS: Hyperfocusing is also a disorder that I have been classified with. That must be why I'm such a good hunter.


 
You mean hyperfocusing is now considered a disorder as well? Has anyone besides me noticed that the number of 'disorders' has risen exponentially? 

ADHD (the behaviour 'marks') is not a disorder, it's a normal survival mechanism - it's just not a common one. I like to think of it as being in the same category as being left-handed - which I am as well. 

I've never had my children tested for a diagnosis of ADHD, though I think they may have some of the marks. I never set out to get a diagnosis for myself, either. I was 40 years old and in therapy for something completely unrelated, and the therapist caught on to it and I only went to get an evaluation out of curiosity. I scored very high. Personally, I find it fascinating and quite amusing. The only advantage I found in taking Adderall was that I could understand song lyrics. I can't understand song lyrics at all.


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## Dave (Jul 3, 2009)

Werewoman - My wife works at a Special School for children with Learning Difficulties - before it wasn't PC that would be termed 'mentally handicapped'. Most also have behavioural problems, some also have physical disabilities. I don't think they do have to sit down all day, and most have an individual support assistant, but if you just allowed the ones with the severe behavioural problems to let rip they would be a danger to themselves and the others around them.

I do wonder about the morality of keeping people perpetually drugged just so they fit in with what society expects. There have been cases of old people in Care Homes being drugged just so they don't complain. Taken to the extreme you could imagine a totalitarian government putting some cocktail into the water supply so that we all become model citizens. It doesn't sit right with me at all.

The Procrastinator - that sugar rush effect on children has been debunked. It was shown on a science week on TV last year (sorry but I can't find a reference.) It might make them diabetic, but it doesn't make them hyperactive. However, the experiment was done with sugar solutions and not with fizzy pop, and I agree with you that we have no idea of the effects of combinations of those exotic chemicals, colourings, flavourings and preservatives together with sugar. I think more research is needed.


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## Werewoman (Jul 3, 2009)

Dave - Ah, I understand. 

I spent a year working in a kid's day treatment program in a local mental health facility. It was the ride of my life! It was a six week (though it varied from child to child) program for children with mental health/learning disabilities/behaviour issues. I never thought I would have to learn how to dodge flying objects - much less biting teeth, roundhouse punches, and various bodily fluids. These children were all under psychiatric care, and frankly, there were a few cases where I was convinced the problem was simply behaviour and not something more serious. 

I remember one kid who was in the fourth grade and we had to teach him how to eat properly. We all thought he was simply a case of a kid that had had almost no supervision and got frustrated to the point of violence. 

Regardless, they were all heavily medicated and that really bothered me. I'm not a doctor, so I never expressed my reservations at the practice, but it seemed to me like everyone around me was looking for answers at the bottom of a prescription bottle. I found the word 'no' followed by stoic determination to be very effective. The trick is to wear them down before they wear you down, and with a little practice, I got very good at it. 

I greatly admire teachers like your wife. Hers is not an easy job. The liabilities are enormous and the only reward is the knowledge that you've made a difference in their lives. It certainly doesn't pay what it should for the amount of responsibility it entails. My hat is off to her!


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