Adapted from the ADHD Weekly published by CHAAD on November 2, 2017
As an ADHD coach, I am often asked if I think ADHD is over-diagnosed and if ADHD medications are over-prescribed. My answer is a firm “no”. Although I am sometimes contacted by parents that have self-diagnosed themselves and/or their children as having ADHD (when they may or may not actually have ADHD), I am more often contacted by parents who have only recently been diagnosed by a qualified professional or recently found out their child has ADHD. Generally, these individuals have suffered for years without pharmacological or ADHD coaching support because they were never diagnosed. This is particularly true with many of my high-achieving female clients.
There have been some claims in the popular press that ADHD medications, especially the stimulant medications, are over-prescribed. But those claims either have had to be retracted (such as the New York Times publishing three corrections to its 2013 article) or have been challenged by qualified professionals for failing to consider critical factors and scientific evidence.
What’s the real story?
According to Max Wiznitzer, MD, a pediatric neurologist at Rainbow Babies and Children’s Hospital in Cleveland, and a member of the CHADD Professional Advisory Board, the idea of over-prescribing has been based on anecdotal situations (such as possible side effects meaning that medications are harmful) rather than on data from controlled scientific evidence.
Furthermore, Dr. Wiznitzer emphasizes that clinicians and parents must remember that all evidence shows that multimodal treatment for ADHD―which includes behavioral interventions like cognitive behavioral therapy and ADHD coaching for the patient (and/or caregivers when the patient is a young child) along with medication―provides the greatest likelihood of success.
“Medications can improve focus, but they don’t teach how to learn and behave,” he says. This is where the multi-modal or “three-legged stool” approach of:
- Pharmacological-interventions (prescriptions medications and supplements
- ADHD Coaching for symptom management via strategy implementations
- Psycho-social therapies for emotional management and regulation
So what explains the persistence of the idea of over-prescribing? Anecdotes versus scientific evidence, is one issue. Dr. Wiznitzer offers several other reasons:
- There is a misconception that the “stimulants” prescribed for ADHD are in the same category as cocaine or other addictive drugs. But there is a big difference between these two classes of drugs, having to do with different rates of absorption and retention; the medications for ADHD have been shown not to be addictive.
- Some people harbor a suspicion of medical science and believe doctors are in collaboration with the pharmaceutical industry.
- Some people (such as some college students) seem to think that ADHD medications will make them smarter and they attempt to misuse their or their friends’ medications. Research has shown that this is not the case. A good night’s sleep before an exam is more effective, and pulling an all-nighter to study without sleep degrades performance.
- Parents may sometimes see a problem behavior in their child that they can’t handle, and proactively seek a prescription to “fix” it, neglecting to also provide the behavioral training and ADHD coaching to ensure a supportive environment. When the problem persists, the medication gets a bad rap.
- Both effectiveness and appropriateness of medication depends on an accurate diagnosis by a highly skilled physician that understands and is experienced in treating ADHD with medications. There are sometimes issues of misdiagnosis, for several reasons.
- Some people may “self-diagnose” themselves or their child based on what they see on the Internet, and ask their doctor to diagnose ADHD without going through the full rigorous diagnostic process.
- Some symptoms of ADHD are shared by other disorders, resulting in diagnosing the wrong disorder. In other cases, ADHD is only one of two or more co-occurring disorders, therefore requiring different medications.
- In some cases, clinicians are given unintentionally skewed information regarding behavioral symptoms from caregivers, or there can be ambiguity of symptom description and severity, making it hard to know which symptoms belongs to which medical condition.
What can you do?
The right diagnosis will help ensure the right treatment.
- Take the time to be sure the diagnosis is right by going through a rigorous evaluation process by a trained ADHD professional.
- Carefully monitor, log, and report to your doctor the response to treatment (side effects, behavioral changes) over time.
- Feel free to get a second opinion if necessary.
- There are a number of medication options for ADHD. If you or your child are experiencing intolerable side effects from a medication, ask your doctor to ask your doctor to consider alternatives.
- When behavioral interventions, like ADHD coaching and therapy are included with medication in a multimodal treatment plan, the dose of medication is often less than it would need to be when behavioral training or therapy is lacking.
Do you want to know more about using a multi-module approach to managing ADHD? Do you desire to have more supportive resources like a professional ADHD Coach helping you achieve success? Contact Kimberly via email at Kimberly@KimberlyPutmanCoaching.com or by phone at (504) 261-1026 or for a brief consultation about how ADHD coaching can help you create strategies to better navigate the world.