ADHD: Introducing the Idea of a Placebo

It has been estimated that approximately 6.4 million American children in the United States from the ages of four to seventeen have been diagnosed with attention- deficit/ hyperactivity disorder (ADHD). According to its 2015 report, Centers for Disease Control and Prevention reported that individuals diagnosed with ADHD continues to rise from 7.8% in 2003 to 9.5% in 2007 to 11% in 2011. ADHD can affect many things, but primarily academic performance is one of the main concerns. Thinking of new innovations and ideas to out beat the current best practice for attention-deficit/ hyperactivity disorder should be a main goal.

Attention- deficit/ hyperactivity disorder is a disorder consisting of making it difficult and challenging for individuals to stay focused and control impulsive behaviors. ADHD symptoms typically begin in childhood and could continue throughout adulthood. ADHD is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children (Guideline, 2011). ADHD requires a medical diagnosis. Moods of ADHD usually are anxiety, excitement, anger, boredom, and could have possible mood swings from time to time. Some behavioral and cognitive signs would be fidgeting, impulsivity, difficulty focusing, forgetfulness, aggression, persistent repetition of words or actions, absent-mindedness, difficulty remaining focused, hyperactivity, short attention span, and excitability.

Children who are diagnosed with ADHD commonly present issues involving academic underachievement and learning disabilities. In fact, it has been estimated that approximately 80% of children with ADHD experience academic underachievement and approximately one-third of children with ADHD have specific learning disabilities (Barkley, 2006; DuPaul & Volpe, 2009). The current best practice for individuals diagnosed with ADHD is stimulant medication, particularly methylphenidate. According to a recent study, Baweja et al. [3] conclude that the evidence for a positive effect of medical ADHD treatment on school performance remains more substantial for acute than long- term indicators of academic performance. Other studies also suggest that combining placebos with medications may also have positive outcomes.

A placebo has no therapeutic effects, it may be used to test other drugs or prescribed more for a psychological benefit rather than a physiological effect. Reviews and meta-analyses usually conclude that the placebo response rates in trials in general are higher in children and adolescents than in adults… (Weimer et al., 2013). Therefore, perhaps using placebos can have an equal or higher affect than stimulant medication for symptoms of ADHD. When considering placebos, there may be several mechanisms in which a placebo may operate. Sandler argued that there may be various ways in which a placebo can work. “First, placebos may produce change through expectancy effects on the child with attention-deficit/ hyperactivity disorder. Second, placebos could operate by producing changes in how caregivers perceive children with attention-deficit/ hyperactivity disorder. Third, placebos could operate by producing changes in how caregivers behave toward children with attention-deficit hyperactivity disorder, which, in turn, produce changes in the child with attention-deficit hyperactivity disorder. Fourth, placebos may operate through classical conditioning by producing a conditioned response to placebos” (Waschbusch et al., 2009).

Untreated behavioral problems may substantially impair children’s learning and educational achievement (Fallesen, 2018). Possibly substituting placebos for medication would result in giving children less doses of stimulants and may reduce needed medication. When giving children stimulant medication, many factors should be taken into consideration. Avoiding stimulant medication at all would be a positive outcome. Placebos can help achieve a better academic performance. Therefore, if children with attention- deficit hyperactivity disorder are given placebos, then their academic performance should improve.

References

1. Attention-Deficit, S. O. (2011). ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, peds-2011.
2. Barkley, R. A. (2006). Comorbid disorders, social and family adjustment, and subtyping. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, 184-218.
3. Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., … & Ramon, M. (2014). A randomized clinical trial of Cogmed working memory training in school‐age children with ADHD: A replication in a diverse sample using a control condition. Journal of Child Psychology and Psychiatry, 55(3), 247-255.
4. Corkum, P., McGonnell, M., & Schachar, R. (2010). Factors affecting academic achievement in children with ADHD. Journal of Applied Research on Learning, 3(9), 1-14.
5. Fageera, W., Traicu, A., Sengupta, S. M., Fortier, M. E., Choudhry, Z., Labbe, A., … & Joober, R. (2018). Placebo response and its determinants in children with ADHD across multiple observers and settings: A randomized clinical trial. International journal of methods in psychiatric research, 27(1), e1572.
6. Gray, S. A., Chaban, P., Martinussen, R., Goldberg, R., Gotlieb, H., Kronitz, R., … & Tannock, R. (2012). Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD: a randomized controlled trial. Journal of Child Psychology and Psychiatry, 53(12), 1277-1284.
7. Keilow, M., Holm, A., & Fallesen, P. (2018). Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PloS one, 13(11), e0207905.
8. Sandler AD. Placebo effects in developmental disabilities: implications for research and practice. Ment Retard Dev Disabil Res Rev. 2005;11:164 –170.
9. Sandler, A. D., Glesne, C. E., & Bodfish, J. W. (2010). Conditioned placebo dose reduction: a new treatment in ADHD?. Journal of developmental and behavioral pediatrics: JDBP, 31(5), 369.
10. Waschbusch, D. A., Pelham Jr, W. E., Waxmonsky, J., & Johnston, C. (2009). Are there placebo effects in the medication treatment of children with attention-deficit hyperactivity disorder?. Journal of Developmental & Behavioral Pediatrics, 30(2), 158-168.
11. Weimer, K., Gulewitsch, M. D., Schlarb, A. A., Schwille-Kiuntke, J., Klosterhalfen, S., & Enck, P. (2013). Placebo effects in children: a review. Pediatric Research, 74(1).