When medication isn’t enough: 5 areas ADHD medication may not help

ADHD medication

When it comes to approaching attention deficit/hyperactivity disorder (ADHD) in kids, parents, physicians, and the Centers for Disease Control agree that medication should not be the first line of defense.  The CDC recommends parent training in behavior management and behavioral classroom interventions as a starting point.  A focus on managing challenging behaviors is only addressing one aspect of a developmental condition that can have a whole-child impact.  The next line of defense is considered medication, however crucial areas of a child’s well-being are impacted minimally or to varying degrees with ADHD medication including academics, social interactions, physical growth, and self-esteem. While medication can be extremely helpful in many scenarios, some families hope to avoid the use of medication, while others find medication to fall short of addressing the problems they are experiencing.  

Parenting isn’t easy, and parenting a child with ADHD can add additional stress as you help your child navigate school, friends, and home life. Disruptions in attention and behavior can derail success in each of these areas of life.  When this happens, it can leave both kids and parents feeling like failures, impacting a child’s self-esteem, and leaving parents scrambling for help and guidance.  

During these times of stress, parents start searching for ways to help their child. Scrolling the internet, or calling friends and family for advice can be helpful, but it can also be overwhelming, and frustrating. This journey typically leads parents to the possibility of medication but few other alternatives to use before, during, or after trying medication. Google Trends data shows over the past 5 years the number of searches for non-medication treatment for ADHD is on the rise (and this was prior to the current Adderall shortage). Parents are looking for help, but don’t know where to turn. Beyond medication and behavioral support, determining a clear path forward is not easy.

According to the journal Health Psychology Research, ADHD is one of the most thoroughly researched disorders in medicine, yet we are still left with many unanswered questions. The array of studies has focused on understanding the symptoms and determining to what degree various medications can alleviate some of the symptoms. Where the research falls short is in non-drug alternatives to addressing the vast array of complications. In fact, the CDC has labeled ADHD “a serious public health problem,” based on “the large estimated prevalence of the disorder; and the limited effectiveness of current interventions to attend to all the impairments associated with ADHD.”  Simply put, more information is needed on alternative interventions.  

In January, Harvard Medical School and McLean Hospital published a study aimed to begin to address this void in researched ADHD alternatives.  The study implemented an at home version of the Brain Balance program®, training to determine which aspects of ADHD were impacted and to what degree.  The kids in the study ranged from 8-14 years old and were diagnosed with ADHD. The fifteen-week integrated program consisted of sensory, physical, visual, and Interactive Metronome® timing exercises. The study found a marked reduction in symptoms as reported by both parents and physicians in the ADHD total score as well as in the subcategories of hyperactivity and inattention. The improvements measured were described as change significant enough to be meaningful in the real world. What is worth noting is that the changes documented were similar to those improvements seen in a low-dose stimulant medication. While this study is promising by demonstrating a non-drug alternative to minimizing symptoms of ADHD, more studies of this nature are needed to provide parents with additional evidence-based options.   

As a parent trying to determine the path forward that’s right for your child, start by asking yourself a few questions. First, define your goal. Are you hoping to avoid the use of medication?  Or is your child currently medicated yet there are still areas of struggle?  Then determine the areas of need so you can align the right support for your child.       

All too often parents and professionals focus on the most disruptive symptom, yet for many kids, the impact is far broader. A simple search on the impact of ADHD reveals extensive lists that are long and go beyond inattention including things such as impulsiveness, poor self-image, mood swings, unstable relationships, poor work or school performance, difficulty with time management, multitasking, and following through on and completing tasks. Current medications address some, but not all of the symptoms involved, and can introduce additional side effects and challenges. A Consumer Reports survey of parents with children taking ADHD medication showed that 41% were highly satisfied with the outcomes. While this is excellent, that leaves 59% of parents not highly satisfied, and 44% of parents strongly agreed they wished there was another way to help their child.   

