Why the Stigma and Misinformation Around ADHD & Stimulant Medications Needs to Stop

 

“ADHD is a made up disorder.”

“Only lazy parents would drug their child into submission.”

“Stimulant medication turns kids into zombies.”

“You give your child speed? You’re just creating a future drug addict!”

“Pharmaceutical companies & psychiatrists are just colluding for financial gain.”

Sadly there’s an enormous amount of unfounded judgement, criticism and misinformation in the community around ADHD and stimulant medication, which adds to the stigma kids with ADHD and their parents experience. 

Unfortunately this stigma (or mark of disgrace) can have severe, if not dire consequences, on the outcomes of kids with ADHD.

For example, fear mongering, as well as the judgement and unsolicited advice parents can find themselves subjected to, can:

• Influence whether a parent decides to have their child assessed for ADHD or not
• Lead to parents underestimating the risks involved with having poorly treated ADHD
• Muddy the truth around best practice evidence-based ADHD treatment options
• Interfere with parents being able to make informed and educated decisions around how to best support their child with ADHD
• Affect treatment adherence and treatment efficiency

I find this extremely concerning, because unfortunately, I know first-hand the impact living with undiagnosed and untreated ADHD can have on your self-esteem and self-worth, as well as your quality of life. And I would not wish the pain and suffering it caused me, on anyone.

The problem is – how do we stop it? 

I wish there was an easy answer, for despite the dedicated efforts of some truly amazing individuals the stigma just won’t go away.

So in the hope of contributing to the conversation, I made the decision to join in the conversation by sharing my story of growing up with undiagnosed and untreated ADHD, along with what the current research trends say in regard to the risks associated with poorly treated ADHD and stimulant medication. Even if it leads to only one person stopping and reconsidering their opinion or being more mindful of the influence their words may have, my effort will have been worth it.

So lets start with my own personal experience. This video is of a presentation I gave at the WA Mental Health Association Recovery Stories Showcase in May 2018. After watching it I am sure you will understand why I wish was diagnosed with ADHD as a child and given the opportunity to take stimulant medication, in conjunction with receiving other evidenced based treatment options.

 

 

As for the risks associated with poor treatment outcomes, the research clearly shows that whilst children with mild ADHD symptoms may respond well to behaviour interventions, such as parenting from an ADHD perspective and class room strategies alone, children with moderate to severe ADHD symptoms tend to experience little improvement when these interventions are implemented in isolation. 

Sadly, without effective treatment a child’s ADHD symptoms can negatively influence their ability to meet expectations, achieve their goals, maintain relationships and negotiate life.

For example, poorly managed ADHD symptoms can negatively affect a child’s academic achievement as they impact directly on a child’s ability to:

• Sustain focus and concentration (especially if a task is boring or tedious)
• Absorb, process and recall information
• Prioritise, plan and problem solve
• Work out what piece of information they should pay attention to (as they struggle to filter the information they receive from their internal world and from the world around them for relevance)
• Stay on track and complete tasks to fruition, as well as transition away or disengage from tasks they are absorbed in
• Pause and inhibit their words and actions (which can contribute to impulsive decision making, careless errors, accidents and injuries, and social violations such as interrupting others or blurting out answers in class)
• Inhibit and regulate/modulate their emotions
• Deal with delay aversion due to their inability to cope with discomfort (which may contribute to them acting impulsively in order to terminate the delay i.e. pushing in; interrupting or badgering others; opting for immediate smaller rewards rather than delaying gratification in order to achieve long term goals)
• Perceive time and regulate their attention, behaviour and motivation relative to time
• Interact effectively with their peers

In addition to this, poorly managed ADHD symptoms also greatly affect a child with ADHD’s ability to self-reflect, as well as develop self-awareness and accurate self-perception; communicate effectively; think socially; interact with others, be accepted by others and form bonded relationships; participate fully in extracurricular activities; and, develop independence. Their symptoms can also negatively impact upon parent-child and child-sibling relationships and family function.

As a consequence, a child with ADHD’s self-esteem and quality of life can suffer, for when children with ADHD are:

• Unable to meet the expectations placed upon them and therefore experience failure over and over again (even when they are trying their hardest)
• Constantly on the receiving end of correction, redirection, criticism (and possibly social rejection and isolation)

they are more likely to feel frustrated, embarrassed, humiliated, demoralised and discouraged, as well as ashamed, inadequate, unworthy and regretful. They may also come to believe over time that they are fundamentally different, flawed or broken, and begin to anticipate or predict future failure (Barkley, 2015).

