You have probably heard the debate and maybe even participated in it sometime over the years. The use of methylphenidate, the main ingredient in Ritalin, (or any stimulant medication) is a hotly debated topic. Some decry the evils of giving a child medication to tame “normal” childhood behaviors. Some believe that parents and teachers would rather drug children into submission than put in the hard work it takes to help them. Others believe the studies that show methylphenidate as effective in reducing symptoms of ADHD. Or maybe they believe what they see in their own child - the ability to sit still, pay attention and better grades - when taking ADHD medications.
There have been plenty of studies that have come to the conclusion that stimulant medications are safe and effective. But how reliable are these studies? A meta-analysis of 185 studies on methylphenidate were reviewed by Professor Ole Jakob Storebo, a clinical psychologist at the Psychiatric Research Unit in Denmark and his team. The findings of the meta-analysis was published in the Cochrane Review.
According to the researchers, there are questions as to the effectiveness of methylphenidate, or at least to the question of whether the effectiveness outweighs the risks. What did the researchers find?
- Methylphenidate is moderately effective in improving ADHD symptoms, general behavior and quality of life
- Children taking methylphenidate have reduced appetites
- Children taking methylphenidate have trouble sleeping
- Methylphenidate was not linked to any serious or life threatening adverse reactions
For the researchers, one of the most concerning parts of the meta-analysis, was the lack of reliable data for the previous studies. They noted that in some of the studies, people could have been aware of which treatment a child was taking (for example methylphenidate or placebo). There were also studies that had incomplete reporting of results, variations of results or short follow-up periods. Most were small studies, although the total participants for all the studies was over 12,000. Some of the studies were financed by the pharmaceutical industry.
The scientists called for better designed trials with longer follow-up periods and more complete reporting to definitely determine the effectiveness and risks of methylphenidate in treating ADHD. Based on the low quality of the previous studies, the researchers states, “we cannot be confident that the results accurately reflect the size of the benefit of methylphenidate.” They also noted that while methylphenidate was not associated with any serious side effects or life threatening concerns, it was associated with non-serious problems such as decreased appetite and insomnia.
These types of concerns, according to the researchers, should be carefully weighed and methylphenidate should be “cautiously” prescribed although in a press release regarding the study, they urged doctors and parents not to rush to discontinue medication. If a child has responded to medication and does not have serious adverse reactions it would make sense to continue it. However, should parents have questions or concerns, they should discuss them with their doctor and together determine whether the medication is beneficial.
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