Slide above: Adapted from Exploring the Neurocircuitry of the Brain and Its Impact on Treatment Selections in ADHD, PRAKASH S. MASAND, MD; PETER S. JENSEN, MD; STEPHEN STAHL, MD, PHD
There’s been a certain amount of press and attention on the intense marketing of medications for people with ADHD, and the perceived over-medication. Representing the this type of attention is an article in the NY Times a couple of months back, The Selling of Attention Deficit Disorder
On a personal level, I’m happy when people get sensitized to how easily manipulated into quickly reaching for a pill we can get. However, from a professional perspective, I’m nervous when we do a backflip into equally dangerous territory. The statistics bear out that the consequences of untreated ADHD are far more serious than the perceived over medication.
From observational data, interviews and surveys, and two really good long-term studies from UMASS and University of Wisconsin Medical College (The Milwaukee Study) we’ve found that:
Adults with ADHD are three times more likely (21 percent compared to 6 percent) to sell drugs illegally, have significantly more money management trouble, three times as likely when compared with the community control group to initiate physical fights (30 percent compared to 9 percent), destroy others property (31 percent compared to 8 percent) and break and enter (20 percent compared to 7 percent). They get into more and more severe car accidents, and exhibit road rage at higher rates than others. These statistics pertain generally to people with untreated ADHD.
The consequences to families and society when this very real condition is untreated are enormous.
This isn’t to say that people with ADHD can’t lead fantastic lives, or that all are troubled, not in the least, but you can’t wish the syndrome away and often, not always, medication is an extremely helpful agent. This is also not to say that there aren’t other treatment options, which when used appropriately can’t also help. ADHD coaching models, cognitive training programs (notably Cogmed) certain Mindfulness-based meditation practices (the military call it “situational awareness” not mindfulness) and ADHD-informed counseling, can be effective adjunctive or stand-alone therapies.
As it turns out, ADHD is actually under-diagnosed because self-reporting and self-referral are the primary ways that adults in particular find their way into treatment, and until the age of 30 or so, people with ADHD tend to over inflate their perceptions of their own performance. In other words they don’t always recognize the degree to which their distractibility, impulsiveness, or executive function deficits are impacting their lives as well as the lives of those with whom they live and work.
The only group for whom this is not true are college-age students. With this demographic, 1 in 4 are found to be “malingering” (essentially meaning, not being honest) when seeking medication or accommodations for coursework. This is a very real concern for my colleagues in the mental health field, as it should be.
So, while I agree that as a nation we seem too easily drawn to quick fixes, we also have to treat a very real condition with serious and life-changing consequences in a comprehensive and holistic way.