© 2018-2019 by The Neurofeedback lab and clinic - London

Ritalin - Yes or NO?

We leave Ritalin to the doctors' decision. But we wanted to share with you the following: 

At the end of a Neurofeedback treatment your child might not need the Ritalin ever again or can use reduced doses for a limited amount of time. Up to the doctor to say. If you haven't started giving your child medication - it's worth waiting to see if he will need it at all as the NCT treatment will help him improve his concentration levels in a way that he can use any time in the future.

Rossiter and LaVaque (1995) found that 20 sessions of neurofeedback produced comparable improvements in attention and concentration to taking Ritalin. Fuchs, Birbaumer, Lutzenberger, Gruzelier, and Kaiser (2003) and Rossiter (2005) likewise demonstrated that neurofeedback produced comparable improvements to Ritalin. Drechsler et al. (2007) found slow cortical potentials training superior to group therapy with ADHD children.

In a 1-year follow-up, control group study, Monastra, Monastra, and George (2002) found that neurofeedback produced superior improvements compared to Ritalin, not requiring continuation of the medication. In a randomized controlled study, Leins et al. (2007) demonstrated that 30 sessions of slow cortical potentials training or of traditional neurofeedback were both effective in producing cognitive, attentional, behavioral, and IQ improvements, which remained stable 6 months after treatment.

 
Medication doesn't seem to help in the long term

As documented by the eight-year long NIMH-funded MTA Cooperative study, optimal versions of stimulant medication and behaviour therapy only, failed to result in sustained benefit for the majority of ADHD children.

A comprehensive review (Drug Effectiveness Review Project, 2005) of medication treatment for ADD/ADHD concluded that there was no evidence on the long-term safety of the medications used in ADD/ADHD treatment and that good quality evidence is lacking that drug treatment improves academic performance or risky behaviors on a long-term basis, or in adolescents or adults. The latter conclusions were also reached by Joughin and Zwi (1999).

Medication is effective for up to 2 years only

Stimulant medications’ beneficial effects commonly cease when the medication is stopped, and as found in the MTA Cooperative study, the authors concluded that there was no evidence to support the “long-term advantage of (continued) medication treatment beyond 2 years for the majority of children.”

89% still exhibiting moderate to severe symptoms of ADHD after 3 years of medication

Discouragingly, the published 6 year follow-up results from the NIMH-funded Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) found results virtually identical to those of the MTA study. These researchers found that “medication status during follow-up, on versus off, did not predict symptom severity” with 89% still exhibiting moderate to severe symptoms of ADHD. Even more troubling, the PATS researchers found that by year 3 of follow-up, an antipsychotic had been added to the medication regimen for 8.3% of the preschoolers’ and by year 6, 12.9% were taking an antipsychotic.

 

ADHD medication and antipsychotic medication go together

This increased pairing of ADHD medications with antipsychotics is documented in a 2012 article published in Archives of General Psychiatry finding that over the past decade the rate of antipsychotics prescribed to children increased by over 750% (from 0.24 to 1.83% of all outpatient visits to general practitioners and psychiatrists). Their analysis found that disruptive behavior disorders (primarily ADHD) were the most common diagnoses in children that were prescribed an antipsychotic accounting for 63% of such cases, and that in 54.1% of the outpatient visits, whenever an antipsychotic was prescribed there was also an ADHD medication prescribed to the same child.


So while the initial reports of both the MTA and PATS study findings, along with 50 years of research and clinical practice, clearly document the short-term effectiveness of stimulant medications in treating ADHD’s core symptoms, these large taxpayer-funded studies have each failed to find any evidence of sustained benefits from continuing to take these medications during follow-up care and the long-term risks from taking them are still not fully known.

 

The increased pairing of ADHD medications with antipsychotics provides collaborating evidence of stimulant medications’ all-too-often loss of efficacy overtime and is particularly troublesome from a public health perspective given the increased weight gain and risk of diabetes in youth that are associated with taking antipsychotics.

Adverse side-effects

Furthermore even during initial treatment, one-third or more of children do not respond adequately to ADHD medications and/or have significant adverse side-effects from them heightening further the need for effective treatment alternatives.

Studies (e.g., Swanson et al., 2007) have confirmed loss of appetite and growth suppression as a side effect of medication treatment, along with other side effects such as increased heart rate and blood pressure, insomnia, loss of emotional responsiveness, dizziness, headache, and stomachache.

 

In the MTA study, 64% of children reported side effects, 11% of them moderately severe and 3% severe. Side effects associated with ADD/ADHD medications are also so common that less than 50% of children maintain prescribed dosages for more than 6 months (Hoagwood, Jensen, Feil, Vitiello, & Blatara, 2000).

-----

  1. The MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/ hyperactivity disorder. Arch Gen Psychiatry, 56(12) 1073–1086.

  2. The MTA Cooperative Group (2004a), National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: 24-Month Outcomes of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Pediatrics, 113:754-761.

  3. The MTA Cooperative Group (2004b), National Institute of Mental Health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113:762- 169. 

  4. Jensen PS, Arnold LE, Swanson JM, Vitiello B, et al. (2007). 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry, 46(8) 989-1002.

  5. Molina BS, Hinshaw SP, Swanson JM, et al. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry, 48(5) 484-5. 

  6. Rossiter T. (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part II. Replication. Appl Psychophysiol Biofeedback, 29(4) 233-243.