View Full Version : Why Meds FIRST?????


Roy G Biv
01-28-06, 11:22 AM
Is there any law that says meds have to be prescribed before trying anything else?

In my own experience(I'm 48, diagnosed Aug. '05), I was questioned for twenty minutes then put on Straterra(I didn't want the standard stimulants). My doctor said I was '7' on a scale of ten(again, this is after 20 minutes of questions-not exactly a textbook diagnostic progression).

After a while, he suggested the book 'The Complete Idiot's Guide to Managing Your Time'. I got the book(haven't got around to reading it yet:p )and also took myself OFF the Straterra-didn't notice much difference except for the side effects. I'm also hearing about 'Driven to Distraction' and 'Delivered From Distraction'.

Since the vast majority of ADDers are highly intelligent, why not go a more 'homeopathic' route, like coaching, education and support before prescribing meds? Seems to me that would be the FIRST option. If THAT doesn't work, then explore med options.

I hate to think of doctors as pill-pushers, but why not go the SIMPLE route first??

Straterra increased my BP from 118/60 to 130/80. I realize that's still pretty normal for someone my age, but it's still a hefty jump. I was on the meds for 5 months and said, "Enough".

I understand that I will struggle the rest of my life with this. Now that I'm aware of my condition, I hope I'm strong enough to at least not let it run my life. Maybe I'm a fool, but I felt/feel that doctors are throwing medication at problems without even TRYING other options.

mctavish23
01-28-06, 12:39 PM
Of course there's no law that says that.

As an adult ADHD, who specializes in the diagnosis and (non-medical) treatment of children between the ages of 6-19/20, I'm ethically obligated to point out (to parents/guardians,etc.) ALL of the evidenced based (research substantiated that it works for ADHD) treatments.

For ADHD-H-I & ADHD-C types, that boils down to:

1) medication managment;

AND ...

2) a rewards based behavior managment/ home token economy system that balances rewards with natural & logical consequences.

There's also a third (also evidenced based) component of this that's perhaps the most important one and that's;

3) parent education ( about ADHD and how complicted it is , as well as HOW TO establish and maintain the consistent evidenced base way to carry out such a program so that it does what it's supposed to).

I came out of a strict behavior mod/clinical psych grad school program.

In the process, I did my Master's thesis on a Token Economy unit of a state hospital in NC.

Bottom line, it's up to the parents.

However, I'm just not going to turn them lose to do it on their own.

Incorporated into all of the above are handouts on a multitude of ADHD related factors;including the evidenced based RISK FACTORS for not using meds.

MEDS WORK.

MEDS + PARENT EDUCATION & BEHAVIOR MANAGMENT= WORK BEST.

tc (and thanks for the question ):)

mctavish23 (Robert)

mctavish23
01-28-06, 12:51 PM
I neglected to mention this:

The best behavior managment book for ADHD that I've seen,although it's for kids, is :

The Parents Guide to Attention Deficit Disorder by Stephen McCarney & Angela Marie Bauer (Hawthorne Press).

Even though it's for kids, I offer it here as a possible reference because the practical/every day examples can be adapted for adults.

It also gives you a blueprint of specifically what to do, so that you can customize it .

The ADHD Book of Lists by Sandra Rief is still my favorite becasue she's done all the legwork in pulling together what works and what doesn't;with examples.

good luck

livinginchaos
01-29-06, 01:11 AM
mctavish has great info.

I find that meds are a simple answer, you get fast results. But what many people don't understand, initially, is that meds aren't the only answer and won't help everything.

Behavior modification/management is takes time and is a slow process, however, very much worth while It also takes a lot of consistancy, but again, very worth while.

A combination of meds and behavior management is definitely the best way to go.

saskman
01-29-06, 10:11 AM
I'in a similar position where medications help certain aspects of my ADD but cause highly negative physical side effects. Strattera pushed my blood pressure into the 140's and gave me tinnitus. Now dexedrine is causing similar bp problems and is creating anxiety and anger. It's got me worried. I won't read or pay attention to most things that require a certain level of concentration (reading a manual) This is a problem at work. Can any behaviour modification program affect how one concentrate's?

Roy G Biv
01-29-06, 11:11 AM
Great information, now back to our regularly scheduled question:

Do doctors throw pills at a patient as a reflex action(or, kickbacks from the drug companies)?

Here's a better way to put it......if I were obese, would they prescribe weight-loss medication, or put me on a diet?(Let's not over-rationalize).

SnappyCloud
01-29-06, 11:41 AM
Sorry, it is not a question that can be answered with a simple yes or no.

Using your weight loss example, I would say most docs would put you on a diet.

If you have a bacterial infection, they would give you antibiotics.

