The University of Florida just published a news release about medication management for children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Particularly, the study focused on how early medication interventions impact chosen medications as the child ages. This has been a hot debate topic within the medical and mental health communities for several years, with a number of professionals concerned that children are being overly medicated for ADHD.
Basically, their findings show that children prescribed medication between the ages of 3-9 are at greater risk of being prescribed multiple psychotropic medications, antipsychotics or seizure medications (despite no scientific evidence that seizure or antipsychotic medications are effective strategies for ADHD) within the following 5-year timeframe. With a sample size of 16,500 children used for the study, these results appear pretty darn strong…and that’s alarming news.
What’s unclear from this research is the why behind these findings; what is causing these probabilities?
My interpretation of this would be that the diagnosis is wrong, the medication is wrong or research needs to be done to explore the efficacy of these intensive medication treatment strategies.
You can read the news release yourself here.
What alarms me most about this research is that 3 year old children are being treated with medication and diagnosed with ADHD. Considered a neurodevelopmental disorder, brain functioning plays an integral role in ADHD; particularly executive functioning or the decision-making ability of our brain. Kids this young are still developing executive functioning skills and are notorious for being highly energetic and disruptive by nature; particularly when tired. In fact, executive functioning isn’t entirely formed until around age 25!
I have seen quite a few children under the age of 6 already previously diagnosed with ADHD by a medical provider being treated with antipsychotic medications. It’s beyond my qualifications to determine whether these medications are needed, as I’m not a medical doctor, but a concern that I have had is that often there was never any therapy put into place prior to me; or that if therapy was recommended, it was not an evidence-based therapy for ADHD.
Behavior therapy and Applied Behavioral Analysis have been shown to be effective way of managing ADHD symptoms, particularly in younger children. There are also a number of factors that need to be taken into consideration before a diagnosis of ADHD is made. Some medical problems can mimic ADHD symptoms, as well as trauma symptoms, learning disorders and a number of environmental factors. Parent-training and school-based programs can not only provide supportive and behavioral interventions to manage symptoms but also rule out these other conditions prior to attempting medication. It’s my strong belief that medication should always be the treatment of last resort for children.
According to a 2011 American Academy of Pediatrics (AAP) subcommittee article, found here, behavior therapy should be prescribed for children 4-5 prior to any medication trials. Children under 3 years of age are not even recognized in this article. For older children, the recommendations are that behavior therapy be considered prior to medication use, at the family’s preference.
Well shoot, basically this is saying families have a choice of:
- A 30 second intervention in the morning of taking a pill or
- Therapy – which requires a willingness to not only participate in weekly hour-long sessions but to follow through daily between sessions.
The AAP is not anti-therapy, and they do advocate for its use; realistically, there are many reasons that family’s may not try therapy approaches first. The AAP article does discuss that behavioral therapy have been found to be effective, and that behavior therapy is effective when used in combination with medication. In my opinion, behavioral therapy and medication use should be treated as a magnetic relationship. However, not all physicians are knowledgeable about mental health treatment as it is not their area of expertise and I would be curious how they explain behavioral therapy and potential interventions in a way that would promote its use on the frontline of treatment.
I’m not against the prescribing of medication for ADHD, or any disorder, they are another tool to put into our toolboxes to assist us; many people benefit a tremendous deal from ADHD medications. But medication is a tool, not a cure. The use of medication without any additional therapy or alternative treatments does not help the child (or parent) gain new skills. Reliance is built on the medication and effective strategies are not learned for when medication may need to be stopped for funding issues, missed doctor appointments, medication changes; or even for in the afternoons when stimulant medications often wear off.
What are your thoughts on this research? Please share your viewpoint in the comments below!
Update: After reading through the comments, I decided to do a bit of research into vitamin deficiencies and ADHD symptoms. You can read about that here. My findings have sparked me into creating a posting series on vitamin deficiencies and mental health symptoms.