TO MEDICATE OR NOT TO MEDICATE
(Or Seeking Help When All Else Fails!)
Deciding about whether to use medication to treat ADHD can be a great dilemma for many families – parents, adults and young people.
Accepting Help
I think many of us believe it is a sign of weakness to use medication for so called “mental” problems, also known as emotional or psychological issues. It should be something we can control and if we can’t, that must mean something bad about us: “we are weak or inferior.” Some people have this same stigma about seeking help from a therapist. Often people will only go for “psychological” help when all other avenues have been tried and failed, or when a crisis occurs and our normal coping mechanisms aren’t working. Even then some of us wait it out. God forbid that we should ask for help, reveal that we are not perfect, competent and independent!
Whose Fault Is It Anyway?
In the ADHD arena, things are a little different. First of all, ADHD is a biologically-based, cognitive disorder. It is not going to go away with time. It is not our fault. It is not a mental problem, but can be a cause of emotional distress. We have often exhausted every other option possible. How many new or different types of calendars and systems have we bought or designed to help us stay organized and be on time? How many times have we faced an obstacle, failed, given up, and then at some later point, tried a different approach?
Educate or Deny?
Once we receive a diagnosis of ADHD, one of the first and major steps we need to take is to understand what this diagnosis means. How does it impact our lives, our families, and our work? Coming to understand and accept an ADHD diagnosis requires education. What does it mean to have ADHD? For some people it’s a relief to have a label, a medically acceptable reason, for our challenges. For others, denial is a strong component: denial that ‘my brain functions differently;’ self recrimination that ‘I am not normal.’ (Well, who is normal?!)
Not wanting to learn about ADHD or resisting taking actions that will teach you new strategies and habits to work with your ADHD challenges are both signs of denial. Recognizing and accepting the amount of hard work and persistent change that is necessary (and available) to help you improve your life can be very frustrating. This article is designed to help those who are struggling to make sense of all the information and figure out what to do about it. The good news is there is a lot of information available. If you take advantage of the resources available, it is likely that a combination of strategies and treatments, found through much trial and error, will have a very positive impact on you and your loved ones.
What Does It Mean To Have a Neurological Cognitive Impairment?
Do you know that medical scientists can identify patterns in the brain via technology that show the unique aspects of an ADHD brain? It’s called Brain SPECT Imaging. See Daniel Amen’s book, Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD, or his website: http://amenclinics.com to explore further. It’s there, it’s been documented. The advances in the last ten years in brain research, brain imaging as well as documented studies of people with ADHD, have advanced tremendously. We know a lot more about what we are dealing with now. No longer can someone accuse you of being lazy, unmotivated or uncaring. There are factual reasons for your behavior. This information does not provide with you an excuse to coast, but as a validation that what you are experiencing at work, at home and in every aspect of your life is real. It provides a foundation for you to take responsibility for your brain and your behavior. The research in the field is so strong and so clear that at this point if you receive a clinical diagnosis of ADHD and do not take the proven steps, such as exploring medication, and getting help through therapy and/or coaching, then you are not being responsible for yourself. There is a great deal that you can do to make the best of your ADHD brain. It is not hopeless, you are not a failure. You will have to ask for help, work hard, and take the necessary actions that will make your life more satisfying, more manageable and more productive. It is possible and you can do it!
ADHD brains function differently. In the prefrontal cortex, where the brain’s command center is, research indicates “gaps” in the efficiency of the neurotransmitters (the brain’s chemical messengers) That means that the signal strength of our brain cells are not relaying messages reliably. We have what might be called “sluggish circuitry.” (Pera, p. 226) The mechanisms for internal communication from one part of the brain to another can get tangled or lose signal strength over the long circuitous journey. (i.e., have you ever noticed or been told that you are inconsistent? Sometimes you can produce top quality results and do a super job, and then the very next day, you can’t seem to get anything accomplished? Or your timing is off? Some people with ADD have poor time management skills, which range from inability to estimate time to timing related to processing speed. You’re either on “overdrive, aka hyperfocus, and forget to eat, or you get lost in the chaos and do not make headway with your goal. Well, this explains it folks.)
Communication
Let’s take another example, that of communication. Effective communication assumes that you listen well to the other person as well as respond appropriately in a conversation. It’s a two way street – you are both the sender and receiver of information. Sending and receiving information requires the brain to take in information, process and interpret it, i.e., make sense of it, and then determine a response that is relevant and appropriate to the other person. This requires time, memory, and attention, as well as the ability to ‘read’, or understand the other person’s nonverbal cues, tone of voice, mood, etc. Communication is a highly complicated process. It requires a lot of ‘brain processing’ for messages to be received, translated and transmitted across our brain’s wiring system. If there is a sluggishness, or gap in the process, if one or more pieces are skipped over, then part of the accuracy of understanding or conveying the message can get lost. Have you ever been accused of not listening, not understanding, and not caring? “I told you three times that this needed to be done by 5 PM.” You may or may not remember that message, or you may have not understood the urgency of it, but how many of you can truthfully say, “I meant to hurt you; I meant to let you down by not following through?” That is just not the case. Very few of us are intentionally, by choice, dropping the ball.
