The methylphenidate (Ritalin ®, did Devise ®)is efficient and safe heart treating children suffering from disorder attention deficit hyperactivity (ADHD)? The question redoes surface periodically since the years 1990.
The debate took the vigor since some months, following the publication of four studies American exits of the Multimode Treatment Study Children of ADHD1 with (MTA). During this second phase of the survey, the same researchers wanted to know what it occurred of the children after two years of treatment.
According to the results, published lately in the newspaper of the American Academy of Child and Teenage Psychiatry, the medicines against the TDAH would not be as efficient as one would have believed it to long terme2,4. They could also cause a delay of growth at the enfants5.
The medicines against the TDAH would not bring any measurable kindness anymore to the children after two years of treatment, that means those that always present important symptoms, conclude the researchers who participated in the second phase of the survey.
For the half of the topics of the cohort, however, the medicines proved to be efficient during the first or the second year. The observed improvements also maintained even themselves after one year without medicines.
The Ritalin: a medicine to the paradoxical effects
Patented for the first time in 1954 under the name of Ritalin®, methylphenidate is has psychotropic drug acting in the manner of cocaine: he/it stimulates the central nervous system as inhibiting recaptures it of the dopamine, what increases the concentration of this neurotransmitter in the brain. Although it is a stimulant, he/it has paradoxical effects at the hyperactive: he/it has the agitation lowered and increase the attention span. One uses the methylphenidate since 1960 to treat the children enduring the TDAH, but the use of this medicine took a considerable flight since the years 1990.
The American authorities threw the Multimode Treatment Study then Children of ADHD with in order to value the efficiency and the linocut of the medicine by a cohort of near 600 children treated during two years for the TDAH. In 1999, the researchers concluded to the efficiency and the linocut of the methylphenidate on one period of two years.
Of the shared opinions
According to the professor of psychology William Elam, of the university of Buffalo, member of the team that led the first phase of the MTA survey, the efficiency of the methylphenidate would have been overestimated initially. " Nothing indicates that the medication is more efficient than all other intervention", he/it has declared. He/it would have wished that the protocol of the survey puts the accent more on non medicinal psychotherapeutic interventions.
On his/her/its side, psychiatrist Lily Henchman, chief of the clinic of the TDAH to the hospital of Montreal for children and member of the team of researchers having led the MTA survey, interpret the results of the second phase of the survey differently. " The studies don’t put in doubt the efficiency of the medication, goal they stress that the strength of departure is too often poorly defined and that monitoring child is medicated unfortunately inadequate. "
The results collected for the second part of the survey concern the children who were treated in the community and that didn’t benefit anymore of the tight follow-up to which they had right during the first phase of the survey, she/it explains. The dosage of the medicine had been established then carefully to the departure, for every child, and the treatment has been adjusted, if need be, once per month. In the community, otherwise, the follow-up sums up most of the time to one or two medical visits to year, and one often ignores if the medication is prescribed adequately and if the child adheres there correctly and with assiduity, specify the psychiatrist.
Same sound of bell at the Dr Philippe Lange, psychiatrist connected at the academic institute in health mental Douglas and to the River-Of-Prairies hospital, that treat since close to 20 years of the topics concerning the TDAH. " A minimum of two years of non-stop medication is necessary to the departure, with adjustment of the dose to the three months", he/it makes notice. After, that depends on the child’s progress, he/it pursues. " The symptoms vary from an individual to the other and it is necessary to revalue the functional capacities of the patient and his/her/its degree of adaptation constantly to what the society waits for it. "
According to the two psychiatrists, children who are still medicated after three years and withdraw some benefits of treatment, slots are heavier gold haggard received inadequate monitoring. What explains, according to them, that one observes delinquent behaviors more at the children during more of three years that at those that are not anymore
As much at the boys as at the girls The TDAH is trouble most frequent intradepartmental at the children: of 5% to 10% among them would be reached of it. One affirmed a long time than more of boys who were reached of it of girls. However, the most recent studies are not a matter for distinction between the sexes.
Of the growth delays
The children under medication since three years would accuse a delay of growth of the order of 2 cm of size and 2,7 kg of bodily weight in relation to the children, indicate other results of. He/it is known that the methylphenidate can have an effect appetite suppressant.
Some researchers think that it would be necessary to foresee periodic holidays of medicines in order to allow the child to take a normal rhythm of growth. Others estimate that of such stops of the medication must make the object of the child’s assessment by his/her/its medicated psychiatrist, the only one that can determine if the holiday of medicines risk to result in an upsurge of the symptoms of the TDAH.
In light of the results of this second part of the MTA survey, he/it is to foresee that the debate surrounding the treatment of the TDAH will have a lot of ink sunk again in years to come.
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