Evidence-Based Medical Care Cuts ADHD Symptoms but Not Impairment

One of the comments alternative practitioners often make about medicine and medical practice is that their methods, the alternative methods, aren't "cookie cutter" but are instead "individualized." With ADHD (attention deficit hyperactivity disorder) as with many disorders that may, or may not, b a good way to practice.

We actuctually have guidelines for both the diagnosis and treatment of ADHD. Certainly we could end a lot of this misclassification and misdiagnosis if doctors used well know standards and guidelines for the diagnosis of ADHD, but they often don't. Instead they make a quick adjustment based upon their individual experience and a short form or two filled out by a teacher or parent. That leads to misdiagnosis, the wrong medications, and failed treatment.

But the same can be said for interventions and treatment. While I often write about the need for individualized treatment programs what I am usually suggesting is taking a close look at how the symptoms of ADHD effect the individual and focusing treatment based upon the individual's profile. But This doesn't mean we need to, or should, invent treatment modes for everyone. As a matter of fact the main focus of my intervention is following a specific eight week program that addresses a number of different symptoms, and completing the whole program. In ADDITION to this we look at specific deficits and symptoms and address those with individualized interventions. But research has been very clear that following both assessment and treatment guidelines for any number of diseases leads to better outcomes. Highly individualized treatments, overall, show a much poorer response.

The research article noted below, which addresses evidenced-based care, addresses just this issue with ADHD. Researchers show that by adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD)we have a better chance at relieving symptoms. But, and this is important to note also, this had no effect on kids' performance in school or in their relationships with others.

The research program notes that while parents and teachers noted significant improvements in symptoms among ADHD kids in a specialized treatment program, there weren't similar outcomes for functional impairment, that is, how we function in school or in our relationships with others. So attention was improved by following treatment guidelines, but not academic or social outcome.

"This finding highlights the need for physicians to work with or refer patients to educational and mental healthcare specialists who can work with children to develop skills to address targeted areas of deficit," the researchers wrote. The researchers found that, based on teacher and parent ratings, children showed vast improvements in ADHD symptoms (P<0.001). "Improvement of ADHD symptoms occurred mainly in the first three months of treatment and remained improved and relatively stable thereafter," the researchers wrote. "These results suggest that community-based physicians can achieve gains in ADHD symptom improvement comparable with carefully controlled, university-based clinical trials.....However, there were no significant improvements in functional impairment as measured by parents and teachers." The researchers concluded that, "Effective treatment likely requires a multimodal strategy that includes a focus on teaching children [organizational and learning] skills," adding that collaboration (by medical professionals) with other mental health or educational services "appears to be warranted." Often I hear some physicians starting children on a low dose of medication, and titrating them to the highest level they can tolerate. Other physicians do the opposite, trying to find the lowest dose. (There are actually guidelines about this for each medication, and you should ask your doctor about those guidelines.) Some suggest "drug holidays," while others urge parents to resist this idea. Some put an emphasis on medications at school, while others take not these are "life medicines" and not "school medicines." Which is right? I suggest looking at what the NIMH suggests, and checking out what Dr. Russell Barkley, a leader in the treatment of ADHD suggests. Ask, "What are the professional guidelines for this type of treatment?" Finally, if the medication is making the symptoms of ADHD better, what is there so little improvement in academics and social behaviour? (As with any medication, some children and adults do much better in response to the medications than others, but in general we can expect a smaller change in terms of academics, social and behavioural interactions, and for adults, work place behaviour and outcomes.) The answer is simple: ADHD is a developmental disorder. The skills you don't seem to have you really don't have. A pill will not make you organized. Nor will a pill make you start studying better, write papers better, organize your calendar or avoid procrastination. Those are the specific developmental skills an individual with ADHD didn't learn at the appropriate developmental time, and no pill teaches these things. The medication provides your brain with the ABILITY to engage in these behaviours successfully. but you need to learn this skills, you need to have them taught, and they will be harder to learn because you are learning them at the wrong developmental moment. But, thank goodness, we have the ability to teach, monitor and improve those skills through structured positive supportive interventions. If you or your child showed some improvement on ADHD medication for three or four months and then you seemed to hit a plateau what you need is training and support in learning and mastering those developmental tasks you never learned as well as others. And this we can provide. So, in sum, we need to follow both an evidence-based medication treatment program AND and evidenced-based social/academic/workplace skills development program to successfully overcome ADHD. It's easy to get rid of the symptoms, but academic, social and workplace success doesn't come in a pill. for more on the article click on the link below: Medical News: Evidence-Based Care Cuts ADHD Symptoms, Not Impairment - in Pediatrics, ADHD/ADD from MedPage Today


The ADHD blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. My recommendations: Don't go on-line and take an ADHD "test." The diagnosis of ADHD is complex and involves not just looking for symptoms of ADHD, which is all that those “tests” do, but also involves ruling out other disorders that might look just like ADHD. Often individuals who think they have ADHD have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in ADHD from the British Columbia Psychological Association (BCPA).

In my practice I offer Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610