The brain is an extremely complex organ that functions in ways that we are just beginning to understand. Issues of focus and attention are the result of many potential causes that include:
Adverse effects from medication use
Sensory impairment, like vision or hearing
Speech or language problems
Oppositional defiant disorder
Posttraumatic stress disorder
Physical or sexual abuse
Improper learning environment
Parental psychopathology or substance abuse
Social skills deficits
So why are people with attention issues quickly labeled as ADD or ADHD and placed on medication in the USA? This is certainly not the case in most of the rest of the world. Many advanced countries report low or virtually no incidence of ADD/ADHD.
I would argue along with many other clinicians in the US that attention problems are being pathologized with little examination of potential underlying causes. Then those with attention problems are placed on medicine with the mistaken notion that doing something so simple is the solution for a condition that is usually the consequence of many influences on the brain.
Evidence is mounting for ADD/ADHD drugs having positive effects only for a few weeks. These same short-term improvements of improved focus, memory, and energy levels are felt in almost anyone who takes medication, both “normal” and ADD/ADHD-diagnosed subjects. As data from long-term studies is analyzed, no differences in behavior can be discerned in continuously medicated children versus non-medicated children at both 3 and 8 years. Medicated children have no advantage in academic performance, flexibility in thought for complex tasks, peer relationships, antisocial behavior, substance abuse, or arrests. In fact, medicated kids have a higher drop out rate from high school and worse relationships with their parents versus non-medicated kids. Medicated boys trend towards worse academic performance. Medicated girls tend to have more emotional problems.
Problems with medication for ADD/ADHD are well known, and include:
Cardiac arrhythmias, hypertension and other cardiovascular issues
Rebound symptoms as medications wear off
Withdrawal symptoms when attempts are made to discontinue medication
So how have an estimated 15% or 6.5 million American children ended up diagnosed as being ADD/ADHD, and an estimated 3.5 million of them placed on medication? First of all our care system routes children with attention problems into the medical system where attention issues are generally perceived as a biological disorder of biological causes as opposed to a medical condition, psychosocial condition, a condition of differently paced brain maturation, or a mix of these. Our current medical models reward “efficiency”. This means a short, screening visit possibly followed by family and school questionnaires to confirm an attention problem. Then a prescription is written. A follow-up appointment in a few weeks might confirm that the medicated patient is quieter and more focused. However, almost anyone placed on ADD/ADHD medication will also be more focused in the short run, too. Thus begins years of medication, and neglect of identifying and remediating the underlying causes of the attention problem.
Placing kids on drugs give a sense of “doing something” about the issue of attention. Medical providers, families, and schools are looking for a simple fix for a complex brain issue. The mistaken impression that popping a pill is going to solve the issues of someone with attention problems is passing the buck on meaningful treatment. This causes a great disservice to those with attention problems, their families, and society at large since many do not go on to get the attention in school, psychosocial treatment, and other treatments like EEG neurofeedback that have been proven to treat attention disorders as well as behavioral issues on a long term basis.
I try to look at each person who comes into my practice with attention problems as their own unique case. It is important to tease out the important contributions to an inability to focus well and consistently. Then I try to help that person and their support system to prioritize and deal with the factors that seem to be driving the problems that they present with.
EEG neurofeedback is an important component of this treatment. However, most patients benefit from a thorough re-evaluation of their psychosocial milieu. Circumstances that promote inattention need to be recognized. Just like neurofeedback does not change brain function and architecture overnight, psychosocial interventions take time and practice. Neurofeedback and behavioral therapies are time-consuming, but long-term outcomes justify the additional effort. Those who prescribe and use medications for ADD/ADHD are using a Band-Aid approach that can cause more harm than good.