Literature Review

Adolescent ADHD: Mind-altering Stimulants vs Holistic Psychotherapy

Kesha N. Fitzhugh

Columbia Southern University

Adolescent ADHD: Stimulants vs Psychotherapy

Avisar, A., PhD., & Lavie-Ajayi, M. (2014). The burden of treatment: Listening to stories of adolescents with ADHD about stimulant medication use. Ethical Human Psychology and Psychiatry, 16(1), 37-50.

The authors, address the importance of considering the burden of treatment of stimulant medication used by kids and adolescents. This study conducted in Israel, of underrepresented perspectives of 14 semi-structured interviews of adolescents that had been diagnosed with ADHD following treatment, found that while most had trouble with identity loss, emotional side effects and interpersonal relationships, others reported significant improvements in testing and studying concentration. Though most reports are taken from a parental perspective asserting the benefits of stimulants (methylphenidate type), the adolescent perspective was far more negative, especially from a well-being/social interaction angle. Participants included 8 boys and 6 girls ranging from the ages of 12 ½ and 16 ½, the majority being diagnosed in grade school and to their recollection of the process of diagnosis, it was passive and limited. All participants experienced the same side effects: varying stages of dizziness, loss of appetite, and tummy aches. Three main parts to the trajectory of stimulant medication use: Diagnosis stage, regular use of medication and lastly, selective or stopping medication. Thus, the child or adolescents’ experience needs to be considered during diagnosis and treatment.

Drury, S. S., & Gleason, M. M. (2012, March). A delicate brain: ethical and practical considerations for the use of medications in very young children. Psychiatric Times, 29(3), 20.

The authors, discuss the ongoing controversy around the young and vulnerable most affected by this growing debate of nonpharmacological vs psychopharmacological treatments used for treating ADHD. An abundance of literature surrounding parent-child interaction therapy, Cognitive-behavioral therapy, Child-parent psychotherapy supports evidence based effectiveness dating back to 1990s, studies have reported increasing numbers of psychopharmacological prescriptions for children younger than the age of 6. The factors for these prescriptions extend further than the clinical symptoms; such as gender (boys over girls), race (white over black) insurance (state over private) and lastly population (rural over urban). Studies also emphasize that first-line treatments such as psychotherapeutic ministrations saw fewer than 40% of preschoolers during, after or while on antipsychotic agents. Atomoxetine and methylphenidate are treatment drugs for ADHD which the latter has a specific warning against use in preschool aged children, yet has a wealth of support for safety and efficacy. Literature however, suggests that adverse effects in younger children at higher rates due to psychopharmacological agents being less effective. Early exposure to these atypical antipsychotics and stimulant medications have been connected to shortages in cognitive function, memory and neurotransmitters in the brain, asserting treatment for young children nil with limited options and information.

Haelle, T. (2017, January). Recognizing giftedness: addressing kids' needs can be challenging. Pediatric News, 51(1), 1+.

The author, a writer gives an expert analysis of the conflict in giftedness and its commonplace misdiagnosis in youth as explained by Dr. Peters at the American Academy of Pediatrics (AAP) annual meeting. Too often giftedness takes on the mimic the risk factors of other conditions. Much like the barriers to African American youth to proper mental health services, gifted children are often misunderstood and face the same challenges with misunderstanding and lack of resources for their needs. For optimal development of a gifted child, again relative those with ADHD, parenting, teaching, and counseling require modification from the “norm”. There was a 66% increase in ADHD diagnosis from 2000-2010, with a staggering 90% of those children on some sort of stimulant medication, with one in five being misdiagnosed. Yet, there is a possibility of a child being twice exceptional, meaning they are gifted and have an emotional, behavioral, or learning disorder, which creates intense challenges.

Kaplan, G. (2015, September). Nonpharmacological ADHD treatments for youths: how to implement evidence-based practice recommendations. Psychiatric Times, 32(9), 49.