Other less obvious situations are handled differently (same problem, different treatment) by different doctors.

Yes, many doctors are in bed with drug companies. Their prescriptions are being tracked and monitored by drug companies. Have you seen the large-breasted drug company sexy representatives at medical offices? Some doctors are invited, together with their families, to week end retreats (all expenses paid!) at resorts. Oh, they may need to attend a short "conference" while they are there.

mctavish23
01-29-06, 02:41 PM
ROY,

Doctors..... DO NOT GET KICKBACKS.

My dad was a physician. He put himself thu med school in the Depression.

I had the priviledge of working with him in 2 different settings (private practice and when he served a staff psychiatrist at the correctional facility where I was working) before he passed away.

MY DAD NEVER GOT A DIME FROM PHARMACEUTICAL CO's.

I've been practicing as a psychologist since April/May of 1977.

I've been licensed in Mn.since Feb.1985

Jan.24th was my 22nd anniversary at the rural, non-profit community mental health center where I work.

We have a total of (4) psychiatrist's and (4) Clinical Nurse Specialist's (who can also prescribe);working in 3 different settings.

NO ONE GETS ANY KICKBACKS. NEVER HAVE OR WILL.

For that to happen, it would mean multiple violations of tax laws,interstate commerce, restraint(s) of trade, as well as stock manipulation.

The IRS, Postal Service, FBI, and the SEC would be kicking in doors and the Federal RICO staute violations would be front page news.

The bottom line is THERE ARE NO **** KICK BACKS.

Dr.'s are all trained in the Medical Model. They ALL prescribe, regardless of specialty.

SNAPPY, THAT COMMENT IS COMPLETELY/TOTALLY FALSE.

I CANNOT BEGIN TO TELL YOU HOW MUCH THIS INFURIATES ME.

THE AVERAGE PRACTITOINER GETS COFFE CUPS AND STICKY NOTE PADS AND COOL/WEIRD PENS.

I get invited to dinner presentations by the SHIRE rep,evern tho I dont prescribe.

The invitation is based on my expertise and passion for the subject.

PS.

No one I know or have ever worked with in NC,Texas, GA,or Minnesota, has ever gone on a *** **** vacation junket.

***** getting edited. This is offensive as he** to me.

mctavish23
01-29-06, 02:49 PM
saskman,

Straterra jacked my BP up to where it landed me in the hospital.

Now that I've switched to Addderall, we've increased my BP med (Monopril).

I get my BP checked at work and it seems to be doing the job.

I wish you a lot of luck.

My experience with Straterra simply means I can't take it.

I also recall it took a very long time to get out of my system.

For many, it seems to be helpful, although I havent' seen it do much with kids.


good luck
mctavish23 (Robert)

Roy G Biv
01-29-06, 03:10 PM
Hey, my comment was tongue-in-cheek, nothing more.

mctavish23
01-29-06, 06:25 PM
Sorry. I realized that, and I wasn't really upset till I read the other post.

That's what set me off.

That subject has come up before and I went off on whoever suggested it then.

I have no doubt I'll do it again, if it comes up.

To me, this is like an urban myth or something.

People often assume different things about ADHD that aren't true,although this would go beyond that with respect to other disorders,etc.

To me,the most interesting thing about all this is that no one ever really pinpoints the real "bad guys."

This is strictly my opinion, but that would pertain to Managed Care companies.

About 7-8 yrs ago, the Minnesota Pych. Association had the state's Attorney General Mike Hatch, as our Annual Conventions keynote speaker.

He's the one who took on Big Tobacco and won.

Let me try and paraphrase what I heard him say.

He picked one Managed Care co. at random; in this case it was Allina.

What he told us was that their top executives took numerous (lavish) trips that were paid for by outside interests ( he didn't specify, but there's your juncket).

He also said,and now get this,that the top execs also belonged to not one, but SIX country clubs (apiece).

All of that paid for by the company.

Meanwhile, people are getting turned down for services.

While mentally ill and the handicapped are some of the easiest targets for discrimination, children are also in that same boat.

Thats's still not the best part (or most infuriating, depending on how you look at it).

Each top exec. reportedly had.......SOLID GOLD GOLF BALL MARKERS.

He went on to say that, because these complanies are set up as "Non-profits," he can't sue them.

He did successfully sue BCBS and they have become much easier to deal with.

I don't recall the guy's name who made the documentary about the Pres of GM, something about Roger and Me, but I did recently hear that his next film is on managed care.

I certainly hope so. So stay tuned for that.

Snappy, I don't know you or have anything personal against you.

