ADHD: Pharmacological vs Non-Pharmacological Treatment
Attention deficit/hyperactivity disorder (ADHD) refers to childhood-onset neurodevelopmental condition typified by developmentally unsuitable levels of impulsivity, inattention, or/and hyperactivity, together with significant and pervasive functional impairment (Miller & Thompson, 2013). ADHD is among the most extensively treated disorders in the adolescent and child psychiatry field, with about 5-10% of adolescents and children diagnosed with ADHD globally.
According to the research about 6.4 million children aged between 4 and 18 years have been diagnosed with ADHD in the United States. The data also demonstrates that boys are three times more affected by ADHD than girls (Ahmann, Saviet & Tuttle, 2017). ADHD is a mental condition that interferes with child’s intellectual ability, resulting to low academic achievements. A child suffering from ADHD records lower grade point average (GPA), low rates of college and high school graduation. This generally ends up affecting their entire life (Kellow, Holm & Fallesen, 2018).
Based on these statistics, it is considerably important for parents with children suffering from this condition to identify the best treatment methods to handle the condition, to improve quality of life of their children. The two main methods of treating ADHD include the use of pharmaceutical and the use of non-pharmaceutical techniques which include therapy. This paper proposes that non- pharmaceutical ADHD treatment methods are more effective than pharmaceutical treatment techniques.
Untreated behavioral issues might significantly impair the educational achievement and learning ability of children. Past researches have established that on average children with ADHD attain 2.2. to 2.5 years less schooling compared to non-ADHD age mates. In addition, about 25% of teenagers with ADHD do not complete their high school education. Both attention deficits and externalizing behaviors have been found to contribute to lower academic achievement (Kellow, Holm & Fallesen, 2018).
Children suffering from ADHD also demonstrate higher academic impairment, lower test scores, and lower cognitive attainments. The research consistently demonstrates that ADHD impacts different education results ranging from school behavior to achievement and performance measures (Hinshaw & Scheffler, 2014). ADHD is thus, a condition that requires early diagnosis and intervention plan to prevent sever damages on the life of the affected people.
ADHD can be treated by use of non-pharmacological intervention method, pharmacological intervention method or a combination of the two, a method that is commonly regarded as pharmacotherapy. Different people different prefer different methods of ADHD treatment based on their beliefs or past experience. Pharmacological treatments are preferred since they act faster.
Psychosocial treatments are preferred due to creation of permanent changes and lack of side effects. Other may consider using a combination of both for more improved outcomes. According to Tamm et al. (2017), both behavioral and pharmacological intervention measures are effective in improving the symptoms of ADHD and ADHD-associated impairments but at a different rate and different rate of side effect. However, their combination may result to more improved outcome than when used independently.
Pharmacological intervention techniques involve the use of prescribed medication to treat or suppress the symptoms of ADHD. Different kind of medication can be used based on severity of individual condition, or based on body medical interaction of a person with commonly used medication. Pharmacological measures can also be used to suppress symptoms so as to give room for non-pharmacological measures. However, they are mostly recommended in a severe condition of ADHD.
According to Bown, Samuel and Patel (2018), the use of pharmacological measures to treat ADHD has been established to be positively related to enhancement of academic attainment in children in elementary stage, enhanced health-associated life quality in adolescents and children, and brain dysfunction improvement.
Some of the medications used in ADHD treatments include stimulants and non-stimulants. Stimulants refer to medications whose action mechanism is to enhance prefrontal cortex arousal. Medications such as amphetamine and methylphenidate act to boost neurotransmission dopamine and norepinephrine in the prefrontal cortex (Bown, Samuel & Patel, 2018).
Their general mechanism matches the general mechanism of illegal stimulants drugs. They can thus result to similar side effects as illegal stimulants which include elevation of systemic blood pressure and heart rate. Moreover, just like other stimulants, the medications have the addiction aspect, such that they can easily be abused by adolescence using them for ADHD treatment (Breggin, 2002). Although the heart rate and blood pressure arousal may be manageable in normal prescription, the condition may worsen in a situation where these medications are abused.
Stimulants act as the basic pharmacological intervention for ADHD patients. Although they are associated with high level of symptomatic improvement, many caregivers do not prefer them, mostly due to stimulants addiction and abuse possibility of the ADHD pharmacological first-line agents and need for constant monitoring of the adolescent users to prevent cases of addiction. The use of pharmacological treatment may simply result to introduction of a new comorbid condition of drug addiction, if effective monitoring is not done.
ADHD pharmacological treatment can also be done by used of non-stimulants medications that include atomoxetine. Atomoxetine refers to a discriminating inhibitor of norepinephrine reuptake that results to increased dopamine and norepinephrine concentrations, in prefrontal cortex (Bown, Samuel & Patel, 2018). This medication lack addiction ability, though its initial response to the ADHD symptoms might be slower compared to stimulants medications, and hence it may be ineffective where quick response is required. Another challenge is that some of non-stimulants such as atomoxetine may cause other serious side effects such as behavioral and mood changes increasing potential for self-harm or suicide.
