A Balanced View of the ADHD Medication Controversy

An interesting article called "The Smart Pill Oversell" was just published in the latest issue of the online publication Nature International Weekly Journal of Science. Unlike much of what has come out in lately in the media, this article is more balanced; offering a variety of opinions and some interesting points of discussion.

The majority of current studies indicate that medication treatment alone does not improve long term academic performance. ADHD and how it impacts learning is very complex, so why would we expect that medication alone would solve these complex impairments, especially those of executive functioning? This is why multimodal treatment for ADHD: including learning strategies, behaviour strategies, therapy, coaching, and so forth is recommended.

Unfortunately, many forms of treatment are often difficult to access due to the lack of availability, cost, and the continuous demand by schools that students with ADHD prove their learning is actually impaired. This requirement still exists in in many school boards and some universities; although current testing does not accurately assess executive functioning impairment in those with ADHD. At the same time, medication has proven beneficial for many children, and parents should not be made to feel guilty for or fearful of choosing to add this treatment to a child’s regime. They should, however, be fully informed, as some researchers in the article point out, medication is not magic, and will not automatically make their child academically successful.

Recently, many of the researchers involved in the original MTA study and the follow-up of the study are evaluating why long term gains for those in the study were not what they originally expected.  This article presents a variety of different viewpoints, including the fact that after three years, these children went back to accessing community treatment, which was most often of a lower quality of care than they received in the study. Peter Jensen’s statement that only one in four children in the U.S. is getting adequate treatment for ADHD is very concerning, because I would assume it is no different here in Canada. Further research is really the only option that would provide  us with a definitive answer. Unfortunately, these long term studies are very expensive; and often unethical because they necessitate  a control group of children that you inadequately treated for a long period of time.

The article also points out that, while we know that medications for ADHD are misused by those without ADHD as study aids or cognitive enhancers, there is no evidence that these medications actually enhance cognition. Interestingly though, a paper that is cited here states that students who do not have ADHD, report  feeling a boost motivation after taking the medication and perhaps that is why they feel their learning has been enhanced.  This theory is yet unproven. We should be improving our efforts to educate young adult students that ADHD mediations do not really make them smarter or improve their academic abilities.

In closing, I would recommend this article for anyone interested in the current discussions on ADHD medication.

Heidi Bernhardt