However, when it comes to ADHD and related issues such as this, I'd clothesline the Pope;with no remorse.

tc

Tara
01-29-06, 06:44 PM
If you are seeing a medical doctor for AD/HD then it makes sense that medication would be the line of treatment. If I go to a medical doctor for a sinus infection I usually get a prescription of antibiotics. Like medication for AD/HD, antibiotics are not the only way to treat a sinus infection but that's how medical doctors are trained. The treatments are also supported by research.

My body doesn't always respond well to antibiotics and it's my choice as an adult not to take them. Even if I leave the doctors office with a written prescription for them it's my choice whether or not fill the prescription. If I choose not to follow the 1st line and most researched treatment for my sinus infection then I believe it's my own responsibility to research other methods of treatment.

Like AD/HD many of the other types of treatment for my sinus infection do not have the research behind them to support them. This doesn't necessarily mean they won't work. But, since they don't have much evidence behind them I don't feel it is the responsibility of my doctor to suggest them or even make me aware of them.

Tara
01-29-06, 06:47 PM
I think it all depends on how obese you are and how long you have been obese. If you have struggled with obesity your whole life and it is a real health issue a good doctor might suggest medication. He or she might realize that it's a not as simple for you to just go on a diet and lose weight.




Great information, now back to our regularly scheduled question:

Do doctors throw pills at a patient as a reflex action(or, kickbacks from the drug companies)?

Here's a better way to put it......if I were obese, would they prescribe weight-loss medication, or put me on a diet?(Let's not over-rationalize).

SnappyCloud
01-29-06, 07:20 PM
Snappy, I don't know you or have anything personal against you. However, when it comes to ADHD and related issues such as this, I'd clothesline the Pope;with no remorse.tc
Robert, I'm sorry you got offended.

There are a few docs in my family (good ones, like most) and I worked over ten years on the management side of the managed care industry. My experience is different from yours - a couple of bad apples might be ruining it for the rest. I hope you realize that I did not iimply that all doctors are guilty and that I was not talking about ADHD.

barbyma
01-29-06, 07:47 PM
It doesn't matter if you're seeing a psychologist, a psychiatrist, or a GP. The first line of treatment that a knowledgeable practioner uses is medication because medication works. Period.

Why is it the first? Why not try the other things you mentioned first?
Because they do not work. At best, they are short-lived band-aids.

Here's the landmark study that Robert usually cites for these questions:

The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

This study found that treatment with medications was far superior to any other treatment. They recommended a combination of medication and behavior therapy because, although this combination did not improve AD/HD symptoms more than medications alone, it was reported by participants to improve nonAD/HD behaviors.

Meds work. Behavior therapy helps if meds are also used.


No, medication cannot do the work for me, but I cannot do the work without it. Ditto for my son. Medication doesn't make me succeed, it removes the roadblocks that sometimes keep me from succeeding.

mctavish23
01-30-06, 12:17 AM
No problem, you're cool.

Things have actually improved ,as far as getting prior auths for testing.

Now that there's an evidenced based format for ADHD assessment, I get exactly what I ask for.

Tara
01-30-06, 01:12 AM
I don't agree that they other things don't work. We don't really know if they work or not. The truth is that we do not know whether they work or not because there hasn't been enough research conducted on many alternative and/or complimentary treatments for AD/HD.

Research does suggest that medication does work in about 70% of those with AD/HD. Since there are around 30% who do not benefit from medication and a percentage who can not take AD/HD medication for health related issues I really hope that more research continues to be done on other treatments too.

It sounds like you are saying that if a person is not able to take medication that there is no other treatment for him or her???

I don't belive that the be true since I know quite a few people with AD/HD who do not take medication and who have been able to manage their AD/HD and even thrive with it. Some have chosen not take medication, some can't take it, and some didn't find any help after several different trials.



It doesn't matter if you're seeing a psychologist, a psychiatrist, or a GP. The first line of treatment that a knowledgeable practioner uses is medication because medication works. Period.

Why is it the first? Why not try the other things you mentioned first?
Because they do not work. At best, they are short-lived band-aids.

Here's the landmark study that Robert usually cites for these questions:

The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

This study found that treatment with medications was far superior to any other treatment. They recommended a combination of medication and behavior therapy because, although this combination did not improve AD/HD symptoms more than medications alone, it was reported by participants to improve nonAD/HD behaviors.

Meds work. Behavior therapy helps if meds are also used.


No, medication cannot do the work for me, but I cannot do the work without it. Ditto for my son. Medication doesn't make me succeed, it removes the roadblocks that sometimes keep me from succeeding.

Scattered
01-30-06, 01:40 PM
Is there any law that says meds have to be prescribed before trying anything else?

