It is common knowledge, in the psychiatric community that 'pills don't teach skills' yet despite this knowledge, in the United States, ADHD is usually treated with stimulants alone and parents face considerable pressure from teachers and physicians if the choose to treat ADHD with no medication. In fact, in England, the experts recommend that at first ADHD be treated without medication and that treatment should begin with behavioral and pychosocial interventions and report that an 'ADHD no medication' approach as first line therapy is appropriate and encouraged.
A recent report in the Journal of Pediatric and Child Health concludes that treating ADHD with medication alone is wrong. The report argues that the findings from PET scans done on individuals with ADHD that were on medication alone and on individuals that were on medication and other behavioral, social and psychological treatment, clearly demonstrates the benefit of a combined approach to treating ADHD.
The official statements from The American Academy of Pediatrics (AAP) recommends stimulant and/or behavior therapy and suggest that physicians evaluate progress and 'when the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis, use of all appropriate treatments, adherence to the treatment plan, and presence of coexisting conditions.'
In practice what happens is that the child and parent (or adult patient) has a ten minute visit with the pediatrician or doctor and a stimulant is prescribed. The option to treat ADHD without medication is never discussed. The what about, 'ADHD no medication' question is brushed off and the office visit is over.
If the particular stimulant prescribed does not work, another is prescribed, and then another and another. Behavioral, social or psychological services are rarely offered or received. Memory or attention training is never offered. The AAP statement urges pediatricians to insure that behavioral interventions are reinforced if the child fails to respond to stimulant treatment, but it just does not happen.
Most often what happens is that, when stimulants fail, the patient gets referred to a specialist. Ideally, the specialist would begin some form of psychosocial therapy or perform a more thorough evaluation but in fact what happens is that the patient has a fifteen minute visit with the specialist and more medication is prescribed.
In the case of Inattentive type ADHD this is most unfortunate because there is great evidence that this subtype responds well to ADHD social skills therapy, cognitive therapy and behavioral therapy as well as to memory and attention training and that this type of therapy is superior to stimulant or non-stimulant medication.
We as parents and patients must advocate for our health and insist that behavioral, social, cognitive therapy, memory training and attention training are a part of our ADHD treatment plan.
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Management of attention-deficit/hyperactivity disorder: The importance of psychosocial and medication treatments.
Vance A, Winther J, Rennie K.
Journal of Pediatric Heath, January 18, 2011
My insurance won't pay for memory and attention therapy. We paid for it on our own to the tune of nearly $4k and while his scores went up, I'm not convinced there was that much carryover. My insurance did pay for behavioral therapy, but I think I learned just as much from self-education. Thank goodness for the Internet!
ReplyDeleteIt is interesting because some of the studies on Cogmed have shown that there is a benefit but you have to continue to do it to continue to gain the benefit. Once you stop, the benefits stop. It is sort of like doing physical exercise, you become stronger as you do it but lose the strength if you stop. Our behavioral therapy sessions were also not very helpful and I found that I learned a lot more from reading a few books and it was tons cheaper. The books that I found the most helpful were 'The Explosive Child' and 'Motivational Breakthrough'. I also think that the internet is a great resource as you say.
ReplyDeleteThank you so much for your comments!! Tess