There are many concerns about the use of medication in children with ADHD, and especially about methylphenidate, which is sold under various brand names such as Ritalin®. In the Netherlands, the Health Council concluded in 2014 that there is overtreatment with medication. Child and adolescent psychiatrist Karen Vertessen, who works at UPC KU Leuven, investigated in a national study as a doctoral candidate at VU Amsterdam how drug treatment of children with ADHD can be better tailored to their individual needs.
Dr. Vertessen compared two ways to determine whether children with ADHD benefit from using methylphenidate and – if so – which dosage produces the best results with minimal side effects:
- the usual way of starting with a low dose that is gradually increased
- a method in which different doses and a placebo (a “fake pill” without the active substance) are prescribed.
Useful placebo effect
Her PhD research shows that the approximately 30% of children who do not benefit from treatment with methylphenidate are better detected with the method that uses a placebo. Furthermore, contrary to prevailing thought, a higher dose of methylphenidate does not appear to lead to a better effect for every child. There also appears to be a significant ‘placebo effect’, with parents, and to a lesser extent teachers, reporting positive effects of ADHD medication while children are treated with a placebo.
It is therefore important that doctors, when initiating treatment with methylphenidate, test all possible suitable doses, preferably compare the effects with placebo, and involve both parents and teachers in evaluating the effects. In this way, doctors can avoid unnecessarily treating children with medication and, if medication has beneficial effects, the correct dosage is prescribed.
Vertessen advocates that policymakers release sufficient resources for a broad implementation of this method in current clinical care and that pharmaceutical companies make it possible to easily carry out this systematic trial treatment with all forms of methylphenidate (both short- and long-acting) that are on the market. be a market.
Defense of thesis
Dr. Karen Vertessen will defend her dissertation publicly at the Vrije Universiteit Amsterdam on November 8.