In my own experience(I'm 48, diagnosed Aug. '05), I was questioned for twenty minutes then put on Straterra(I didn't want the standard stimulants). My doctor said I was '7' on a scale of ten(again, this is after 20 minutes of questions-not exactly a textbook diagnostic progression).

After a while, he suggested the book 'The Complete Idiot's Guide to Managing Your Time'. I got the book(haven't got around to reading it yet:p )and also took myself OFF the Straterra-didn't notice much difference except for the side effects. I'm also hearing about 'Driven to Distraction' and 'Delivered From Distraction'.Less than optimal diagnosis but probably pretty typical if you saw your family doctor. A proper work up by a psychologist familiar with ADHD can be very valuable. The books my psychologist recommended first were Driven to Distraction and So You Mean I'm Not Lazy, Stupid, or Crazy. Stimulent medication generally works better (not to mention faster for many ADHD folks).

Since the vast majority of ADDers are highly intelligent, why not go a more 'homeopathic' route, like coaching, education and support before prescribing meds? Seems to me that would be the FIRST option. If THAT doesn't work, then explore med options.There is nothing wrong with this except that by the time most folks start asking for professional help with their ADHD their problems are serious enough that they need right now help. Meds have a very good track record. Also doing therapy without meds for someone with more than very mild ADHD probably will be of limited effectiveness -- just too hard to remember and implement what you learn there. Coaching might be more effective since it is more regular and on site. Personally, I tried the education, diet, exercise and so forth approach first and it helped a little, but not nearly enough. Meds made a huge difference for me. You might like Daniel Amen's book, Healing ADD -- he discusses supplements, exercise, diet and such that can be helpful for ADHD.

I hate to think of doctors as pill-pushers, but why not go the SIMPLE route first??Meds are the simple route -- you may have tried the wrong med for you first. I think I read somewhere that Strattera worked well for something like 50% of folks. Stimulents are around 70% -- don't hold me to exact percents but those are in the ball park. There is still a lot to learn about adult ADHD -- hopefully things will improve with further research and the number of options will broaded -- hang in there and educate yourself all you can -- I'm dubious about wasting your time with the Idiots book though.:)
Scattered

mctavish23
01-30-06, 03:10 PM
Tara,


Here's what we DO know:

1) There's 30 years of research showing that diet/nutirtional supplements don't work as a clinical treatment for ADHD;

2) The research on other alternative treatments such as Biofeedback, have continued to show that they don't work with respect to ADHD.

The ADHD Handbook : Third Edition (2005) by Russ Barkley and The US Surgeon Generals Report on Mental Health ( Chapter 3 : Disorders of Infancy, Childhood & Adolescence) are my references.

This has been a consistent trend since the 1970's.


P.S.

The MTA study has been replicated and continues to be a "landmark" study.

ADHD usually sets statisitcal significance @ 1 & 1/2 SD's above the mean.

That translates to the 93rd %, which means that those data are separated from random chance 93 x's out of a 100.

With anecdotal information, there's no way to document anything.

Hence, it's no better than random chance.

barbyma
01-30-06, 08:50 PM
ADHD usually sets statisitcal significance @ 1 & 1/2 SD's above the mean.

That translates to the 93rd %, which means that those data are separated from random chance 93 x's out of a 100.
I think that 93rd standard is for diagnosis. The standard in psychological research is almost always 95% confidence. But, most results sections list p-values now, so we know exactly how confident to be.

In that study, the p-values for the primary results are all below .03, and almost all of them are below .001. This means they are separated from chance more than 999 times out of 1000.

I guess it's not surprising that it replicated. ;)

mctavish23
02-01-06, 12:34 AM
np,

I was really paraphrasing what Russ said regarding research.

I've been so swamped that I haven't had a chance to really wade into the third edition of the ADHD Handbook; but I will eventually.

I usually use the 90% CI for test scores, but I know what youre saying.

sherigraph
02-01-06, 04:23 PM
Well, my son is 17 and medication helps fastest. Stratterra was terrible, then we did nothing except work with him on trying to be consistant and routines. That only helps you so far and with a teenager, it doesn't always work. He would tell me that. So now he is on Adderall XR, which is working pretty good. We still try to use consistancy and routine with him, but without the meds, he would probably still be failing. I say if the meds work, go for it, but be carefull.

Tara
02-01-06, 09:36 PM
As a person with AD/HD myself I'm not going to wait around to see if some other treatment which could take 6 months to a year to work when I know that medication can help me with in a few hours of taking it. I just can't see many others particpating in studies waiting around either.

I often wonder extactly what is meant by superior treatment too. Does it just mean better or does it mean quicker too?

