It's Complicated

As always, the medication issue is way more complicated than a lot of people think. And this Washington Post article—"Debate over Drugs for ADHD Reignites"—illustrates that. Do ADD meds offer long-term benefits for children? Even the researchers collaborating on a major study are squabbling about it. There's a lot to learn from their debate as laid out in the article.

Psychologist John M. Grohol brings up an interesting point in a related blog post at PsychCentral: Maybe medication decisions shouldn't be so much about whether to use meds, but also about how to sequence different treatments—possibly including meds—in the best way.

And Grohol links to a post on health-care finance expert Maggie Mahar's blog about the big picture of research, money, politics, and ADD meds, with an interesting look at the issue from an international standpoint. It's a balanced and informed piece.

I've added another post on the complexity of medication, "It's Complicated Redux."

Comments

[Claire Walter]

Medication or no medication. If medication, how much, how often. What once might have just been a medical/psychological decision has gotten way more complication. And every layer of complication and bureaucracy seems to make medication costlier for whoever pays. Viscious cycle.

[Peggy Dolane]

The significant problem I see with this study is that it's so focused on medication, that it skips over the most important part of the story -- what kind of treatment should we giving our children. Parents need ideas and resources about what works to treat ADHD -- not more worries and criticism about whether medication is right for their child.

Talk therapy with the wrong therapist does NOT help reduce symptoms of ADHD -- from my experience it can even make them worse. Talk therapy does not work with a 4, 5, 6, 7 or even 8 year old who don't have the cognitive skills in place to work on inattention or hyperactivity. Perhaps the parents were the ones receiving the talk therapy? That makes more sense to me.

What parents need are clearly defined treatment parameters. They need tools to evaluate whether a psychologist is capable of addressing the problem. They need clear guidance about what are the core components of a behavioral intervention to ADHD. And we need standards and certification that our licensed mental health professionals are trained in treating ADHD.

We also need to talk about who pays for this therapy? Even middle class families with insurance can hardly afford long term behavioral intervention support of a trained professional.

I bet the vast majority of parents have their children on medication because nothing else was working They were desperate, they tried it and it worked. They continue to use medications because they work. In our family we tried everything else first -- including talk therapy. We can see the difference in focus, hyperactivity and executive skills with medication -- even after 3 years. If we didn't, we'd stop using them.

Parents of ADHD children need support, not criticism. Reports such as this latest study, only add fuel to the fire to those on the outside of this disability who are quick to criticize the families who are struggling to live with it every day.

We need to shift the focus away from the medication debate, and instead shed light on what parents can do to help their children be successful in life -- much less remember to bring their homework to school tomorrow morning.

[Kathleen Christensen]

Peggy,

Thanks for your comments and for sharing your experience! I agree with you on all but one point. I think information from studies can be helpful for families when it comes to making decisions about medication. I don't think that researchers should avoid doing a study out of fear that someone might misinterpret it. Seems like the more info, the better. Including, as you say, on other kinds of treatment--would be great to see more research in that arena.

I'm also totally with you when you say that parents need support, not criticism. So many people have developed such oversimplified and polarized ideas about medications. Are meds just a way for big pharma to make big profits? Are meds really the only modern, scientific treatment? Aaaaaargh! Again, the picture is really so much more complex and individual, as you allude to as well.

You bring up so many other good points, too. What else helps, how do you find a professional who really understands ADD, and how do you pay for it? While the non-ADD world debates about meds vs. no meds, I'd love to see those of us in the ADD community nonjudgmentally share all the things that have worked for us and our children. (Although, I have to say, I'd also love more understanding from the outside world.)

If you didn't get a chance to read it, do check out John Grohol's post (second link in my post). He addresses the issue of how to dovetail meds with other interventions.