Let me start by saying that the decision to give medication to a child always rests with the parent. If a parent feels uncomfortable about medication, they should not be shamed or coerced into feeling differently. That being said, there is a lot of misinformation and misguided notions out there on not only ADHD medication, but the disease itself. My goal is to educate people on what ADHD is, what it is not, and the facts regarding treatment. I have no agenda other than that, and no, there is no pharmaceutical company paying for this article. Let’s answer some questions!
What is ADHD?
ADHD is a disease. It is a neurological disorder in which the prefrontal cortex of the brain is under-functioning. Because the most common symptom of ADHD is hyperactivity, this is somewhat counterintuitive to what people think is going on. Stimulant medication works because it stimulates the part of the brain that is not functioning at the level it should be. The prefrontal cortex is responsible for impulse control, higher order thinking, social cues, memory, and emotional regulation. When the right neurotransmitters are not being released those responsibilities can fall by the wayside, leading to the ADHD symptoms we see. There is a very specific set of symptoms attached to ADHD, and a quick Google search for DSM V (5) ADHD symptoms will take you there.
Is there a test for ADHD?
No. It would be great if there was, but there just isn’t. However, there are several assessments that will tell you the likelihood your child has ADHD. The most well-known and commonly used is called the Conner’s Checklist. The parent and teacher each fill one out, the checklists are scored, then provided to the doctor. This checklist is considered to be pretty ironclad when determining likelihood of ADHD.
Couldn’t every child be diagnosed with ADHD?
Nope. This is another common misconception. The Diagnostic and Statistical Manual, 5th version, lists very specific symptoms (too numerous to list here). The DSM also lays out what is known as diagnostic qualifiers. These qualifiers are in place to ensure that the disorder is not over-diagnosed. Here they are:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
- Several symptoms are present in two or more settings (such as at home, school or work, with friends or relatives, in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms are not better explained by another mental disorder. The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
Why should I consider medication?
I had the privilege of speaking with a well-known pediatrician over the weekend and he shared some insight in working with ADHD over the past 20+ years. He is a proponent of ADHD medication and started by saying this. “If I told you your child’s body is not producing the insulin it should, as we see in diabetes, I would prescribe synthetic insulin and you wouldn’t hesitate to give it to him. If I diagnose your child with ADHD and tell you his brain is not producing the chemicals it should and I prescribe a stimulant medication, you would likely balk at the notion. What’s the difference? We know that low insulin can affect and change their mood, focus, and concentration. We want them to be who they truly are, not changed by their condition.” That struck me, as I had not thought of it that way before. Which is amazing when you consider that mental health is my job. He went to say that “stimulant medication is at least 80% effective when used for ADHD, making ADHD the most treatable disease we know of.” If your child has been diagnosed with ADHD, or if your child’s school is recommending a doctor’s evaluation, then the symptoms are severe enough that they are affecting your child’s performance. If this is the case then they need help.
Won’t my child become addicted to the medicine or face horrible side effects?
The definition of addiction is that the substance must cause two things: tolerance and withdrawal. Tolerance means you get used to the substance and require more of it to get the same effect. Withdrawal means you experience negative symptoms (stomach ache, headache, etc.) when you do not take the substance. ADHD medication has not been shown to cause either of these. Stimulant medication is in a person’s system for a set amount of hours, depending on the medication and the dosage. It does not last 24 hours a day, which means that if there were withdrawal symptoms they would be seen daily — and they are not. The most common side effect of stimulant medication, and this is not seen in every case, is decreased appetite. The doctor I spoke with this weekend went as far as to say, “There is no other class of medications for no other ailment that has fewer potential side effects and is as effective as stimulant medication.”
If medication is so effective, why would counseling help?
One of the most exciting findings in the field of neuroscience is the discovery that the brain is plastic — meaning it can be changed and grow based on our experiences and what we focus on. What does this have to do with ADHD and counseling? Everything. Working on focus and attention can actually rewire portions of the brain and help develop better skills for the future. A counselor can help to develop a set of coping skills and strategies aimed at improving attention and focus.