From scientific stand point of view I know anecdotal doesn't mean much but as both a person with AD/HD and a professional I pay attention to it. Take AD/HD Coaching for example. Sam Goldstein currently wrote an article about the lack of scientic eveidence to support AD/HD Coaching as a treatment to AD/HD.

There is currently no way to really measure AD/HD Coaching as a treatment option. However this doesn't mean it does or doesn't work. Since many AD/HD experts reccomend AD/HD Coaching and many people with AD/HD claim to benefit from it some may jump to the conclusion that it does work and help people with AD/HD.

Since there really is not research behind AD/HD coaching should people just assume it doesn't work to help treat AD/HD? Should people wait around until somebody comes up with a way to measure whether it does or doesn't work?

I really don't think there is right or wrong. I think what important that that people take the time to carefully research any type of treatment before jumping into it.

Tara,

Here's what we DO know:

1) There's 30 years of research showing that diet/nutirtional supplements don't work as a clinical treatment for ADHD;

2) The research on other alternative treatments such as Biofeedback, have continued to show that they don't work with respect to ADHD.

The ADHD Handbook : Third Edition (2005) by Russ Barkley and The US Surgeon Generals Report on Mental Health ( Chapter 3 : Disorders of Infancy, Childhood & Adolescence) are my references.

This has been a consistent trend since the 1970's.


P.S.

The MTA study has been replicated and continues to be a "landmark" study.

ADHD usually sets statisitcal significance @ 1 & 1/2 SD's above the mean.

That translates to the 93rd %, which means that those data are separated from random chance 93 x's out of a 100.

With anecdotal information, there's no way to document anything.

Hence, it's no better than random chance.

Bean Delphiki
02-02-06, 07:43 PM
Since the vast majority of ADDers are highly intelligent, why not go a more 'homeopathic' route, like coaching, education and support before prescribing meds? Seems to me that would be the FIRST option. If THAT doesn't work, then explore med options.

I hate to think of doctors as pill-pushers, but why not go the SIMPLE route first??
SIMPLE route? :eek: :confused:

I tried everything I could think of before I went to the doctor, including every organization system known to man, time management classes of all sorts, various combinations of vitamins and diet, and blah blah. I read numerous books on ADD, and tried to make my life more "ADD-friendly." I don't think coaching would work well in my case, simply because I hate people interfering in my life so much I'd probably deliberately rebel. But I tried most everything else I could with my own resources.

None of it was simple, and none of it WORKED very well. And my ADD is supposed to be mild, gah. I'm just praying at this point to find a med that works well enough that I don't have to drop out of my career path again - changing schools, changing programs has already cost me several thousand dollars because I landed myself in programs of study where I couldn't cope.

If not, well...I will have to re-structure my life yet again and try to find something that work better. I will likely have to do that anyway - I chose the path I'm on before discovering I have ADD - but I would like to at least have some time to choose the best off-road to take, instead of being forced to scramble with financial resources yet again.

mctavish23
02-02-06, 08:50 PM
Roy,

Simply put; the "majority" of ADHD's have NOT been found to be highly intelligent.

The range of IQ scores literally runs the gamut from Mild MR to Very Superior/Gifted.

The other point to make is that HOMEOMPATHIC REMEDIES DO NOT WORK.

My profession and it's accompanying ethical principles, require me to keep up with the literature,so as to provide the parents of the (ADHD) children I work with, the most up to date evidenced based (research substantiated) information.

There's absolutely NO research supporting ANY of those alternative treatments as working for ADHD. Zero.

As far as the issue of diet goes, I'll paraphrase what I heard in Sept,when I attended a presentation by a Neurodevelopmental Pediatrician from the Phila area.

What she made a point of saying about diet had to do with questions like "Since dopamine is a neurotransmitter AND an amino acid, why can't I just give my kid amino acids like L-Dopa?"

The answer is that the main route through the brain that dopamine "travels" is the Mesocortical Pathway.

The answer is it won't work because "L-Dopa Doesn't Work in the Mesocortical Pathway."

Scattered
02-11-06, 07:40 PM
As I was reading title of this thread it occured to me that one very good reason for trying meds first is so you have a baseline improvement to measure against. I may try supple X and find some improvement, but if I've never tried well researched medication I may never realize that the 5 % improvement I got was nothing compared to the 50% (figures totally made up to make a point) improvement on medication. I literally didn't know how bad I was doing until I started meds. I thought a lot of the problems going on were other people's faults. It was sheerly amazing how other people improved when I started meds!:rolleyes: I was clueless about what a large part of conversations my brain was editing out, how much I forgot, how volatile my emotions were, etc. I didn't know what I was missing before I tried medication. Even at what I would have called my best period (college making high honors) I was making personal decisions of such an impulsive nature that they could have cost me my life, health, or career. It's only in retrospect after starting medication that I look back and go wow -- was I ever skating on the edge of disaster. My mind has this funny little edit function where I tend to remember only the good and dismiss the bad. With meds both are a lot clearer to me.

