Sarah Schmermund, MA

Sarah Schmermund is a child development and parenting expert and specializes in couples work and marriage counseling.

The standard of care for the treatment of ADHD, with which 11% of all school-aged children are diagnosed, is typically the prescription of medication. About two-thirds of all those with a current diagnosis are prescribed stimulants like Ritalin or Adderall. And while these medications are believed (and advertised) to improve the lives of those with ADHD, a recent study out of Johns Hopkins Children’s Center shows that, at least with young children, they actually don’t.

Specifically, the researchers followed 186 children, ages 3 to 5, diagnosed with moderate-to-severe ADHD over a six-year period. The study showed that 90% of the children followed continued to struggle with ADHD symptoms six years after diagnosis. Even more striking, the researchers found that the severity of the symptoms did not differ between the more than two-thirds of children on medication and those not taking any medication.

Six years later, the children taking ADHD medication had just as severe symptoms as those who were medication free.

As a parent of an 11 year-old, who was 5 when the study began, that’s six years of begging, of bribing, and of banging your head against the wall trying to help improve the inattention, hyperactivity, and impulsivity of your child. Six years of calls from the teacher, of micromanaging homework, and of repeating yourself for the umpteenth time.

So why don’t ADHD meds work?

Because they’re not supposed to. At least, not alone.

ADHD is generally considered a neurobehavioral condition, meaning that there is a neurological (brain wiring) and a behavioral (the actual inattention and hyperactivity we can see) component. Medications, like Adderall, Ritalin, Concerta, and Vyvanse, address the neurological aspect of ADHD, as they work to remedy the existing inconsistency or “misfiring” in the brain.

For the majority of ADHD patients, though, this is where the treatment stops. The general understanding (from your pediatrician or psychiatrist or the pharmaceutical commercials) is that this medication’s impact on the neurological component will translate into a correction of the behavioral difficulties.

But as many parents, and now research, will tell you, it doesn’t really work like that.

To better understand why, let’s look at another neurobehavioral condition: depression. Depression is also considered to be part brain problem (a deficiency of neurotransmitters in the brain) and part behavioral problem (manifesting in number of ways, including fatigue, loss of interest in previously enjoy activities, insomnia, weight gain or loss, difficulty concentrating, irritability, etc.).

To best treat moderate-to-severe depression, medication is often first used to help correct the neurotransmitter issue. The medication helps to lift the mood and improve the functioning of the patient enough so that they are able to then actively engage in and benefit from therapy, typically cognitive-behavioral therapy. It would be particularly challenging to help someone see the world differently if their brain is literally incapable of doing so. With the assistance of medication, a patient is able to learn and implement new or previously underutilized tools and skills to help him cope, self-regulate and maintain his mood and emotional state.

Neuro (medication) + behavioral (behavioral therapy) = depression (and thus its treatment).

With ADHD, however, this equation is predominantly lopsided, and without a behavioral treatment component to a predominantly behavioral condition, the meds can only do so much don’t do much at all. Nor should we just do away with the meds: a six year-old with severe ADHD symptoms is at the mercy of his misfiring brain, and he literally does not have the capacity or ability to understand or incorporate the tools and skills that other children may learn to help them manage and regulate their own behavior. Much like trying to do therapy with a severely depressed person, trying to intervene behaviorally without first addressing the neurological component is often a wasted effort.

Like an antidepressant, ADHD medication helps to correct a child’s “misfiring” brain so that he is better able to engage in learning how to correct the behavioral aspects. Just because he now has the capacity to learn and implement the numerous tools and skills that can help him with things like waiting his turn, finishing his homework, or considering the consequences of his behavior doesn’t mean we don’t still have to teach them to him. In addition to working directly with a child, classroom interventions and parent training and support also help to effectively reduce the symptom severity and improve the behavioral and academic performance of a child with ADHD.

The often neglected behavioral treatments for ADHD should be considered just as essential as medication. For those with moderate-to-severe ADHD symptoms, the medication appears to be useless without it. And for those with more mild-to-moderate ADHD symptoms, the behavioral treatments are often the best course of action, doing enough on their own to prevent the need of medication in the future.

Sarah Schmermund, MA is a child development and parenting expert providing marriage and family therapy via her private practice in Washington, D.C. You can read more of her posts on relationships, marriage, and parenting at In Your Corner.

What do you think?

4 Responses to “ADHD: Why Meds Don’t Work”

  1. ADHD: Why Meds Don’t Work | Parents Space Guest Blog | In Your Corner Says:

    [...] Click here to ready more and learn why the meds don’t work. [...]

  2. Laura Hedgecock Says:

    I have two boys with ADHD. I do agree with you that behavioral therapy is also (not sure about equally) helpful. Unfortunately, ADHD meds are getting an undeserved bad rap. Their medication isn’t a cure, so it doesn’t change their condition, but it has helped each of them tremendously.

    Because he had the hyperactivity and impulsivity issues along with his inability to focus, without medication, I can pretty much guarantee that my eldest would have severe self-esteem issues and would have struggled with his grades. Years of behavioral therapy was also helpful, but he admits that even now in college (partial scholarship), without meds he has to study more than other kids because he’s unable to focus in class.

    Laura Hedgecock

  3. Sarah Schmermund, MA Says:

    I completely agree, and hope that this message was clear; for some children, medication is a necessary and important first step. Without it, these children simply aren’t able to implement any of the behavioral tools or modifications we might try to teach them to help them better manage their environment to stay focused or on task.

    The issue with meds is more about making sure children who don’t need meds aren’t taking them, and that everyone, meds or no meds, is also getting the supplemental support and skills to optimize their meds or improve more mild symptoms.

    Thank you for reading and for sharing!

  4. Charles Crookenden Says:

    I go back and forth as to whether ADHD even exists. Before you consider that statement outlandish, you should listen to Sir Ken Robinson’s speech to the Royal Society of Arts in London. Apart from an example of a perfect and hilarious delivery, he illustrates an interesting fact about the demography of ADHD in the US. It barely exists in CA, begins to evidence itself in the mid-west and has the highest density on the East Coast. It’s a fascinating speech and well worth the time.

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