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Home > Research Articles > Low dose meds plus placebo may help ADHD

United Press International

Monday, May 05, 2003

United Press International

SAN FRANCISCO, May 03, 2003 (United Press International via COMTEX) -- After a child is diagnosed with attention-deficit-hyperactivity-disorder many parents agonize over whether to place their son or daughter on long-term stimulant drug therapy, the most commonly prescribed treatment for the disorder. A new pilot study suggests that a less potent therapeutic approach -- a low dose of medication coupled with a placebo -- could be an effective alternative. The intriguing preliminary results -- presented Friday at the annual meeting of the Pediatric Academic Societies -- may open the door for new treatment options for the 5 percent of the U.S. population that suffers from ADHD. Researchers from the University of North Carolina at Chapel Hill examined the outcomes of 26 children between the ages of 7 to 15 who received one of three alternating weekly treatments: Their usual dose of medication, half the usual dose with a placebo or half the usual dose and no placebo. Over the course of each week, parents, teachers and clinicians were asked to monitor and rate the children's behavior using a standardized scale. Both the parents and children were fully aware when the placebo treatment was given -- a feature of the study which allowed the researchers to side-step the ethical dilemmas associated with denying the children effective treatment. Surprisingly, the results of the parent and clinician ratings indicated that 40 percent of the children in the study responded well to the low dose plus placebo treatment, with equally good ADHD control and fewer side effects, compared with the full dose they had taken previously. In contrast, the children's ADHD symptoms did not improve with just the lower dose of medication alone. While the study size was small, the results were statistically significant, says lead author and University of North Carolina-Chapel Hill psychiatrist Dr. James Bodfish, who cautioned about reading too much into the findings. "Some people could misinterpret this study and think that some children don't need to be on medications or as much medication," Dr. Bodfish told UPI. Instead the study suggests that through placebo conditioning, or training the body to expect a certain reaction, the body may react to the "dummy pill" in the same way that it would to the usual drug dose, Bodfish said. "Pairing the inactive placebo with the active medication is what's key here. It seems to give the placebo some physiological characteristics of the medication," he told UPI. However, the study was too small and short-term to draw any conclusions about the potential therapeutic benefit of conditioned placebo treatment for children with ADHD over the long-term, says Dr. David Rabiner, senior research scientist with Duke University's Center for Child and Family Policy. "This doesn't tell us anything about sustaining children on lower doses over an extended period of time. The effect could fall apart after a few weeks," Dr. David Rabiner told UPI. Moreover, the parents and children in the study could have influenced the outcome by changing their behavior because they hoped that the placebo treatment would work, said Rabiner. "Parents could have some inherent interest in showing that the placebo dose works or they could be trying to please the experimenter," Rabiner told UPI. The study is the first of its kind to examine conditioned placebo treatment for a brain-based disorder and the researchers hope it will eventually lead to less toxic treatment approaches for the management of ADHD. The UNC team is currently conducting a larger, two-year trial involving 150 children with funding from the National Institute of Mental Health. That study will examine the effectiveness of a conditioned placebo treatment when decreasing doses of stimulant medications are paired with different placebos. The trial -- which Bodfish expects to complete within one year -- will attempt to answer many of the questions raised by this initial pilot study. Copyright 2003 by United Press International.