I guess my position is that if the impairments from ADD have become serious enough to seek professional help, than they warrant a trial of medication to see what kind of improvement is possible.

Also there is nothing necessarily any safer about homeopathic medication. I had a friend with heart trouble who went to see a homeopath and was almost killed by the "safe natural treatment" he was given. Fortuantely, his accupuncturist told him to see a medical doctor who gave him lots of drugs and saved his life. As my husband frequently reminds me, snake venom is all natural, but that doesn't make it safe.

Scattered

barbyma
02-11-06, 07:54 PM
I literally didn't know how bad I was doing until I started meds.
:eek:

Have you been in my head?

I knew I had problems. I knew I wasn't thinking as clearly or as quickly as I did once, but I had NO idea just how bad it gotten. As I've recovered more functioning (it's taken some time), I notice more and more of what I've been missing the last few years.

Scattered
02-11-06, 08:55 PM
:eek:

Have you been in my head?

I knew I had problems. I knew I wasn't thinking as clearly or as quickly as I did once, but I had NO idea just how bad it gotten. As I've recovered more functioning (it's taken some time), I notice more and more of what I've been missing the last few years.It's possible -- I get lost and can end up almost anywhere!:p

Actually, getting lost in your head might be a fun learning experience -- there seems to be an awful lot of interesting stuff happening up there!:) Maybe I could pick something up by osmosis!

Scattered

ADDfor2
02-28-06, 08:17 AM
Hi Roy,

I totally understand how you feel. When my daughter was diagnosed, the school was hinting medication as all of the children that have ADD in her school were on meds. I think right now we could possibly have been the only ones that aren't. Every child that my daughter and I know of(including her best friend) are on meds. Interesting isn't it. I'm of course not closed minded about them, but I believe you should try other methods also and they work, then great. I am currently looking into some information on some sensitivities my daughter has and am hope some type of therapy may work. She makes A's and B's in school and is not on meds. I am going to look into some of these books suggested and I am thinking about having my daughter join me in counseling but I know she doesn't want to so that will be a tough one. So far we are doing ok with no meds. but I do agree that the first thing that is suggested is usually medications and we so far have not had to go that route. Dee

katatak
03-12-06, 03:58 AM
I have a thyroid problem. It runs in my family, on both sides so it was not a surprise when my GP told me abou the blood test resutls.

Should I have tried Behavious Modification to get me up out of bed in the morning? Of course not! When you have a lack of some hormone, the first course of action is to try to replace it. As it turns out, this is they *only* way to treat hypothyroidsm.

ADHD is a malfunction fo the Dopamine and Norephinpherine nuerostransmitters. We know this. So why would you not try and replace these neurotransmitters?

This is a basic question where we *know* for sure that this is neurological in origin. While you can change how you react in some situations and you can repair psychological damage done by years of not being diagnosed, you will never change the biological malfunctions by behaviour modification ro any other psychotheraputic methods. They are band aids which keep slipping off and failing by themselves.

Why on eath would you not go right to the heart of this physiological malfunction? I have spent *years* using all manner of psychological methods, and I can tell you that they do not work in any sort of permanent way. The only way is to take soemthing which replaces those neurotransmitters.

I cannot for the life of me uderstand why people have this view of dexedrine and methylphenidate which borders on giving them supernatural powers to addict people. Both Dexedrine and methylphenidater are now generic drugs, so drug companies are not making wheel barrows ful of money selling them.

I have found most GP's loathe to write a prescription for these drugs, so I don't know where you get that doctors instantly write prescriptions for them. They don't. One study at Harvard claims that Adults with ADHD are being *undermedicated*, not over.

This is a matter of logic, pure and simple.

chloe516
03-12-06, 11:00 AM
I was diagnosed when I was 20 (am now 24), chose not to take meds. This was in part to my disbelief that I had ADHD and in part to my belief that I was doing okay without meds.

As I have thought about my difficulties, I have realized while I am doing okay without them (I too get only As and Bs on report cards, I have never been fired...) I was always so frustrated with myself because I could not focus to study. I keep losing things and have difficulty with social skills.

I not feel that if I can do even better with meds, and have some of the difficulties that have made me feel so badly about myself made better, I am now willing to do it.

Point: I tried doing it without meds, had HORRIBLE self-esteem even though to others I do well, so now I am trying meds.

mctavish23
03-12-06, 02:07 PM
katatak,

That was very well stated. Thank you.

ADHD is actually underdiagnosed.

