Placebo Effects in Caregivers May Change Behavior of Children with ADHD

Jun 29, 2009

(PhysOrg.com) -- 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 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.

"The act of administering medication, or thinking a child has received medication, may induce positive expectancies in parents and teachers about the effects of that medication, which may, in turn, influence how parents and teachers evaluate and behave toward children with ADHD," said UB researcher Daniel A. Waschbusch, Ph.D., lead author of the review.

"We speculate that the perception that a child is receiving ADHD medication may bring about a shift in attitude in a teacher or caregiver. They may have a more positive view of the child, which could create a better relationship. They may praise the child more, which may induce better behavior."

Such a placebo effect in caregivers could have both good and not-so-good results, Waschbusch added. "If teachers treat children more positively if they think they are on medication, that is a good thing. But if the child's medication is increased because caregivers think it is effective, that may not be a good thing."

Waschbusch is an associate professor of psychology in the Department of Pediatrics at UB and conducts his research in UB's Center for Children and Families. The study was published in a recent issue of the Journal of Development & Behavioral Pediatrics.

Waschbusch and colleagues reviewed existing studies that evaluated whether placebos produce significant changes in children with ADHD and assessed four possible ways placebos could have an effect:

• Through the child's expectations of a change -- The analysis showed that any change in children's behavior was a direct result of the medication, not the expectation.

• 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 .

• 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.

• Placebos may operate through classical conditioning. "For example," explained Waschbusch, "if a parent routinely gives their child active medication in pill form and then sees their child's behavior immediately improve, they will likely learn to connect administering a pill with improved child behavior. This learned connection could then be generalized to administering a placebo pill."

Waschbusch said the next step in this investigation could be a study that observes parents and children interacting under three different conditions: after children received a pill with real medication, after children received a pill with fake medication (a placebo) and after children didn't receive any pill.

"Comparing these conditions would provide information about the effects of actual medication relative to just getting a placebo," he said.

William E. Pelham, Jr., Ph.D., and James Waxmonsky, M.D., from UB, and Charlotte Johnston, Ph.D., from the University of British Columbia, are co-authors on the study.

When conducting this review, the authors were supported partially by grants from institutes within the U.S. Department of Health and Human Services, the U.S. Department of Education and the Eli Lilly Corporation.

Provided by University at Buffalo (news : web)

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freethinking
3 / 5 (2) Jun 29, 2009
This is not a new study... but Im glad its repeated... Ive heard this before!!! Now Im going to bookmark it because many people didnt believe me.
I have said for the longest time that ADHD should be called TBS (typical Boy Syndrome) and the cure is proper discipline, better teachers, better parental training, and if all else fails the medication of the teachers and parents who want to medicate their children with mind altering drugs.
DGBEACH
3 / 5 (2) Jun 30, 2009
This is not a new study... but Im glad its repeated... Ive heard this before!!! Now Im going to bookmark it because many people didnt believe me.



I have said for the longest time that ADHD should be called TBS (typical Boy Syndrome) and the cure is proper discipline, better teachers, better parental training, and if all else fails the medication of the teachers and parents who want to medicate their children with mind altering drugs.


You obviously have never had a child with ADD, because if you had you wouldn't so flippantly dismiss its existence.

I honestly wish there were other ways to help children which are affected by it, because the drugs we are forced to use have many negative side effects (depression, lack of appetite, aggressivity).

On many occasions my son won't take his pills, but pretends he did...we notice the difference in his demeanor within an hour, when he becomes completely unfocused and then subsequently combative with everyone around him.

DO NOT underestimate the impact that this disorder has on, not only the child involved, but on ENTIRE FAMILIES. Parenting children with ADD and ADHD is an entirely different experience from the one you appear to have lived!