The brain is our command center, in charge of coordinating huge amounts of information, such as memory storage, translating sensory information, such as sound and directing our behavior and actions. It is an extremely complicated system which affects every aspect of our being. If our “hard wiring” is not functioning properly it’s going to trip us up. The good news is that today’s medications “strengthen the signals” so that connection can be made more easily. The research about stimulants (the most commonly used meds for ADHD) is very clear. It can help make your life simpler and things that have been difficult to manage can get easier. Medication can help you to slow down and listen to your loved ones, to show them that you care and are paying attention. ADHD medication has been shown to improve a core component of working memory, specifically visual-spatial memory ( Pera. P. 269) What kind of a difference can an improvement in visual-spatial memory make? Well, for example, research suggests that “ADHD can significantly impair reading comprehension due to problems with sustained attention, processing speed and working memory.” With the appropriate level and delivery of medication, an improvement can occur in the recognition and memory of letters and symbols, regardless of co-existing reading and language challenges.” Translated into English, this means that your reading ability and comprehension is likely to improve. How great is that?!
What is Executive Function?
Executive function finds its home in the pre-frontal cortex in the brain. Executive function is what is impacted the most by ADHD. It can affect our ability to focus, plan, prioritize, activate, integrate and modulate our thoughts and behaviors. Executive Function affects our capacity to make, plan and carry out our goals. (Tuckman, p. 47) The existence of our Executive Function is hard wired, meaning it is not a learned ability but one we are born with. The capacity of executive function is based directly on the pre-frontal cortex and its connections through out the brain. (Tuckman, p. 49) ADHD brains tend to have less robust hard wiring, which means that hard wiring can sabotage our intelligence, ability and talents.
The positive side of this is that you are smart, able and talented and that you can learn to enhance your hard wiring through learning and experience. As a matter of fact, you already have. Look at your strengths, skills, interests and hobbies. What are you good at? What have you already worked at and improved? If you have had undiagnosed ADD for a long time, you may have become frustrated and even defeated about your capabilities, but it is extremely important that you begin to identify your strengths and build on them. Come on, you do have strengths. If you’re not sure, ask someone who loves you and whom you trust. Ask at least five people! Think back through your life. List your accomplishments. They are there no matter how deeply you have buried them and they need to come out into the light. You need your strengths to move forward!
How Does a Stimulant Help to Calm a Restless Body or Mind?
So now that you have had a quick review of the neuroscience of your brain circuitry, back to the question of “to medicate or not to medicate.” How does a stimulant help to calm a restless body or mind? Sounds like a contradiction to me!
To summarize what we have learned thus far, the ADD brain is most significantly impacted in the area of executive functioning, which is in charge of our conscious (voluntary) thought and planning. EF plays a critical role in our lives, as it is responsible for making sense of all incoming and outgoing information. Somehow it has to deal with the constant bombardment of information, aka stimulation, from the external world as well as from our internal world. It needs to figure out what’s important and what’s not so important. Remember the words “sluggish circuitry?” Well, stimulant medication helps strengthen the brain signals so that we can make better sense of our environments. It helps our brain make connections in a more timely fashion. So that’s the stimulant part. Medication can help us clarify our priorities, Instead of overwhelming our circuitry to the point of inaction, it helps focus us. Think of the times that you have been hyperfocused and able to accomplish things with speed, accuracy and quality. Many of us have had that experience when we have put off a project to the last minute (like writing this article) and then, having put tremendous pressure on ourselves, we have (unconsciously) activated our brains to get in gear and get the job done. That’s what ADD medication can do for you. It amplifies the important stuff and helps reduce the allure of distractions. (Pera, p. 267)
Reluctance To Change
So, how much of your resistance to the idea of medication is due to not knowing? How much is it due to fear of the unknown? How much is it to do with making a change? I suspect, if you open your mind and your heart, do the homework and read the research, talk with the experts, that what you are left with might be your hesitancy to try something new and different. Let me reassure you that medication used for ADD is among the best researched, most effective and least harmful of all psychiatric meds. Side effects are short term, and long term effects almost non existent. (See XXX refer). So I encourage you to do your homework, become well informed, and then explore what’s holding you back.
Most of us human beings are reluctant to make changes. We fear what we don’t know. To consider taking a medication to help us feel more in control of our lives is a major step. Evaluate the pros and cons. Separate your fears from the facts. And then address your fears. You may have to see several doctors before you find one you like, trust, and can work with. You may have to try several different medications before you find the right type, dosage and delivery method best suited for you. But if you are willing to do the work, you are more likely than not, going to find a better outcome in your daily life. Medication alone will not solve your problems, but it might give you a much better chance to learn the strategies and take the actions that will definitely enhance your life. What’s to lose?! You already know how frustrating things can be for you. (Probably you are a master of frustration and can handle it better than the average person. Add that to your strength list!) What if your life could only get better?!
For more information on medication for ADHD, the following references, from this article, tend to be reader friendly:
1) Is It You, Me or Adult ADD? by Gina Pera (Chapter 21, pp 277-291)
2) Integrative Treatment for Adult ADHD by Ari Tuchman (Chapter 5, pp. 109-140)
3) Life Coaching for Adult ADHD by Nancy Ratey
4. Healing ADD: The Breakthrough Program That Allows You to See and Heal the Six Types of ADD, Daniel Amen
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