Medication Is An Incomplete Treatment For ADHD In Children
A 2015 report from the George Washington University Milken Institute School of Public Health finds that the number of diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) has risen by 43% since 2011. What the hell is going on?
In a recent episode of Straight Talk MD, author of “ADD Explosion”, Dr. Stephen Hinshaw, explains the various causes for this dramatic rise in ADD and ADHD diagnosis. He also discusses the treatment of ADD and ADHD in children, and explains how the healthcare system is set up to incentivize treating these disorders through medication alone, which is only part of a healthy and effective treatment for these disorders.
“You outline how a combination of medication and behavioral therapy usually leads to the best outcomes for ADHD, but is our health care and mental health system even set up for this kind of treatment?”
“One of the policy changes back in the ’90s that led to a lot of the ADHD diagnosis was a change in authorization of Medicaid, which out here in California is Medical, where ADHD was a reimbursable diagnosis for doing, again a fairly cursory, but the assessment of it. There’s only one reimbursed treatment under Medicaid which is medication. There’s no reimbursement for family management training or doing a school consult which are the evidence based psychosocial treatments.
So medicine is reimbursed sometimes only, or exclusively, as a quick way to get at the symptoms.”
"So medicine is reimbursed, sometimes only or exclusively, as a quick way to get at the symptoms."
“Medication means giving stimulants or something like that?”
“Stimulants are the primary medication for ADHD, and that’s confusing! Why would you stimulate a kid who seems already too active? The short story here is that the stimulants are SDRIs, selective dopamine re-uptake inhibitors. They stop dopamine once it’s squirted out from the first neuron in the chain from being taken back into that first neuron. It allows more dopamine to be active.
Dopamine is the neurotransmitter that gives you that sense of intrinsic reward. It helps you regulate your motor behavior. It has implications for learning, with the projections that go out to the frontal lobes (planning and organization). The medications do a good job in about 80% of cases, if you get the right kind of stimulant and the right dose, of keeping those symptoms in check, for as they are as long as they’re in the bloodstream, which is just a day at a time.
But what the medications, of course, can’t do is actually teach academics, or teach better social skills, or teach families how to discipline in a more consistent way. So almost by definition, it’s an incomplete part of a multimodal package that requires building skills in families and in schools and in the kids themselves, to learn in groups and learn how to interact socially better.
It’s those combination treatments that have the best chance of treating the whole child, and persisting in their effects longer than just medication alone.”