Poorly treated ADHD in childhood no doubt contributes to the reason why adults with ADHD are at high risk of developing anxiety and depression, alcohol and substance abuse issues, and eating disorders. They are also at higher risk of criminality, self-harm and suicide with the suicide risk of individuals with ADHD being approximately 1.8 times higher than the general population (Barbaresi et al., 2013).

These mental health risks are frightening and as you would imagine, not much fun to live with. And they are not something I want for my son or any other child with ADHD to experience. 

Which makes me question – why haven’t I come across a commercial media article or documentary that has discussed any of the potential mental health risks associated with not effectively treating kids with ADHD? Or that has made mention of the other risks associated with poorly treated ADHD such as future financial difficulties, car accidents and injuries, relationship challenges and marriage breakdowns, and shorter life expectancy.

Also why does the media seem so hell bent on focusing on the potential side effects of taking stimulant medication (all medication potentially can cause side effects) and the unsubstantiated risks which feeds stigma and increases the chance of kids with ADHD having poor outcomes?

Goodness knows!

 

According to Barkley (2015) stimulant medication produces few mild negative side effects. However, if a child does experience negative side effects, they either develop tolerance for these symptoms or their symptoms can be reduced to a tolerable level by lowering their medication dose. Occasionally, changing to another stimulant medication (or non-stimulant medication) may be required.

 

So lets rectify some of this by examining what the current research says in regard to three risks often highlighted by the media:

• “Your child won’t grow if you give them stimulant medication”
  There is some concern that long-term stimulant medication use may affect the growth trajectories of children with ADHD resulting in mild growth suppression. For example, a meta-analysis of 22 studies found that stimulant medication had a statistically significant effect on a child’s height and weight. However, some studies suggest that children with ADHD may display different growth trajectories to neurotypical children, and that it is the disorder itself, not stimulant treatment, that is responsible for these differences (Barkley, 2015). Parents therefore should be encouraged to weigh up the potential risk that their child may not grow as tall as their peers against the potential risk of their child developing mental health issues, when making treatment decisions.
  
  
• “Childhood use of stimulant meds leads to future drug addiction”
  Concerns that stimulant medication may increase the risk of later substance abuse appear unfounded as these claims have been refuted by more than 14 studies (Barkley, Fischer, Smallish, & Fletcher, 2003). Instead, the data suggests stimulant medication may significantly reduce substance abuse risk in individuals with ADHD (Chang et al, 2014). For example, in their 2016 study, McCabe et al.(2016) concluded when stimulant medication treatment is started early (before age 9) and continued for more than 6 years, it may cut the rate of substance abuse in half. In fact they found, stimulant medication reduced the risk of substance abuse in youth with ADHD back to the same level of risk associated youth without ADHD. (Please note: when taken at therapeutic doses, stimulant medication does not produce the euphoric effects associated with drug abuse in individuals with ADHD.)
• “Stimulant medication will harm your child’s brain”
  The prefrontal cortex, which is part of the cerebral cortex, is the part of the brain responsible for one’s executive functions. Studies currently show that taking stimulant medications to treat ADHD does not adversely affect the development of the brain’s cerebral cortex (Barkley, 2015). Instead there is exciting evidence emerging that indicates stimulant medication may have a protective effect on a child’s brain, as there are over 32 studies that show the brains of kids with ADHD who continuously take stimulant medications in the long term, develop in a manner that is more in line with their neurotypical peers. In other words, stimulant medication appears to promote brain development (Barkley, 2015a).

I hope from reading this it is very clear why the stigma and misinformation around ADHD and stimulant medications needs to stop. And why the ADHD community would be so very grateful if everyone would stop and think before they voiced their opinion on the topic, for they really do not know how much harm they may be doing.  

For all kids deserve to develop into well adjusted, happy individuals who contribute positively to the world and thrive – what ever it takes.

 

If you are a parent of a child with ADHD and want to learn more about stimulant medication so you can make an informed treatment decision please go here:
Childhood ADHD & Stimulant Medication.

 

Blog post references are available here