Meds or not for ADHD
Medications or no medicine for ADHD? From the series “I want you know what I know.” Brain chemistry vs. the mind using ADHD as an example.
Why do you want us to know some of what you know about this?
By knowing what I know about the biology of these problems and the interventions available at least you would have the choice of doing nothing, or trying something, perhaps the mental training approach with or without a medication trial, at least as it applies to ADHD.
Should medication always be used in biologically based disorders like ADHD?
Though the emphasis on this series is on biologically based highly medication responsive mental health disorders this is not to underestimate or deny the role that non biologically based interventions may have on these disorders. In fact it is a false dichotomy to even talk about biological vs. non biological, or nature vs. nurture, the role of brain chemistry vs. the direct experience of the mind as make stronger with mindfulness. Both are always involved and operating and one effects the other, there is no either or, both are present at all times.
The emphasis is about using the proper intervention depending on severity of the problem at the right time at the right dosage, whether a medication or a psychosocial intervention such as psycho-education, counseling, psychotherapy, or using meditation techniques of mindfulness.
How do you know what do use, and how do you choose?
One can conceptualize three levels of intervention based on the amount of distress and impairment the signs or symptoms may cause. The level of little or no problem, of being perhaps just considered a personality feature or trait, next would be causing mild problems, thus being or having actual symptoms or signs, and lastly the most serious, representing a disorder because of significant impairment and distress.
Let use problem associated with ADHD to illustrate this issue and what interventions might be considered. I start here because of the strong genetic hereditary biological and medication responsive nature of this disorder.
Level 1. At the base of mental health functioning is the ability to attend and concentrate, some people pay attention better than others, some have a traits of being mildly distractible, impulsive and active, the three cardinal features of ADHD, leading to little or no problems. Level 2. Others may in fact may in fact have actual signs and symptoms of ADHD, Attention Deficit Hyperactivity Disorder, being mildly hyperactive, impulsive, and distractible, yet don’t qualify as having a disorder because it doesn’t cause sufficient problems by causing distress and impairment. Level 3. Here the problems cause significant distress and impairment and the actual diagnosis of ADHD would be made.
How do you apply this to actual treatment?
The biological basis of ADHD may be present in these three levels but based on problems caused no or different kinds of intervention may be chosen. Level 3. If the biology causes severe distress and impairment at work, school, home , in relationships, in the community then medication management may be treatment of first choice. Level 1. If the is little to no problem then education, environmental accommadations, counseling and “mental training” using interventions such as mindfulness meditation may be sufficient to help and prevent worsening. Level 2. Here the interventions might be medication but only temporarily so the non biological interventions would have a chance to work even better.
Can you give an example?
It is never an either/or type of choice, the treatment needs to be tailored to the individuals needs, and considering the flexibility and changeability of the environment , brain chemistry, and the minds response to these different approaches may be needed at different times. Take Level 2, the person is having mild problems at work or school, struggling to do average, because of deficits in concentration due to ADHD, say the grades are mostly C’s and B’s. One would not know unless one first knew this was a biological based problem, how much better they could do if they had a medication trial combined with the “mental training” of meditation, the “medication-meditation” combo for a while, and then depending on the response, say grades got to A’s and B’s, and to go off the medication, and continue to use only the meditation keep concentration sharp and even improve it with practice.
Can grades really improve that much?
Yes, this is not unsual at all to see grades and actual IQ on formal testing go up after proper treatment with this disorder. The average good student can become an excellent student, and make the differnce when you think about college years, of struggling to get a bachelors degree, to being able to focus and organize to the extent that the same person could get a doctorate degree, the difference say between being a high school teacher vs. a college professor. I have seen this happen, thus illustrating the importance of knowing how these disorders, like ADHD can be helped with or without medications.
Do enviromental or life style factors play a part in ADHD?
We live in a culture of "mass distraction" and for all of us mass media causes a drain on concentration and mental health in general.
Sometimes just by eliminating toxic drains of concentration such as excessive TV, video games and using meditation would be enough, especially for more mild cases, but first you have to know what if anything is the problem. For more on this: VideoGamesElectronicMedia