ADHD Children & Treatment Options: Review of Academic Literature

by robynmgoode

Treatment of ADHD: Parental Choices and Treatment Options

Introduction
“The school wants him medicated. My mother wants him medicated. Doctors want him medicated. I think, at the end of the day, I am his mother. I need to make that decision for him. In my heart, I just- I don’t think it’s the right thing for him” (Jackson & Peters, 2008). A mother shared this with researchers whom were interviewing mothers of children with Attention Deficit Hyperactivity Disorder (ADHD). Navigating the various treatment options, combined with a grab-bag of social stigmas, leaves many parents of ADHD children feeling the same way that this mother does. A literature review of research on this topic reveals that the mental health community and popular culture have perpetuated, not mitigated, the stress felt by ADHD families. My reaction to Jackson and Peter’s (2008) research about the maternal role in choosing ADHD treatment inspired me to further investigate 2 topics pertaining to early intervention in ADHD treatment. Here I have outlined my reactions and research objectives in the form of 2 questions:

1. Why do mothers and fathers of ADHD children experience such profound stress in choosing treatment , and what are the primary causes of these stressors?
2. What are treatment options for these children, and are parents being adequately educated?

Question 1: The Pressure to Medicate and Shame
Singh (2004) conducted research specifically focused on the “blame game” associated with hyperactive children and the decision to use medication for their symptoms: “Responses to the ADHD/Ritalin phenomenon often center around the question of blame: Who or what is to blame for rising ADHD diagnoses and Ritalin use? Answers are situated within a web of vigorously pointing fingers” (Singh, p. 1194).

Singh’s research echoed many of the interview responses from mothers in Jackson & Peter’s 2008 study who said:
When mothers are accused of using Ritalin as a quick fix to make their own lives easier, they stand accused of violating a cherished ideal for the sacrificing mother: Good mothers sacrifice themselves for their sons, not the other way around.
(Singh 2004, p. 1208)

This creates a severely toxic, nuanced environment in which parents are expected to make very important decisions on behalf of their children. Brene Brown (2013) has extensively researched the correlation between blame and shame and she has found mountains of evidence, and personal stories, that support the fact that shame is psychologically paralyzing.
We have to understand the power of shame and fear. If we can’t stand up to the never good enough and the who do you think you are?- we cannot move forward… When the shame winds are whipping all around me, it is almost impossible to hold onto any perspective. (Brown, 2010, pp. 8-9).
The blame, shame, and finger pointing also perpetuates the problem that there is not enough good information available to ADHD families. “They experienced a degree of ambivalence that was further complicated by the confusing array of conflicting information from various sources” (Jackson & Peters, 2008, p. 2727). How are parents supposed to make the best decision for their kids under these circumstances?

Question 2: Treatment Options
In addition to handling pressure from family, friends, and society- parents are thinking about their child’s future and the quality of life for their family.

“Though there was acceptance that the medications could bring some benefits, some of the mothers wondered at what cost these benefits came. Some worried that their child’s personality would be altered, while others feared that their child’s emotional development could be stunted by using medication”
(Jackson & Peters, 2008).

Mothers have every reason to have these concerns- articles published this month confirm that medications can have negative emotional side effects:

Personality changes are a common side effect of stimulants, according to pediatrician Sanford Newmark, an ADHD specialist at the University of California, San Francisco. Although many children tolerate drugs, others can become emotionally flat, angry, anxious, or lose the ability to feel joy… After one girl discontinued her medication, her mother likened the Adderall to a dam that had been holding back her daughter’s happiness.
(Laber-Warren, 2014, p. 63)

Laber-Warren’s (2014) also talked to researchers at Queens College who are looking for new answers to help ADHD youngsters. They have developed a 5-week protocol that centers around “brain games” aimed to help children develop cognitive skills to better cope with their hyperactivity and inattention (p.62). The games have proven to be very effective for the children- and an added benefit is that parents are completely integrated into the process, allowing them to incorporate the “brain game” fundamentals in their child’s daily life (Halperin, 2008). ADHD symptoms improved markedly in several research studies that postulated the effectiveness of these games. In one study, not only did behavior improve, but parents reported that their children still showed the improvement 3 months later (Halperin, 2008). ADHD parents would benefit greatly from knowing this research, and these treatment options exist. Playing games versus administering stimulants certainly sounds like an attractive option for parents.

Here you see a consistency with Halperin’s (2008) work in treating ADHD children- aiding the activity in the prefrontal cortex yields positive outcomes for ADHD individuals. Amen (2008) has numerous protocols for raising dopamine levels and increasing prefrontal cortex activity that does not require the use of stimulants (p. 75). Parents who learn about the biological implications of ADHD will find that Amen’s work is consistent with other research findings: stimulants are not the only answer.
Vitamin D supplementation is an example of an intervention that could be used to treat ADHD children. “Neurotrophins are the family of protiens that induce the development function, and survival of nerve and brain cells. Vitamin D upregulates neurotrophins, such as nerve growth factor, up to five-fold” (Neveu, 1994) Omega-3 fatty acids are also an essential nutrient that can greatly improve ADHD symptoms (Amen, 2008, p. 97).

Conclusion
In conclusion, there must be solutions to reduce the psychological trauma that parents of ADHD children face when choosing treatment options. This will result in more empowered parents and a healthier disposition toward hyperactive and inattentive children. The evidence based treatments in this paper are a very important part of this discussion, however I feel the most fundamental piece of solving this puzzle is to focus on Brene Brown’s research. As long as having an ADHD child is associated with shame and blame, our children who need treatment will suffer as a result. Parents simply cannot make informed, self-aware decisions in the current cultural climate regarding ADHD children and stimulants.

Bibliography
Amen, D. (2008). Magnificient Mind at Any Age. Penguin Press.
Brown, B. (2010). The Gifts of Imperfection. Hazeldon.
Halperin, J. M. (2008, September). Neuropsychological Outcome in Adolescents/Young Adults with Childhood ADHD: Profiles of Persisters, Remitters and Controls. Journal of Child Psychology and Psychiatry, 49(9), 958-966.
Jackson, D., & Peters, K. (2008). Use of drug therapy in children with attention deficit hyperactivity disorder (ADHD): maternal views and experiences. Journal of Clinical Nursing, 17, 2725-2732.
Laber-Warren, E. (2014). Concentrate. Scientific American Mind, 62-65.
Neveu, N. (1994, July). 25-dihydroxy d3 regulates the synthesis of nerve growth factor in primary glial cells. Brain Res Mol Brain Res, 70-76.
Singh, I. ((2004)). Doing their jobs: mothering with Ritalin in a culture of mother-blame. Social Science and Medicine, 59, 1193-1205.

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