How to Treat ADHD Effectively? Pills, Skills & Love

by | Feb 8, 2012 | ADHD

Joseph, a five year old boy diagnosed with ADHD, was making good progress in yoga class at school. He was coming to friendship group once a week, and his mom and dad were working with me [Lynea] on parenting skills.

For Joseph, change came slowly but consistently. He had learned how to catch himself when excited and ask for help. His breathing practice was more rhythmic and controlled. His parents were learning how to help him regulate his emotions.

Then he was put on medication for ADHD. The results were quick and impressive. He was instantly calmer and more capable of focusing in class. Parenting and teaching him were both a lot easier. But it also seemed like he’d lost some of his fire and passion.

Soon after, Joseph stopped attending yoga and friendship group. His mom and dad stopped coming for parenting classes.

Deciding whether to medicate a child is a big decision. It can give a child the chance to experience life with less anxiety and social conflict. Sometimes, medication is absolutely necessary. But often, there’s an unfortunate side effect: parents drop the skills-training and other support they were providing their child. And their child gets the message loud and clear: When you’re struggling, use medicine. No need to keep practicing your friendship skills or learning tools for attention and how to self-regulate. Put all your faith in the pills.

Yet, as L. Alan Sroufe, professor emeritus of psychology at the University of Minnesota’s Institute of Child Development, noted in a recent op-ed in the New York Times, ADHD drugs offer a short-term solution at best.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

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To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve.

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

Indeed, all of the treatment successes faded over time, although the study is continuing. Clearly, these children need a broader base of support than was offered in this medication study, support that begins earlier and lasts longer.

The skills and strategies we teach in Yoga Calm, of course, aim to provide just this kind of support. Over time, the desired effect of drugs like Ritalin, Adderall and Strattera fade, while undesired effects – i.e., side effects – remain. But when we provide opportunities for kids to develop self-awareness, focus and social skills; when we safely address underlying issues of stress and trauma; when we instill and support healthy habits, we provide them with a body of skills, knowledge and experience they can draw on for the rest of their lives.

And we see this especially with children who have weaknesses in attention and impulse control – like Joseph.

Concurring with this need for a broader treatment approach, ADHD specialist Dr. Edward Hallowell, writes in Ritalin Redux, his response to Sroufe’s article, that what’s most important is

a loving, safe, and richly connected childhood. The long-term study that Dr. Sroufe cited in his opinion piece does indeed show that over time, medication becomes a less important force in a child’s improvement and that human connections become ever more powerful. It is good and heartening to know that human connection — love — works wonders over time. Love is our most powerful and under-prescribed “ medication.” It’s free and infinite in supply, and doctors most definitely ought to prescribe it more!

This doesn’t mean that, as Dr. Sroufe say[s], Ritalin has “gone wrong.” We may go wrong in how we use it, when we over-prescribe it, or when we use it as a substitute for love, guidance, and the human connection.

Indeed, continuing on the current path of biasing treatment approaches toward pills while ignoring proven and complementary behavioral interventions carries some serious risks, says Sroufe:

First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.

Second, the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.

Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers and parents — off the hook. Everyone except the children, that is.

Consider Joseph, 10 years after first being given medication. He’s now 15. His relationship with his parents is tense. He wants more freedom. They want him to focus on school and get a part time job. As he’s grown, doctors increased his dosage. Since his latest growth spurt, he’s noticed that he feels anxious and is having a hard time paying attention in class. After an argument with his girlfriend, a friend offers him some drugs to help him mellow out.

What have we, as a culture, taught Joseph to do?

Image by jlynn11235, via Flickr

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