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ADHD and Stimulant Medications, A Matter of JudgementAllan Schwartz, LCSW, Ph.D. Updated: Jul 24th 2009 In my experience, people tend to become polarized on the issue of medication. There are those who are agreeable to the use of any and all medications recommended by their medical doctors. On the other hand, there are those who are totally opposed to the use of medications, even when recommended by the medical establishment. The best solution probably lies somewhere in the middle of these two positions. When it comes to having a child diagnosed with Attention Deficit Hyperactivity Disorder, the decision to use medications are not can be extremely complicated.
Stimulant medications have a paradoxical effect on children and adults with ADHD. While taking stimulants would cause most of us to become hyperactive, they have the opposite effect on those with ADHD. While stimulants can cause children with this disorder to have difficulty sleeping and can cause them to feel uncomfortable, it actually quiets their hyperactivity and improves their attention.
The problem is that, like all medications, the stimulants, such as Ritalin and others, have side effects. I recently read an article that expressed concern that long term use of stimulants can result in having a negative effect on the brain. Other concerns about these medications have centered on their impact on the liver and even whether they can cause a person to turn to drug abuse as a result. Actually, this last has been dismissed as a fallacy but the other worries are real, even if to a small degree.
Yet, weighed against the problems of medication side effects are the impact the symptoms of ADHD can have on the long term development of the child and on family and friends. Children whose ADHD is out of control can be very real management problems at home and in school. In fact, untreated, ADHD can cause children to become alienated because they are identified as behavior problems. By the adolescent stage of development, these individuals can identify themselves with other youngsters who feel abused, disaffected and who feel like failures. Many of these are the children who turn to drug abuse and drop out of school. One psychiatrist I know related to me in a private conversation that in his work in the prisons, many inmates are identified as having ADHD but went untreated as children.
This presents parents with difficult choices. Depending on the severity of the case, they have to weigh the positive effects of medication against the side effects of both the medications and leaving their child untreated.
I believe that part of the problems is that there is a tendency, on the part of many people, to look for quick solutions to behavioral disorders. This tendency is reinforced by health insurance companies who do not want to pay for long term treatments and who prefer fast solutions because they are less expensive. However, there are many problems in life that do not respond to quick solutions and one of them is ADHD.
While stimulant medications do help many children to calm down and focus their attention there is also a need for them to learn the skills that will help them control their impulses and compensate for those times when the fail to focus their attention, such as writing down a homework assignment that is due.
In fact, whether dealing with children or adults, everyone with ADHD needs to learn how to cope with their symptoms. There are psychologists and clinical social workers with expertise in helping either children or adults compensate for their behavioral and attention difficulties.
I prefer to think of the use of psycho stimulant medication as a way to make someone available so that they can profit from learning how to compensate for challenges presented by this disorder. Afterwards, it is possible for many people to stop using medicines because they know how to handle their symptoms.
It is also important to remember that not everyone with ADHD needs medication. Those with milder case and those with primarily attention deficit without hyperactivity, can learn how to help themselves. In addition, there is evidence that many children overcome ADHD when brain and nervous system development catches up with other children.
If you have a child with ADHD it is important to see your doctor and discuss the options available to help the child. Included in the options should be the type of coaching that will help the child learn to function by learning how to get around the symptoms, whether they are on medication or not.
For adults diagnosed with this disorder, the same ideas hold true. In discussing the options available for treatment it is not only medicine that should be considered but coaching as well.
Your comments and questions are welcome.
Allan N. Schwartz, PhD |
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Readers in the Boulder, Colorado metro area (or Denver area people willing to drive) may contact Dr. Schwartz for face-to-face consultation and psychotherapy. Email him at dransphd@aol.com for details.