By Ron Bashian, MD, Research Committee.
Using a biblical reference is an uncommon but apt way to bring up the topic of medication for ADHD because pro and anti-medication arguments are fiercely held and sharply debated.
A number of recently published titles for the general public, including A Disease Called Childhood, The ADHD Explosion, Rest Your Child’s Brain, and the provocatively titled ADHD Does Not Exist, all question our current concept and treatment of ADHD. Additionally, Big Pharma has contributed substantially to skepticism through recent examples of price hiking and logarithmically escalating sales – thereby encouraging a not totally delusional perception of profit preceding all considerations.
Yet medication remains a first line treatment for ADHD, well-supported by evidence.
The purpose of this article is to bring reader’s attention to a recent review article in the medical journal Pediatrics, titled “Pediatric Psychopharmacology for Treatment of AHDHD, Depression, and Anxiety” (Southammakosane and Schmitz, 2015). As pediatricians are on the front line of ADHD diagnosis and treatment, such a review, summarizing state-of-the-art pediatric pharmacology in the treatment of ADHD, is most welcome.
I encourage readers to procure a copy of the article, as coaches benefit from understanding the names, categories, and indications for typical ADHD medications. Although we do not prescribe, general knowledge is part of an awareness of the multifaceted management of ADHD. Moreover, it is not inappropriate to ask a client whose mood or attitude has changed, if there have been medication changes or if medication has been discontinued.
The article first emphasizes the need for a thorough evaluation, and the need to rule out medical, psychiatric, and learning issues before a diagnosis is made. Additionally, it stresses the responsibility of a pediatrician (in what is colloquially called a “medical home”) to arrange for or confirm psychological education, parent management training, and school accommodations (editor’s note: this may be an area in which coaches can partner with pediatricians to the benefit of all concerned).
The article then provides a scientific overview of medication usage, dosages, precautions, side effects, efficacy, and examples of proper medication management, plus its own lengthy bibliography of peer-reviewed literature.
This is a link to the abstract, and readers may pay for access to the full article. Alternatively, medical school libraries usually have subscriptions to Pediatrics, and librarians may be generous in making copies or downloads.
To go back to my original point regarding the medication debate, I submit that this article in Pediatrics demonstrates the large scientific body of evidence, from peer-reviewed articles in respected journals, that firmly justifies the usefulness of appropriate medication in the management of ADHD. As with any diagnosis, it is unavoidable that there will be some mis-diagnoses. As with any medication, there will be some inappropriate medication use and some medication abuse. Nonetheless, neither greed nor misuse nor individual reports take away from medication as a highly useful component of treatment.
Ron Bashian, MD, is both a pediatrician, who has worked for years with young people with ADHD, and an active ADHD coach. You can contact him at firstname.lastname@example.org or through his website at validationcoaching.com