Three Expert Opinions on the Importance of Medication in the Treatment of ADHD

Introduction: A Conversation about ADHD Medication

Him: "Okay, look. You wear glasses. How well can you see without them?"

Me: "I can't. I can see colors and general shapes, but I'm functionally useless without glasses."

Him: "Right. Without your glasses, life is just a blur that you can't really focus on. You can squint a little, and it helps you focus on something a little bit, but it takes a ton of effort and isn't terribly effective. Sound familiar? Well, Adderall are my glasses, and attention is my vision.

As far as the medication goes, stopping it is equivalent to asking me to take my glasses off and walk around blind. The difference is that big. I am not going to give them up. Addiction be damned.”

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This is the difference medication can make:

It's like running into a headwind, with light in your eyes, a cramp, and going uphill. Then suddenly, you're on the flat, all those other problems have vanished, and it's beautiful but takes some getting used to.

Ari Tuchman—Psychology of ADHD Medication

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Questions I would ask a parent who chooses not to medicate their child with ADHD:

1. Has anyone educated you about the long-term safety of stimulants?

2. Are you familiar with the research data on untreated ADHD and substance abuse?

3. Are you familiar with the research data on long-term outcomes for people with ADHD who go unmedicated?

4. If you choose a "medication-free" approach, are you doing so with the information that your decision could put your child's safety and well-being at risk?

The research citations here are just some of the highly concerning outcomes that research data has shown about people with ADHD who go unmedicated.

𝗠𝗮𝗸𝗲 𝗺𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗱𝗲𝗰𝗶𝘀𝗶𝗼𝗻𝘀 𝗯𝗮𝘀𝗲𝗱 𝗼𝗻 𝗱𝗮𝘁𝗮, 𝗻𝗼𝘁 𝘆𝗼𝘂𝗿 𝗳𝗲𝗮𝗿𝘀 𝗼𝗿 𝗼𝘁𝗵𝗲𝗿𝘀' 𝗼𝗽𝗶𝗻𝗶𝗼𝗻𝘀.

Ryan Wexelblatt, the ADHD Dude  

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Four reasons adults stop their medication for ADHD:

1. Ask a patient why they stopped taking an ADHD prescription, and you'll hear: "I don't know why I was taking the medication in the first place." This is the single most significant cause of medication non-adherence.

Often, the motivation to start medication doesn't come from the patient but from another adult affected by the symptoms, like a spouse or employer.

Questions clinicians should ask the patient to get them onboard.

• What does it mean to have ADHD?

• What would it mean to ask for help?

• What does it mean to treat ADHD?

  Patients must accept that they are not wired the way neurotypical people are wired and will have to work twice as hard as neurotypical people. ADHD medication will give them a break as they try to adapt to their foreign neurotypical nervous system.

2. Suboptimal dosing is a second reason patients stop their medication

An ADHD medication may fail to control symptoms adequately or produce intolerable side effects. It takes time to find the suitable molecule and dose. Ask the patient to rate the medication from one to ten.

Is it the medication? (patient blames terrible side effects on the wrong thing.

3. Practical obstacles can reduce medication compliance.

There is the difficulty finding a knowledgeable, willing physician. Patients as well can be an obstacle because of their ADHD. Medication management – from taking medications as directed to getting refills every month – touches on this very challenge. Encourage patients to ask others, like family and friends, for help overcoming these obstacles to consistent medication use.

4. Unsupportive clinician attitudes

Clinicians who discourage consistent medication use – and many do so unconsciously – do a tremendous disservice to their patients. A good treatment regimen must meet a patient's needs throughout mornings, evenings, weekends, and vacations. This is, unfortunately, not the case for many patients.

Though many patients take medication as directed, they report insufficient effect duration and thus continue to experience challenges and impairments when the medication wears off.

A supportive clincian should provide written post-appointment notes and medication instructions (Do not rely on a patient's memory).

• Do pill counts to assess adherence.

• Encourage patients to use tools like pillbox timers and medication tracker apps to promote adherence.

• Commit to ongoing patient psychoeducation. (Share resources on ADHD support groups and websites.)

Dr. William Dodson, from a webinar with ADDitude magazine