I've seen no data that people with ADHD are overmedicated either.

jacey
03-13-06, 03:07 AM
Meds work? for some of us they do, some of us they don't. But is it so unbelievable that we all need to learn coping strategies- i.e. behavior modification?- sometimes meds make it easier to start over- learn some new things- but in the end with or without meds we need to learn what works for us to keep our life on track and sort-of organized. Not the same tricks or techniques for all of us- every aDDer is unique and sometimes you have to try a lot of stuff before anything works- but don't give up. In our house- 2 ADD parents and 2 ADD kids make it work- at least most of the time. Yes, sometimes our house is messy, yes we still aren't really organized by normal standards but we are stable and happy most of the time. We are grateful we have each other because no one else gets it. We support each other- ADD can be a pain at times and yes we are all at least occasionally annnoyed at each other. Believe it or not, there can be good things about ADD occasionally. On our good days we can be creative, high energy people who don't sweat the small stuff. Even whe the kids are their most irritating we have been there - we know thay are not just being defiant. I was raised by NON ADD parents and always felt different- my daugher says everyone else is different, we are okay. We've modified our world as much as possible to make it easier for all of us. We are not really soft on the kids but nothing says we have to constantly struggle to be like other people.

addinbc
03-13-06, 04:21 AM
But is it so unbelievable that we all need to learn coping strategies- i.e. behavior modification?- sometimes meds make it easier to start over- learn some new things- but in the end with or without meds we need to learn what works for us to keep our life on track and sort-of organized. OF COURSE....I think that goes without saying. ADDers should learn management and coping strategies to help us in our daily lives. Nobody here ever said anything to the contrary.

However, as a FIRST LINE treatment, medications have proven to be the most effective (I like what Katatak said....).

It is my belief (and personal experience) that only once one is effectively medicated do the behavioural techniques and strategies become practical and can be put to proper use. Undiagnosed for years, I tried and tried and tried to put my life into some sort of order, but just never could. It eventually got to the point that after putting so much energy into just trying to cope with daily living and trying to keep some semblance of order in my life, I ended up totally exhausted, burnt out, broken down and in the psych ward in hospital for a week.

When the Strattera was working for me, it amazed me how easy it was to put into place all those behavioural techniques I had tried with little success for so many years prior!

Behavioural treatments just don't work by themselves. But they are very beneficial (maybe necessary?) once one is effectively medicated.

Just my $0.02 :)

barbyma
03-13-06, 09:38 PM
Meds work? for some of us they do, some of us they don't.
But is it so unbelievable that we all need to learn coping strategies- i.e. behavior modification?- sometimes meds make it easier to start over- learn some new things- but in the end with or without meds we need to learn what works for us to keep our life on track and sort-of organized.
1) Yes. Meds work. For 90% of us.

2) Yes, it is unbelievable that we all need to learn coping strategies. For many of us (me, for example) there is absolutely nothing wrong with my coping strategies or my ability to organize.

My problem is an inability to perform tasks that require focus, particularly when I've been forcing myself. It's purely neurological.

Yes, there are many people who would benefit from organization skills and coping strategies. But, the question had nothing to do with this. The question was: Why try meds first?

barbyma
03-13-06, 09:41 PM
Behavioural treatments just don't work by themselves. But they are very beneficial (maybe necessary?) once one is effectively medicated.

Just my $0.02 :)
The research says they don't add anything significant to treatment with medication in treating ADHD, but they also don't hurt. They don't, however work by themselves, as you said.

They certainly aren't necessary in a general sense.

mctavish23
03-13-06, 10:25 PM
George DuPaul has some intersting work on classromm behavior managment.

Ravenfrost
03-18-06, 11:30 AM
Why? Well, why give a vision impaired child glasses first? Why not just use a better method to teach him to read? After all, he's intelligent, right?

ADD is a neurobiological condition. It is not just a lack of organization. I have tried every book and method I can think of and couldn't use a single one because I could not physically do it. I couldn't remember from one second to the next, follow steps, or concentrate with all the stuff bouncing around in my brain. Believe me, with three children who need proper care, I tried as hard as I could which resulted in frustration and depression. How many times has an ADD person heard that they just don't care enough to get it together?

Well, I went and got "glasses" for my central nervous system, and lo and behold, I can now follow steps, set up systems and routines, be logical, remember things, and have turned my life around. I follow up with counseling monthly. I can't imagine being denied such a simple necessity.

mctavish23
03-18-06, 12:21 PM
Ravenfrost,

Welcome to the Forum.

That was very well articulated.

ADHD is actually a "performance" disorder; due in large part to Working Memory deficits impairing our ability to "stick to" something long enough to finish it.