Suggesting that caring parents WANT to needlessly medicate their child is callous and insulting. Try talking about something you actually know something about next time!
freethinking
1 / 5 (2) Jun 30, 2009
DGBEACH
Raising kids is difficult no questions about it. I have 4 and been around kids for many years as a coach.
I agree, some kids are more difficult that others, no question about it. Interestingly my daughter now claims I have ADHD.
However, a lot of parents dont know how, or just don%u2019t bother to control their kids (ever see the show Nanny 911, or the other nanny show that I cant remember right now?), but if they would discipline them probably, they become manageable. (Again, in comes the nanny who knows how to discipline, and after a week or so of PARENTAL training, the kids are much better behaved.) Ive had an experience in a store where a mother of two kids had no control of her two kids and just looked at me and asked what could anyone do? I looked at her kids, and told them to stand by their mother and stop running around. Guess what? They did.

Ive coached kids who had "ADHD", they were difficult to control, but I got them to listen to me by being firm, being fair, and having expectations for them. I too could tell when the kids were on ADHD medication. They still were difficult to control, but they were drowsy, slow, and in a fog. I much prefer the kids not to be on ADHD medications, they were harder to control, BUT they were alive.

Ive yet to meet a kid labeled as ADHD that wasnt normal and impossible to control. Ive met a lot of parents who dont know or dont want to put the effort into training their children. Ive met a lot of teachers and a principle of a school who dont know or dont care either about difficult kids.

To summarize, kids who have ADHD are difficult to raise, but they are normal. Learn how to discipline them, be patient, be kind, understand, get support, have expectations of them, it is difficult, cry, but if you have them, it is your responsibility to raise them.
DGBEACH
not rated yet Jul 01, 2009
Again...none of your 4 has ADD, so you only spend very limited timed around any which do.



Discipline plays a huge role in my family, because without it, it would be pure mayhem. I also have 4, 2 teenage boys an 8-yr old boy and a younger daughter.

For example, Saturday mornings are usually house cleaning times, whereby each collects their dirty clothes, cleans their rooms, and the house gets vacuumed and cleaned. Every task is listed on the fridge so there's no misunderstandings as to who does what. Invariably everything gets done by 10AM or so and then we have the rest of the weekend to relax...everything EXCEPT what my son with ADD has to do. His chores are never done fully, and much time is spent 1)urging him,2)trying to encourage him, 3)and then once SUPPER TIME comes around it becomes LOUD! And this is only ONE day of the week!

The other children, meanwhile, cannot spend time with their father because he has to stay around to make sure that "things are getting done".

He has just failed another year of school, and will be in the same grade as his younger brother this year.

With the medication, he is able to concentrate long enough to absorb what's being taught him during the day, and apply himself...and sometimes remember it all. Homework is another story, however, since his meds have run out by then.

When he doesn't take his medication he becomes extremely unfocused, and cannot accomplish even the simplest of tasks (like pouring himself a glass of water) within the time it would take a non-ADD afflicted person...he's too fidgety. The pitcher will be picked up then put down several times, the glass often times will end up getting broken (we now only allow plastic cups to be used by the kids because of him).



This might sound mundane or unimportant to many of you, but I assure you that ADD and ADHD are disorders which are extremely disruptive to families, and they are the cause of many marital break-ups.



From your prospective *freethinking* the kids you were coaching on meds were slow and in the fog. OF COURSE they were...their meds are made to help them concentrate on ONE THING AT A TIME! Team sports are notoriously hard for children with ADD and ADHD because there is so much going on at once! In my son's own words "imagine being in a room full of people, where everyone is yelling at once, and trying to concentrate on what just one of them is saying"...they can't do it...nor could any of us!
freethinking
1 / 5 (1) Jul 01, 2009
If you want to drug your child that is your choice and I will never take that away from you.

As for the kids on ADHD meds, they played sports fine off the drugs I could get them to move and listen to me better. In fact when they were on their meds, I had a harder time with them to listen to me as they were spaced out.

All Im saying is that kids with ADHD (and not mental illness) need teachers and parents to adapt to them. I can give my daughter 30 things to do, and she would do them in order and on time. Give that list to one of my boys and not one thing gets done.

The bottom line is that one day you kids will be off the medication. Either s/he learns skills to cope with their unique gifts (yes ADHD is a gift, just a different gift than those who can concentrate on 30 tasks) or the gift destroys them.
Our role is to help kids adapt, not to take drugs.

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