Parents, physicians, and the Centers for Disease Control agree that when it comes to approaching attention deficit/hyperactivity disorder (ADHD) in kids, medication should not be the first line of defense. The CDC recommends parent training in behavior management and behavioral classroom interventions as a starting point. While guidance to manage challenging behaviors is a start, all too often this falls short of addressing the whole-child impact of the disorder. The next line of defense is considered medication, however crucial areas of a child’s well-being are impacted minimally or to varying degrees with ADHD medication, learning, social interactions, growth, and self-confidence. While medication can be extremely helpful in many scenarios, some families hope to avoid the use of medication, while others find medication to fall short of addressing the problems they are experiencing.
Parenting isn’t easy and parenting a child with ADHD can add additional stress as you help your child navigate school, friends, and home life. As parents we want our kids to be happy, healthy, and excel in what they do. We hope for our kids to have a great group of friends and to thrive in school and sports, but disruptions in their attention and behavior can derail success in each of these areas of life. When this happens, it can leave both the kids and parents feeling like failures.
During these times of stress, parents start searching for ways to help their children. Phone calls to pediatricians, psychologists, and friends as well as late-night searches on the internet can provide an array of options that may feel overwhelming. This journey typically leads parents to the possibility of medication but few other alternatives. Google Trends data shows that over the past 5 years the number of searches for non-medication treatment for ADHD is on the rise (and this was prior to the current Adderall shortage). Parents are looking for help, but don’t know where to turn. Beyond medication and behavioral support, the path forward is simply not clear.
According to the journal Health Psychology Research, ADHD is one of the most thoroughly researched disorders in medicine, yet we are still left with many unanswered questions. The array of studies has focused on the causes, symptoms, and complications as well as the impact of various medications. Where the research falls short is in non-drug alternatives to addressing the vast array of complications. In fact, the CDC has labeled ADHD “a serious public health problem,” based on “the large estimated prevalence of the disorder; and the limited effectiveness of current interventions to attend to all the impairments associated with ADHD.” Simply put, more information is needed on alternative interventions.
A recent exploratory study conducted by Harvard Medical School and McLean Hospital aimed to begin to address this void in researched ADHD alternatives. The study implemented an at-home version of the Brain Balance program®, training to determine which aspects of ADHD were impacted and to what degree. The kids in the study ranged from 8 to 14 years old and were diagnosed with ADHD. The fifteen-week integrated program consisted of sensory, physical, visual, and Interactive Metronome® timing exercises. The study found a marked reduction in symptoms as reported by parents in the ADHD total score as well as in the subcategories of hyperactivity and inattention. Scientifically that equates to a large effect size, which is described as change significant enough to be meaningful in the real world. Clinician ratings validated those findings with changes noted in the same categories. What is meaningful to note is that the changes documented were similar to those improvements seen in a low-dose stimulant medication. While this study is promising, more studies of this nature are needed to provide parents with additional evidence-based options to support their child’s needs.
As a parent trying to determine the path forward that’s right for your child, start by asking yourself a few questions. First, define your goal. Are you hoping to avoid the use of medication? Or is your child currently medicated yet there are still areas of struggle? Then determine the areas of need so you can align the right support for your child.
All too often parents and professionals focus on the most disruptive symptom, yet for many kids, the impact is far broader. The Mayo Clinic provides multiple lists that cover symptoms, complications, and coexisting conditions related to ADHD. These lists are long and go beyond inattention including things such as impulsiveness, poor self-image, mood swings, unstable relationships, poor work or school performance, difficulty with time management, multitasking, and following through on and completing tasks. Current medications address some, but not all of the symptoms involved, and can introduce additional side effects and challenges. A Consumer Reports survey of parents with children taking ADHD medication showed that 41% were highly satisfied with the outcomes. While this is excellent, that leaves 59% of parents not highly satisfied, and 44% of parents strongly agreed they wished there was another way to help their child.
Top Five Areas that ADHD Medication May Not Address
Learning:Classroom concerns are a hallmark of ADHD with disruptions to the child’s learning, classmates and the learning environment itself. Kids with ADHD can struggle more with cognition which includes sustained attention, working memory, task switching, reasoning and comprehension. When it comes to medication and learning the theory has been, you can’t remember what you didn’t pay attention to, however, studies involving learning outcomes and medication have not supported this theory. While medication has been shown to minimize the amount of disruptions and movements, it does not always translate over into changed academic outcomes. A large study in Canada explored the connection between medication and outcomes and shared “We find little evidence of positive effects on academic outcomes or schooling attainment. In fact, we find deterioration in important academic outcomes including grade repetition and math scores on discernible learning outcomes between medicated and non-medicated ADHD students.” Other studies have found an increase in completed classroom seatwork but that “medication has no detectable impact on how much children with ADHD learn in the classroom.”
Social Interactions: Kids with ADHD can struggle with social immaturity, impulse control and managing their emotional outbursts, which can complicate social interactions, leaving others frustrated and annoyed. In fact, a study shared that 50-60% of kids with ADHD experience social rejection by their peers, versus 13-16% of non-ADHD students. This impact can be seen at all ages with higher divorce rates in adults, and higher rates of both bullying and being bullied which can stem from struggling to fit in and challenges reading social cues. While impulse control can be reduced with medication, it does not directly impact the ability to read and respond to non-verbal social cues, nor mature the social skills.
Handling frustrations and upsets:Children with ADHD have been shown to experience mood swings and difficulty controlling their temper and reactions to upsets. In younger children, this can result in tantrums, and in older kids, this can present with physical outbursts and rage. It’s also important to note that the upsets can be quiet and internalized with increased feelings of shame and inadequacy. Medication usage can both help and hurt mood swings and outbursts, as this is one of the top five most common side effects. This side effect can come from the medication itself or can be seen as the medication dosage wears off or is discontinued.
Self-Confidence: The combination of challenges at home, school, and with friends can leave kids feeling like they’ve let people down – parents, teachers and even themselves. Being aware of the expectations but not feeling equipped to meet those expectations can be discouraging and can leave kids with feelings of, “I can’t do this, it’s too hard, what’s wrong with me?” The use of medication has shown increased levels of confidence while taking the medication, but that feeling of capability can ebb and flow with usage.
Healthy growth and development: The most common side effects of ADHD medications reported by parents include decreased appetite, sleep problems, weight loss, irritability, and upset stomach. Changes to a child’s nutritional intake and sleep can have a direct impact on growth and development, resulting in reduced height as an adult.
So, beyond medication, how do we support the whole child? One potential answer lies in addressing the root cause. ADHD stems from the brain, and the good news is that the brain can change. Creating stronger pathways in the brain through integrating sensory stimulation, physical activities, and visual and auditory exercises combined with healthy nutrition can be a powerful tool for parents and kids who are looking to not only address ADHD symptoms but improve overall well-being.
ADHD is complex and so is its impact on the child. While the condition itself is well-researched, the gap in knowledge around methods to create meaningful change is not. It’s critical that parents have an array of researched options to choose from in supporting the overall well-being of their child. Each family’s journey is unique and personal but know that change is possible and there are many paths to get you there.