We know what to do, we just can't do it.

tc
mctavish23 (Robert)

Lunacie
03-18-06, 02:37 PM
I don't think there have been anywhere near the amount of studies done to test the efficacy of supplements and homeopathic remedies as has been done for prescription meds. I started taking Omega 3 (fish oil) supplements about 3 months ago and could see a difference almost immediately. I can also see a difference when I forget to take the supplement. There is no question in my mind that it works and works very well for me.

BTW, I have ADD, not ADHD. I think the first poster said he had been diagnosed as ADD, I'm not sure when the focus of this discussion became ADHD alone.

Roy,

Simply put; the "majority" of ADHD's have NOT been found to be highly intelligent.

The range of IQ scores literally runs the gamut from Mild MR to Very Superior/Gifted.

The other point to make is that HOMEOMPATHIC REMEDIES DO NOT WORK.

My profession and it's accompanying ethical principles, require me to keep up with the literature,so as to provide the parents of the (ADHD) children I work with, the most up to date evidenced based (research substantiated) information.

There's absolutely NO research supporting ANY of those alternative treatments as working for ADHD. Zero.

As far as the issue of diet goes, I'll paraphrase what I heard in Sept,when I attended a presentation by a Neurodevelopmental Pediatrician from the Phila area.

What she made a point of saying about diet had to do with questions like "Since dopamine is a neurotransmitter AND an amino acid, why can't I just give my kid amino acids like L-Dopa?"

The answer is that the main route through the brain that dopamine "travels" is the Mesocortical Pathway.

The answer is it won't work because "L-Dopa Doesn't Work in the Mesocortical Pathway."

mctavish23
03-18-06, 04:34 PM
Starting with the Feingold Diet,there are 30 + years of research that absolutely back that up.

I'm not opposed to the idea at all.

In fact, it would be great news as far as I'm concerned.

My comments are strictly related to the state of the science and are accurate .

The research isn't limited to one type of ADHD.

Today, everything is called ADHD.

The previously defined ADD is now ADHD- Predominantly Inattentive type.

Part of my job is to keep up with the literature, which I do on a regular basis.

This refers to all types of ADHD.

If the research changes, then I'll changge with it ( and report it ).

panthoot
03-26-06, 08:04 PM
Re: doctors getting kickbacks-

my doctor is outside of my insurance plan. He prescribed me ADD meds, then had me take the prescription to my HMO and have one of their doctors re-prescribe it so it could be filled under their plan. He is not listed as the prescribing physician and could get no recognition for having prescribed the meds. He says he does this all the time with HMO patients.

As to being too quick to prescribe meds, I was 29 when I was diagnosed. I tried for YEARS to change my behavior on my own, without knowing specifically what they were caused by, and was unsuccessful. I also have many years of coping mechanisms and bad habits to unlearn. Drugs are not an "easy fix-" they're what makes it possible for me to actually make the behavior changes stick.
My doctor has always emphasized the importance of therapy and behavior modification in partnership with drug therapy. I think if your doc prescribes anything as a magic pill that'll cure you, you should switch to a doctor who better understands ADHD.

vegansoprano
03-29-06, 10:28 PM
The same reason why someone with juvenile diabetes is put on insulin right away instead of being told to modify his/her diet.

AD/HD is a neurochemical disorder, not a behavior disorder. It is most effectively treated when this is recognized.

I spend almost 24 years undiagnosed and trying to modify my behavior. No surprises here - it didn't work. One dose of meds did more than all the "trying hard" in the world.

Alekat
04-02-06, 02:07 AM
Why not go the simple route first? What's so "simple" about suffering all the time? You obviously don't have severe ADD and it didn't play havoc with your life. Meds are not a panecea for everything but they are a great RELIEF to the brain and struggle of an ADD'er.

PlainlyOrdinary
04-16-06, 09:08 PM
i think a more appropriate question would be, "wht not?"

sss180b
08-25-06, 05:08 AM
medication is usually the first option because it is the fastest acting. alternative treatments take time and can be really expensive. Also because adhd is a common childhood disorder, teachers and parents need treatment to be fast acting. this might not be applicable to you because you're not a kid! :D i found this website, it has some really good information for treatment options: (link removed by Admin)

barbyma
08-25-06, 11:26 AM
medication is usually the first option because it is the fastest acting. alternative treatments take time and can be really expensive. Also because adhd is a common childhood disorder, teachers and parents need treatment to be fast acting. this might not be applicable to you because you're not a kid! :D i found this website, it has some really good information for treatment options: ...Medication is not the first option because it is fast-acting.

It's the first option because it is the only proven treatment and it works in approximately 90% of cases.

There are no "alternative treatments" that work at all no matter how much time you give them.