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I recently came across an article that nicely summed up things parents should consider when deciding on ADHD medication treatment: linked here.

The article listed five things to parents should consider when making the decision, the first being a thorough medical evaluation by a trusted expert in the field of ADHD. For a description of what is involved in a thorough ADHD assessment access Diagnosing ADHD on the CADDAC Website. For further reading, access Assessment and Diagnosis for Children and Adolescents.

Once you are assured that your child has ADHD, your next step would be to ask yourself what is your desired outcome. How will it benefit your child? I would add that your expectations of medication treatment should be realistic. The symptoms that you would like to target should actually be something that medication will assist.

You will then need to consider all side effects; not just those of medication treatment, but also symptoms of untreated ADHD.  Also consider that the decision to try medication as a treatment is not a permanent decision. Most ADHD medication may be started and stopped quickly or used only when required.

Finally, remember that this is not a decision that must be made quickly or under pressure. Other treatments, such as school accommodations and parenting strategies, should be tried initially. Medication treatment can always be added at a later date if necessary.

On the other hand, it may become evident very quickly that many things have been tried unsuccessfully in the past and the child is in significant distress. In this case, a medication trial may be initiated immediately.  Also you should be aware that it may actually take some time to find the right medication and the right dose.

Medical professionals make a treatment decision by assessing benefit /risk ratio and so should you. What are the potential benefits to your child and what are the potential risks? While assessing these, make sure that you are relying on proper medical research that has been peer-reviewed and duplicated on a large scale, not anecdotal stories on the Internet.

Although we have not received any significant feedback from parents or patients reporting distress regarding this shortage it is something that we CADDAC has been made aware of. Should you have any concerns please contact us and we would be happy to speak with you about this. For information on what to do if you are caught short please access http://addadhdblog.com/methylphenidate-shortage-in-canada/?inf_contact_key=f6f12e39fac0ce24a27dc692404b39f579083aeb0d6v

 

Sincerely,

CADDAC

 

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

 

For those leery of using ADHD medication, Erlanger Turner, Ph.D., provides some facts as to what types of medications are used and when, how they work, possible side-effects and the role of a parent in managing a child’s condition.

 

http://www.psychologytoday.com/blog/the-race-good-health/201301/adhd-treatment-in-children-addressing-medication-concerns

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