The author, a doctor and clinical associate professor reports no conflicts of interest with this article’s subject matter that reports there are a myriad of evidence-based psychotherapeutic approaches to treatment of ADHD as also asserted previous research by Drury & Gleason. Though the ongoing rivalry of which approach to ADHD treatment is most effective medication vs psychosocial methods, neither is 100% therefore clinicians tend to offer both. Though both “talk” and “drug” only therapies work based on the individual, “drug” only therapy takes time to figure out which medication works best for an individual and their symptoms and always dependent on the severity of the illness. The treatment providers for youth are child psychiatrists and pediatricians. As of 2011 an age-dependent approach of set guidelines has been introduced asserting that in preschool aged children behavioral therapy was favorable over pharmacology, which literature has validated its first-line use as safe and effective in youth.

Moore, G. (2012, February 27). New guidelines for ADHD. Chain Drug Review, 34(4), 54. This author, discusses the statistics in which Attention Deficit Hyperactivity Disorder (ADHD) affects adolescents between ages 4-17 and the predominant medications used to treat this disorder; stimulants, such as amphetamines and methylphenidate, which have a well-documented positive effectiveness in 70-80% of children. ADHD is the most widespread childhood condition affecting about 9.5% of the age group. New guidelines have been set forth by the American Academy of Pediatrics (APP) for behavioral interventions, diagnosis and treatments across all age ranges, instead of just 6-12 as recently addressed. In addition to the recommendations for behavioral intervention, the principles of a chronic care model have also been introduced. Failure to pay attention and poor conduct are symptoms and reason for care clinicians to seek evaluation. The improvement in relationships and academic performance measures the efficacy. There are two major side effects to the medication which will have the weight and growth of an adolescent monitored more frequently; headaches and decreased appetite. Occurrences of agitation and anxiety arise, pharmacists play a huge part in communication. ADHD is chronic and can continue into adulthood but manageable with medication and therapy.

Ritalin Use Up, Only Masks Symptoms--ADD/ADHD Label A Tragic Decoy. (2009, August 24). Basilandspice.com.

The author, a doctor and sought-after expert of learning and human development, discusses the rise of diagnosis of ADD/ADHD over the past thirty years, which has become commonplace in schools across America, the “disease du jour” if you will. The loose set of behaviors that constitute the diagnosis and the treatments used are as problematic as the methods in which the diagnosis is concluded. Disadvantages of Ritalin only masking the symptoms is a concern as it should be a last resort rather a crutch in the wrong instances, yet prescription use was up 500% in 2003. Failure to properly nurture and societal influences agitate “symptoms” and the drug is a scientific way of explaining growing pains and emotional complexity. The uniqueness of each child is loss as the core of their being is stifled and squeezed into what workbooks, videos, and instructional manuals tell parents, teachers and clinicians how children should, act feel, and think. Each child’s needs are different and a more holistic wellness-based approach to learning and coping is recommended.

Tucker, C., & Dixon, A. L. (2009, October). Low-income African American male youth with ADHD symptoms in the United States: recommendations for clinical mental health counselors. Journal of Mental Health Counseling, 31(4), 309+.

The authors, associates of Indiana State University and University of Florida make recommendations for mental health counselors to a population who faces barriers, such as, distrust in the treating professionals and the process, cross-cultural bias, financial and structural issues to the proper mental health treatment. The article asserts that African American boys who’ve been impoverished and marginalized, and exhibit symptoms of ADHD, have barriers to receiving the proper care, assessments and diagnosis, and are continually outcast in staggering numbers over their peers and leading in categories of HIV, incarceration, poverty, homicide and diagnosed learning disorders, according to the Center for Disease Control and Prevention. As stated in research from the Psychiatric Times, the children with state insurance (Medicaid) are more likely to be diagnosed with ADHD than those with private or no insurance. Possible environmental exposure and poverty are risk factors that increase likelihood of developing ADHD. Because African American males are overrepresented in deficit behavioral, emotional and learning disabilities, assessments may be biased, misdiagnosing a child based on cultural differences in the perception of a child’s behavior. Closing the gap involves treating the whole issue (psychosocial), and being on one accord about a treatment plan and goals including the child.