Unlocking ADHD writer Chng Li Ming shares her insights into the important topic of ADHD medication when she attended a presentation by Dr Dan Shapiro at Unlocking ADHD’s Official Launch event. For more details, do watch the recording of the webinar below.
Kicking off ADHD Awareness Month 2021 with our October 1 launch, Unlocking ADHD had guest speaker, Dr Dan Shapiro, renowned US Developmental-Behavioural Pediatrician and Creator of Parent Child Journey shared on the hot button issue of ADHD medication for children – a struggle that parents commonly face when their child is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Medication management is a key cornerstone of therapy. According to Dr Dan, when one makes a diagnosis of ADHD, medication should always be part of a comprehensive management plan. He has written three books: Parent Child Journey: An Individualized Approach to Raising Your Challenging Child, Parent Child Excursions: ADHD, Anxiety and Autism and Raph’s Tale, a children’s book on developmental difference. Parent Child Journey provides details on medication management and non pharmacologic approaches to behaviour management. There is also an accompanying parent training program, which Dr Dan runs. He believes in the importance of good behaviour management, good educational care, and good family support.
Topics Covered
Diagnosis of ADHD
Dr Dan listed inattentive as well as hyperactive and impulsive symptoms of ADHD. The combined type of both inattentive and hyperactive-impulsive features is the most common. He emphasized that these subtypes are artificial as the symptoms change over time. Thus the subtype is based on symptoms over the past 6 months. Often there are hyperactive-impulsive features early in life that reduce over the years.
Dr Dan highlighted that most inattentive behaviours are not ADHD. There can be many causes of inattention that are not a subject of ADHD management. Therefore, unless there is impairment across settings, over time, and across observers, there is no case for a diagnosis of a disorder – they are of normal temperament variation.
The Case for Medication Management
Medication management is usually an uncomfortable topic for parents who are new to the idea of brain-based developmental differences. Dr Dan shared that this is not cosmetic psychopharmacology – there is a misconception that we treat attention problems just to enhance our child’s ability to perform and compete. That is a harmful myth – ADHD is a legitimate brain-based disorder/neuro developmental problem with consequences from failure to treat such as a 30-50% increased risk of a whole list of problems and comorbidities.
Dr Dan also shared medical research results that started as early as 1938 to a more recent Medicines Therapy Assessment [MTA] study that showed the effectiveness of medication management.
How to do a Medication Trial
Dr Dan shared on how to do a medication trial, with free tools and resources available on the Parent Child Journey website. He took the participants of the webinar briefly through the steps of:
- Choosing a target
- Choosing a medication
- Establishing baseline measures for targets and possible side effects
- Establishing observation intervals
- Observing
- Evaluating and re-evaluating
Dr Dan also walked parents through the important do’s and don’ts of how to talk to their child about ADHD medication and shared very useful tips on communicating with children.
Filling Troughs
Dr Dan explained that we need to be aware of uneven medication coverage that needs to be managed. From the time a medication dose is given, there is a kick-in time (trough), then duration of action (where medication is at therapeutic level), and finally a kick-out time (second trough). We need to manage these troughs as there are potential negative effects and misunderstanding to Trough-filling failures (TFF). There are all sorts of strategies to filling these troughs and they are further elaborated in Dr Dan’s website, books, and other workshops.
Managing Side Effects
Side effects of medication can be managed in a few ways – medication can be discontinued or monitored, behaviour accommodated, or we can treat the side effects. The generalisation is that side-effects should not be tolerated if they are significant. Some side effects are relatively minor, e.g. going to bed 10 minutes later is a minor trade-off if medications are working beautifully, but conversely going to bed 4 hours later should not be tolerated. There are many strategies for evaluating and treating side-effects as detailed in Dr Dan’s book.
Discontinuation
What are some of the considerations to discontinue medication? How does one go about it? Some reasons provided by Dr Dan include:
- To see if medication is still needed
30% of childhood ADHD symptoms improve enough that you do not need treatment as an adult. However, about 70% of children with ADHD end up needing medication as adults. The only way to tell if it is still needed is to do a discontinuation trial.
- To see if medication is causing a side-effect
Sometimes discontinuation happens in an accidental way (e.g. the child has forgotten to take medication or has run out of medication). It is much better to do test discontinuation in a controlled way.
Webinar attendees were given a deeper understanding into how ADHD medication works, how to ease their child into establishing a medication routine, and the potential side effects it might carry.
[If you liked this story and found it helpful, please SHARE it. For more personal stories about ADHDers, please click here. Unlocking ADHD has also organized a series of events this ADHD Awareness Month, and you can view our past webinars on YouTube. ]
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