Understanding ADHD: Current Research and Practice | Week 4 | Step 4.

3 |
Medication

Medication as the go-to treatment Please note that this is

a transcript of an online
Dr Mark Kennedy | Senior Research Fellow and Researcher lecture or interview, and
Professor Philip Asherson | Professor of Molecular Psychiatry is not an academic paper.

Dr Mark Kennedy: There seems to be this perception that medication is

the 'be all and end all' of ADHD treatment. But, it's actually a lot more
complicated than that, isn't it?

Professor Asherson: Well, it is true that if you want to reduce the core
symptoms of ADHD, medication is very good at doing that. But, of course,
you have to look at the whole person, whether it's a child or adolescent or
adult. You need to make out the social context, the sort of psychological
context. And, in fact, NICE guidelines recommend that the very first step is
to look at the environment and think about the way that person is
functioning in their environment. And can you adapt the environment in a
way that can support that person?

And, for some people, that might be sufficient. It may be enough for them
to function well and get on with their lives. But, where people have
persistent problems with core symptoms of inattention, hyperactivity or
impulsivity interfering with and causing a problem in their lives, if you want
to help that, then medication clearly has a key role. And, so, NICE say the
next step, if there are significant problems, is to use medication.

Dr Mark Kennedy: OK. So, when we say that medication is effective, what
do we really mean by that?

Professor Asherson: Well, NICE recommend using stimulants first,

because they have slightly larger effects than the other non-stimulant
drugs that we use. But, if you think about the effects of immediate short-
acting stimulants, they're quite interesting because they work over around
three or four hours. And when you take them, within about half an hour or
so you actually see a reduction in these core symptoms. People suddenly
find their mind is wandering much less. They can focus much better and
are less distracted.

And it's easier for them to do things. They may feel less restless. If they're
waiting, they may feel much more patient. And this, of course, can impact
other parts of your life, not just education but also your social life, the way
you get on with your family and where you function in a whole variety of
contexts.
Dr Mark Kennedy: People seem to think that the way that ADHD
medications work is to essentially sedate hyperactive kids. But, can you
tell us a bit more about--

Professor Asherson: I think that is a misunderstanding. And, it is true that

if you overdose somebody, of course, you may have adverse effects. But,
if you get the medication correct, the right medication and the right dose –
and you need to take care over that – what it's actually doing is boosting
the function of the brain. That's why they're called stimulants. And they
actually enhance brain function. So, they make you better at doing things
and they give you more control and regulation. So, it seems that parts of
the brain are just not functioning as efficiently as they should. And the
medications enhance the efficiency of the brain. So, you get more emotion
regulation, less hyperactive restlessness, more self-control and it's easier
to focus on things.

Dr Mark Kennedy: And one question or position that students often come
in with is that you have pharmacological interventions and non-
pharmacological interventions, and that it's basically a choice between the
two. And they both have a shared goal. Can you tell us a bit more about
that?

Professor Asherson: Well, I think that maybe there are a few people
where just medication on their own is enough. But, for most people, they
need to look much more broadly than that. And, so, medication should,
and is, usually given in the context of a much wider range of supports,
whether it's social support, psychological support, you know through
parent training. There's an awful lot to people. And if you just focus on the
medical effects and on symptoms, you're not going to help many people.

One of the key things, I think, with younger children is to really think about
their self-esteem. And, of course, difficult children often get difficult
reactions from parents and teachers. They're often being told off all the
time. And this can instil a very negative self-view of life. And, then, when
you get older, you're much more likely to become an anxious or a
depressed adult, for example. And, so, being very positive and really
supporting somebody in a very positive way is really important to instilling
a positive, long-term outcome for people.

Dr Mark Kennedy: OK. And, so, what do we know about the evidence base
on the ability for treatments to offset some of these negative later
outcomes?

Professor Asherson: It's hard to do those studies, because all the

randomised controlled trials, of course, can only look at short-term
effects. You can't randomise to placebo for years on end. But there has
been a series of studies, mainly from Sweden and other countries where
they have national registries– these are data across the whole country.

And they can track, within individuals, periods of time when they're on a
treatment and compare it with periods of time when those same people
are not on a treatment. And they can show improvements in things like
suicidality and depression, but also things like drug use, the risk of having
accidents, criminal behaviour. So, a wide range of beneficial outcomes
seem to be linked to taking treatments for ADHD.

Dr Mark Kennedy: OK, well, thank you.