Understanding Attention Deficit Disorder as a Long-term Challenge

Regular readers will know that I am a huge advocate of natural and non-invasive methods of treatment whenever possible. But sometimes we reach an impasse, and the only option is to use pharmacological or other types of conventional intervention. But even then, it is a mistake to assume that physical treatment alone will be sufficient to help the individual and their family: it is only sensible also to address the psychological, social, subtle and spiritual dimensions of the person. And we must never lose sight of the positives: some people who have health challenges are transformed for the better, and some “illnesses” may carry gifts with them. I’ve talked about the creativity of people with bipolar disorder and schizotypy and the empathy and innovation that may accompany attention deficit disorder.

There is often a fine balance between the positives and negatives of an illness and the types of help that may be of greatest value.

I have just been involved in a common discussion at this time of year: a young person has quite bad attention deficit disorder (ADD). Since she started pharmacological treatment not only has she risen from being a failing student to getting all As and Bs, but the quality of her life has improved dramatically. Unfortunately, she has been told that she only needs to take her treatment when she feels that it is necessary to complete her schoolwork. Many healthcare providers continue to believe that ADD and ADHD are just academic problems. There is a very good new review article that discusses this misperception in some detail. Prescription patterns show that the majority of school-age children are only being treated from Monday to Friday, and from 7AM to 3PM. Why does this matter?

There is excellent and extensive research about the consequences of non-treatment, and most of it has nothing at all to do with school. If people with ADD and particularly with ADHD are left untreated, they are more likely to:
1. Develop substance abuse
2. Be involved in a serious accident
3. Engage in illegal activities
4. Contract a sexually transmitted disease
5. Have an unplanned pregnancy
6. Become separated or divorced

The article makes a point that we have often discussed with families: these consequences of non-treatment are events that primarily occur outside the school environment. So withholding medicine just when it is needed the most may be a risky business.

We are now seeing increasing evidence that successful pharmacological treatment reduces these consequences of untreated ADD/ADHD to the rates found in the general population. Simply using appropriate medications can protect people from adverse consequences of these problems both now and in the future.

I think that we should look at ADD in the same way that we look at an illness like diabetes. In diabetes, the high blood glucose and elevated lipids are not themselves the problem. They may cause symptoms, but the real danger lies in the long-term physical consequences of high glucose and lipids. It is these that can be so devastating to the person with the illness, causing the so-called complications of diabetes, such as retinopathy, kidney and heart disease.

Similarly ADD/ADHD may cause symptoms – such as problems in school – but it is the long-term consequences that can cause such problems. Children and adolescents, and for that matter some adults with both illnesses don’t realize that these are the main reasons for treatment.

There is a common myth that adults know that they need to take their medication, and so they do. Hands up anyone who has only taken half of a course of antibiotics!!

There is very striking study of adults with ADHD who were asked to do a simulated driving test while on and off their medicines. The people in the study rated their driving performance just the same whether they were on or off their medicines. Despite the fact that when they were off their treatment they were an astounding five “standard deviations” worse in terms of driving safety and responsibility! For people not used to looking at statistics this may not seem like much, but the difference is astonishing. You would not want to share the road with an untreated person with ADD.

We know that within the first three months of treatment 50% of children and adults will have stopped their ADD/ADHD treatment and most studies agree that by 18 months, the figure is around 80%.

We need to get the message out that:

1. ADD and ADHD can create some nasty long-term problems if not adequately treated.
2. For a host of reasons, most people will stop their treatment, so plan for it, and don’t just wait for it to happen.
3. Adequate treatment consists of a lot more than giving medication and hoping for the best.
4. People need psychoeducation.
5. They need to learn coping strategies.
6. The family needs to know how to help and how to deal with the problems that someone with ADD/ADHD may be causing them.
7. And people need to know how and when to use medications and how to integrate them with non-pharmacological strategies.

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