Top 5 areas ADHD medication may not help 

  1. Academics:  Classroom concerns are a hallmark of ADHD with disruptions to learning, classmates, and the environment itself.   Individuals with ADHD have been shown to struggle more with aspects of cognition which includes attention, memory, task switching, reasoning, and comprehension. When it comes to medication and learning the theory has been, you can’t remember what you didn’t pay attention to, however, studies involving learning outcomes and medication studies have been inconclusive. While medication has been shown to minimize the number of disruptions and movements, it does not always translate into changed academic outcomes. A large study in Canada explored the connection between medication and outcomes and shared “We find little evidence of positive effects on academic outcomes or schooling attainment. In fact, we find deterioration in important academic outcomes including grade repetition and math scores on discernible learning outcomes between medicated and non-medicated ADHD students.”  Other studies have found an increase in completed classroom seatwork but that “medication has no detectable impact on how much children with ADHD learn in the classroom.”
  2. Peer interactions:  Kids with ADHD can struggle with social immaturity, impulse control and managing their emotional outbursts, which can complicate social interactions, leaving others frustrated and annoyed. In fact, a study shared that 50-60% of kids with ADHD experience social rejection by their peers, versus 13-16% of non-ADHD students. This impact can be seen at all ages with higher divorce rates in adults, and higher rates of both bullying and being bullied which can stem from struggling to fit in and challenges reading social cues. While impulse control can be reduced with medication, it does not directly impact the ability to read and respond to non-verbal social cues, nor mature the social skills.      
  3. Meltdowns and upsets:  Children with ADHD have been shown to experience mood swings and difficulty controlling their temper and reactions to frustrationss. In younger children, this can result in tantrums, and in older kids, this can present with internalizing the upset, becoming highly emotional, and even physical outbursts. Medication usage can both help and hurt mood swings and outbursts, as this is one of the top five most common side effects. This side effect can come from the medication itself or can be seen as the medication dosage wears off or is discontinued.  
  4. Self-esteem:  The combination of challenges at home, school, and with friends can leave kids feeling like they’ve let people down – parents, teachers, and even themselves.  Being aware of the expectations but not feeling equipped to meet those expectations can be discouraging and can leave kids with feelings of,  “I can’t do this, it’s too hard, what’s wrong with me?” The use of medication has shown increased levels of confidence while taking the medication, but that feeling of capability can ebb and flow with usage.  
  5. Physical growth:  The most common side effects of ADHD medications reported by parents include decreased appetite, sleep problems, weight loss, irritability, and upset stomach. Changes to a child’s nutritional intake and sleep can have a direct impact on growth and development, resulting in reduced height as much as an inch or more. 

If medication isn’t helping enough, how can you support the whole child? One potential answer lies in addressing the underlying cause. ADHD stems from the brain, and differences in brain connectivity in key regions. Research has shown that change is possible when it comes to the brain. Specialized exercises can support improving how the brain utilizes pathways that support attention, focus, and impulse control.  Combining activities that engage multiple systems in the brain including sensory, physical,  visual and timing exercises combined with healthy nutrition can be a powerful tool for parents and kids who are looking to strengthen the regions of the brain involved in ADHD symptoms and challenges. 

ADHD is complex and so is its impact on the child. While the condition itself is well-researched, the gap in knowledge around methods to create meaningful change is not. It’s critical that parents have an array of science-based options to choose from in supporting the overall well-being of their child.  Each family’s journey is unique and personal, but know that change is possible and there are many paths to get you there.

Dr. Rebecca Jackson is an industry leader in optimizing brain performance to drive human performance. She brings 12 years of Brain Balance experience to her role as VP of Programs and Outcomes where she drives programmatic enhancements, the creation of new programs, and research on outcomes. Creating hope and an action plan for kids and adults wanting to positively impact their lives is her passion. Dr. Jackson has published research on the topics of anxiety and emotional well-being as well as cognition and is a frequent media contributor and guest speaker appearing on shows such as ABC’s The Doctors Show, NBC’s Nightly News, and more.