Do not think about, write about or deal with human behavior without determining the effects of incentives. It’s not their money, of course they’ll waste it.
Wherein we see that the long-term results of medication are not positive. Some objective markers of behavior change would also be helpful.
How Following the Trail of “Cutting Edge” and “Convenient” Can Distort Reality
By James Schroeder, PhD
In the late 1990’s, the National Institute of Mental Health (NIMH) set out to provide the most extensive review ever conducted of the effectiveness of ADHD medications in children. It was known as the Multisite Multimodal Treatment Study of Children with ADHD (MTA study). In 1999, NIMH announced that after 14 months, well-constructed medication management programs provided better results than other treatments, including behavioral therapy. But the study was not over, and the tables started to turn as detailed in the new book by Robert Whitaker and Lisa Cosgrove. By the end of three years, medication not only provided no more benefits over other options, it actually predicted greater deterioration of symptoms. In other words, children that were taking medications exhibited worse outcomes (e.g., more delinquency) than those who were not. They also ended up six pounds lighter and an inch shorter than their unmedicated counterparts. After six years, medication use was associated with increased hyperactivity, impulsivity, and oppositionality, and overall functional impairment. Those who had used behavioral therapy alone were less likely to be depressed or anxious.
This reminds me of Follow Through, the largest experiment in education which promised the same thing. They would do this massive experiment, see which education method was best and then use it. The opposite happened, Direct Instruction was the best method, but is used the least. Government bureaucrats can be depended on absolutely, they will always do the wrong thing.
NIMH investigators were shocked. Even after analyzing a number of potential confounding variables thought to contribute to the unexpected findings, they finally concluded, “The findings…were not consistent with views and expectations about medication effects held by many investigators and clinicians in the field. That is, long-term benefits from consistent treatment were not documented…”
The investigators acknowledged that despite previously held beliefs, good science had demonstrated otherwise. It seemed this large scale study would provide clear guidance for those using and prescribing drugs to kids once it was released to the public at large. That never happened. Multiple papers and titles did not report the negative findings, instead highlighting the short-term benefits while minimizing the negative outcomes. The NIMH press release announced the great news, “Improvement Following ADHD Treatment Sustained in Most Children” although they left out that “sustained” only meant through 14 months. Parents were assured by NIMH that despite having no clear gains after three years, medications were the way to go, even for the long-term. Discussion of the negative results was very difficult to find. In 2013, the American Psychiatric Association (APA) and the American Academy of Child & Adolescent Psychiatry (AACAP) published the ADHD Parents Medication Guide that continued to espouse the positive effects of medication found in the MTA study. And yet, despite the assurance given to move forward with medication treatment, other large scale studies have continued to find disappointing long-term effects .
This is just one more reason why I call the Social Services business The Great Pretend.
Government Job or Respect–Which’ll It Be?
Cheerio and ttfn,
Grant Coulson, Ph.D.
Author, “Days of Songs and Mirrors: A Jacobite in the ‘45.”
Cui Bono–Cherchez les Contingencies