Hesitations in Medicating for ADHD

Parents who have children diagnosed with ADHD often feel apprehensive about following through with a physician recommendation for medication in order to manage symptoms. Reasons for apprehension range from concerns about the specific side effects (e.g., disturbance in appetite) to a blanket fear that not all side effects of the medication are discoverable. Research has shown that a combination of medication and therapy provide the best outcome for symptom management of ADHD. Given this information, psychologists are often in the position of helping parents to address the ambivalence associated with the decision to provide medication to ensure that parents make sound decisions based on facts versus fears or misunderstandings. While caution about prescribing medication to young, developing bodies is warranted, it should be tempered with the following considerations:

~The biological basis for ADHD is a neurotransmitter dysfunction. Nerve cells in the brain release neurotransmitters from the end of one nerve cell into a synaptic gap or space. There, they are absorbed by the dendrites of a neighboring nerve cell. Dysfunctions related to brain-based disorders, such as ADHD, involve problems with release or absorption of neurotransmitters. Medication helps to regulate disturbances in neurotransmitter release/absorption.

~Is there a bias that all problems arising from the brain should be controlled with a “mind over matter” mentality simply because thoughts originate in the brain? In other words, would the same hesitations exist if you were faced with a recommendation for medication to treat another organ (kidney, liver) with a disturbance in function or is there a bias with the brain?

~What are the socio-emotional side effects of a decision to not medicate? Recognition of the obvious gain of not having to worry about side-effects or stigma of medication should be tempered with an awareness of what is lost by allowing the neurotransmitter dysregulation to persist. Important costs to consider are:

1. What are the effects of adult reactions to the symptoms (parental yelling, teacher frustrations) on the child?
2. How is the child’s identity compromised when s/he receives messages that s/he is failing (to be organized, to follow through, to remember)?
3. What is the effect of poor peer relations brought about by symptoms (impulsivity)?

These effects are not life threatening in the physical realm, but do challenge processes critical for development of confidence and social-connectedness. In summary, it is important to examine hesitations to medicate to ensure that the biological need for an organ to be regulated is acknowledged. Further, the psychological effects of not medicating should not be overlooked as concerns about medicating are thoroughly addressed.

Virginia DeRoma, Ph.D.
Licensed Clinical Psychologist