Teens with ADHD can’t tell when they are on medication
Multiple studies have established that stimulant medication treatment is effective for adolescents with ADHD, especially in reducing core ADHD symptoms. However, adolescents frequently stop taking medication, such that by age 18, less than 10% continue to take it. This is problematic given that symptoms often persist into adolescence and continued treatment can be essential.
One reason frequently expressed by teens for stopping medication is their belief that it is not helpful. However, teens may not be accurate judges of whether medication is helping them and may not even be able to detect when they are receiving medication. The inability to distinguish active medication from placebo treatment has been demonstrated in children, but not previously examined for teens.
A study published last year in the Journal of Attention Disorders examined this issue [Pelham et al., (2017) Attributions and perception of methylphenidate effects in adolescents with ADHD. Journal of Attention Disorders, 21, 129-136.]. In this study, 46 youth ages 12 to 17 participated in a summer treatment program that combined medication treatment, behavior therapy, and both academic and social skills training. For the medication component, each adolescent underwent a placebo-controlled medication assessment in which he/she was tested on 3 different doses of methylphenidate as well as a placebo. Medication or placebo was administered 3 times per day as methylphenidate is not a long-acting medication.
At the end of each day, youth were asked whether they had received medication or placebo, and, if medication, whether they had received a low, medium, or high dose. They were also asked to rate how much their behavior and academic performance during the day had been influenced by a variety of factors including: their ability, effort level, whether they had been treatment fairly, medication they had taken, and having ADHD. In addition to their self-ratings, counselors and teachers rated their behavior and academic success during the day.
Did medication help? – The answer here was a clear yes. On average, adolescents’ behavior and academic work was significantly better on active medication days than on placebo days.
Could adolescents tell when they were on medication vs. placebo? – No, they could not. In fact, their ability to correctly identify medication days vs. placebo days was not better than chance, i.e., guessing. This replicates a finding previously reported for children.
Furthermore, even though their behavior/academics was significantly better during medication days, adolescents rarely reported that medication played an important role in their success. On good days, they were especially likely to rate their effort and ability as the primary determinant of their success. In contrast, medication was rated as the primary determinant of success less than 1% of the time. The most frequent explanation provided for bad days was that they had not been treated fairly.
Summary and implications
Although medication was objectively helpful to the teens in this study, they rarely saw it as a key factor in their success. And, their ability to correctly distinguish between active medication days and placebo was no better than chance.
While attributing their success to effort and ability is a positive attribution, not recognizing the important help provided by medication may contribute to why so many teens refuse to take it. After all, if you don’t believe medication is really helping, why bother to take it? Given that the adolescents in this study could not reliably tell when they had taken medication or placebo, it is not surprising that they would be similarly unaware of any benefits it provided.
David Rabiner, Ph.D.
Dept. of Psychology & Neuroscience
Durham, NC 27708
(c) 2017 David Rabiner, Ph.D.
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