In general, pharmacological therapy is characterized by a number of side effects some that may be highly severe. They always create a need to manage other behavioral condition of the patient, other than the initial ADHD. In addition to this, they are likely to cause medical adversaries to some patients, where the patient develops allergic reaction towards ascertain medication, either after a short or length use. Patients may also develop resistance to a certain medication, and create the need to use strong stimulants to manage ADHD symptoms. This analysis portrays the negative outcome of pharmacological treatment, ruling it out as the best method to address ADHD condition in children and adolescents.
Non-pharmacological intervention techniques include behavioral therapy among other psychosocial therapeutic methods. Behavior therapy refers to wide set of unique interventions which contain a common objective of modifying social and physical environment to change or alter behavior. Behavior therapy assists children to learn to control their own behaviors much better. This ability to control behavior results to enhance functioning in relationships, at home and at school.
Practicing and learning new behavior needs effort and time. However, it has lasting advantages to the child with ADHD. According to Ahmann, Saviet and Tuttle (2017), there are different evidence based behavior therapies targeting children at different age. For instance, four evidence-based intervention programs have been identified for preschool children, some targeting teenagers and some targeting parents of children with ADHD. The research has also proposed advantages of multimodal interventions that depend on conditioning and skills building, development of planning skills and academic organization, intensive summer-camp treatment, and social skills training.
Psychosocial treatments include skills training, cognitive behavioral, and behavioral techniques. Psychosocial treatments are also related to more improvement in organizational and academic skills that include use of planner and homework completion. The main challenge of these approaches is that they show small to medium range improvements for ADHD symptoms or interpersonal functioning and behavioral symptoms.
Unlike the use of stimulants where ADHD symptoms are surpassed easily, one may need to invest in a lot in practicing before the child adapts to a new behavior and learns how to effectively apply it. Most psychologists have adapted to coaching as a way of enhancing behavioral changes in children with ADHD. Coaching can be provided to an individual, a group, physically or using videos.
The type of coaching may vary effectively based on the main objective of these sessions, which is mostly influenced by the child’s age and the severity of the condition. Although the psychosocial intervention means are considerably hard and tedious, the final results bring permanent change to the child with ADHD. They thus play an essential role in improving quality of life of a child with ADHD. Unlike pharmacological treatment, psychosocial therapy does not have any side effects.
Another non-pharmacological method of addressing ADHD is the use of diet. According to Rytter et al. (2015), dietary change methods that can be used to treat ADHD include elimination diets that remove some elements from the diet, or additional diet where intake of some nutrients is added to control ADHD symptoms. Elimination diet is founded on the notion that some children might some children might experience behavioral changes when subjected to some food items, especially artificial additive foods. Food such as artificial sweeteners and sugar are said to make some children hyperactive. Increase intake in a diet is based on the notion that a child behavior could be influenced by lack of some nutrients.
This intervention measure focuses more on amino acids since it is used in the synthesis of norepinephrine, monoaminergic neurotransmitters, serotonin, and dopamine that are engaged in the ADHD symptoms. Therefore, amino acids supplements may assist children with ADHD. Other additives would include essential fatty acids, vitamins, especially vitamin B compounds, and minerals such as magnesium, iron and zinc (Rytter et al., 2015). Diet management can thus result to effective management of ADHD symptoms. The main advantage of diet intervention measure is that it is cheap and does not demonstrate any side effects. In addition, dietary intervention seems to act faster than the behavior therapy, and hence it can be used to supplement medications, without major side effects.
Based on the above analysis, there are different techniques to treat ADHD and thus, different psychiatrists may prefer different measures of treating ADHD. The analysis clearly shows negative impact of pharmacological treatment. Although it acts much faster in suppressing the symptoms, it present negatives side effects that are hard to handle. This makes non-pharmacological treatment more reliable in making permanent changes without worrying about side effects.
Actually, a combination of different non-pharmacological treatment for instance dietary treatment and behavior therapy are likely to result to more improved results than applying pharmacological treatment alone. An integration of the pharmacological and non-pharmacological interventions may also results to more reliable outcome. However, this approach may also subject patients to serious pharmacological side effect. This proves that non-pharmacological ADHD interventions are more safe and reliable in treating ADHD compared to pharmacological ADHD treatment methods.
Ahmann, E., Saviet, M., & Tuttle, L. J. (2017). Interventions for ADHD in children and teens: A focus on ADHD coaching. Pediatric Nursing, 43(3), 121-131.
Breggin, P. R. (2002). The Ritalin fact book: What your doctor won’t tell you about ADHD and stimulant drugs. Cambridge, MA: Perseus.
Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Transl Pediatr, 7(1), 36-47.
Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: myths, medication, money, and today’s push for performance. Oxford: Oxford University Press
Keilow, M., Holm, A., & Fallesen, P. (2018).Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PLoS ONE, 13(11), 1-18.
Miller, N. J., & Thompson, R. (2013). ADHD: cognitive symptoms, genetics and treatment outcomes. New York, NY: Nova Science Pub Inc.
Rytter, M. J. H., Andersen, L. B. B., Houmann, T., BIlenberg, N., Hvolby, A., Molgaard, C., Michaelsen, K. F., & Lauritzen, L. (2015). Diet in the treatment of ADHD in children – a systematic review of the literature. Nord J Psychiatry, 69, 1-18.
Tamm, L., Epstein, J. N., Taylor, H., Bukstein, O., Koshy, A., Maltinsky, J.………… & Vaughn, A. (2017). Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial. American Psychological Association, 85(5), 434-446.