Attention Deficit, Sans Medicine
Is drug therapy an or the answer in ADD/ADHD?
Some would say to medicate is a remedy for kids or adults whose minds wander. I’d say it is also part of the problem. Medications cannot treat everything and worse, it does not replace making the learning material relevant or the teaching method effective. Often, it's quite the opposite in fact--'Give him medicine and then we can on with the boring subject matter.'
What about that learning experience? Is the child tuned in, seemingly distracted when he or she is actually quite bored or having real trouble at home? Is the patient-student is at a stage of development where he or she cannot prioritize and then focus? What has the teacher done to raise the interest level in the subject matter being taught? How is that subject matter made relevant? Are the mind, body and spirit in sync or, better, synergistic? In some cases there's a physiological reason for learning difficulties; in others a basic skill is missing. Sometimes there's an actual learning disability–visual, auditory weaknesses (or strengths), for instance. Sometimes (like the child in the photo who, it turns out is actually gifted), the student learns extraordinarily well, in their own way, but with their own sense of priorities, not seeming to pay attention or appearing distracted to the frustration of their rigid, if not inept instructor.
Is attention deficit with or without hyperactivity (ADHD/ADD) a true disorder with demonstrable pathology? Is there a genetic predisposition (a "nature" verses "nurture" issue)? Is something wrong with the brain, a chemical disturbance? Unfortunately, we still do not know.
Because the afflicted are easily distracted, inattentive or even disruptive, they can be treated differently, left out and they are usually labeled (meaning they are castigated). In our society, however, that is the price one has to pay to avail themselves of scarce resources–clinical or educational–to help the patient and their family.
Note: often in a more tolerant settings, such as the religiously orthodox community in which I work, patients with ADHD/ADD can be mainstreamed, they can learn and they can succeed, meaning they can perform well, test well enough, stay at task, and retain, surprising us all the time; and, they can accomplish these things, often without heavy, mind-altering drugs. In other words, not all children or adults diagnosed with ADD/ADHD “need” medication. [Also see natural remedies, below.]
Should the main criterion for drug therapy be the typical threat, born out of frustration—‘Without medication he cannot attend this or that class/job/activity?" In many cases, I suggest we prescribe more structure, make reasonable expectations, design, implement and shepherd behavioral interventions, and these patients frequent opportunities to ‘burn’ calories. [See "Raising Cain"--a documentary that probes issues facing boys (and, increasingly, girls) potential solutions for their dilemmas.]
I say a new paradigm is needed in scholastics. Let's seek caring teachers who can deal with those having difficulties in self-control (weakness in 'disinhibiting' certain disruptive or distracting behaviors), and then, and only then, in my opinion should one consider using pharmacology as a supplement or aid.
Clinically, the decision to use meds also depends on the “severity of symptoms, the coping abilities of the child, and the availability of other treatment interventions. Although medication seems effective in managing behavior problems, considerable improvements might be achieved also through properly implemented alternative interventions. Currently, parents, teachers, and doctors make decisions about drug therapy—being the same ones who appear to receive the greatest benefit from it. In the future, these decision-makers should consider selecting therapies less on the needs of adults and more on the long-term needs and benefits of children.”
Given the risk for adverse outcomes, effective treatment of ADHD is both an art and a science. The efficacy of the various interventions that have been available focus on three general approaches:
- Drug (pharmacological) therapy;
- Behavioral/psycho-social; or
- A combination of the aforementioned approaches.
Doggett, A. Mark. “ADHD and drug therapy: is it still a valid treatment” J. Child Health Care (2004):8(1):69-81, esp. 76-77 (Sage Pub.) pdf
Sterman, M.B. ‘EEG Markers for Attention Deficit Disorder: Pharmacological and Neurofeedback Applications’, Child Study.2000; J.30(1):1–24
Natural Remedies or Treating ADHD Without (sans) Drugs
Free fatty acids diet supplementation has shown positive effects in analysis of blinded assessments, after controlling for differences in medication use.
Medication can help alleviate or lesson the symptoms of attention-deficit/hyperactivity disorder (ADHD) among children having this diagnosis however, longitudinal outcomes in marital, employment, and legal areas of interest are still quite discouraging, even among individuals without histories of conduct disorder (JW Psychiatry Nov 5 2012).
Study: industry-supported analysis of randomized, controlled trials
Subjects: 3–18 year old children who carried an ADHD diagnoses.
Findings: free fatty acid supplementation is found to be helpful, but food elimination, cognitive/behavioral therapy and neurofeedback were not beneficial.
Sonuga-Barke EJS et al. Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 2013 Jan 30; [As reported by Geller B. in Journal Watch Psychiatry Feb. 15, 2013]
See also, "Honor Code" by David Brooks where he says:
"The basic problem is that schools praise diversity but have become culturally homogeneous. The education world has become a distinct subculture, with a distinct ethos and attracting a distinct sort of employee. Students who don’t fit the ethos get left out."
NY Times, pub. July 5, 2012