ADHD is classified as a neurodevelopmental disorder that is most commonly treated with medication. Although it is a relatively new disorder, there is already a very standard and popular protocol for treatment, but there are notable gaps in that protocol, specifically in alternative treatment options, support and advocacy, and symptom management tools. I am going to identify those gaps and suggest an alternative protocol to fill the gaps using research and my own lived experiences by presenting 5 touch points that should be carried out by medical professionals.
In the United States, the existing model and dominant view that we operate from is the medical model. In this model, the emphasis is placed on the condition or disease, and the treatment is dictated. Social, psychological, and behavioral elements are left out of the equation. Since ADHD is a neurological disorder, how can it be treated effectively without taking those things into consideration? The answer is, it cannot be without flaws.
In context, using the medical model, ADHD is viewed as a mental disease and it treated with medication. In the United States, we mass produce and do everything from transportation to food at a high pace, and the medical system is no exception to that. Using the medical model, doctors are able to give care to more patients in a shorter duration of time, which is a good thing, but because of the high pace, the care isn’t always adequate. This model is adequate for straight forward medical needs such as treating a broken arm, but not for multifaceted conditions such as ADHD.
Another driving force for the prevalence of the medical model in the pharmaceutical industry, which we know is one of the largest industries in the world. In 2017, the United States pharmaceutical industry was worth a whopping $ 934.8 billion, and it is predicted that it will only increase from here.
In contrast with the medical model, the biopsychosocial model operates from the idea that “Illness and health are the result of an interaction between biological, psychological, and social factors.” This model, developed by George Engel, was developed due to the inadequacy of the medical model.
The biopsychological model breaks down health and illness into three main categories: biological characteristics, behavioral factors, and social conditions. From what we know about ADHD, it is clear that this model is complementary and addresses all aspects the disorder, which is why I based my proposal off of this model.
Individuals are most commonly diagnosed with ADHD during childhood, but it is becoming more and more prevalent to be diagnosed throughout life, even in adulthood. Diagnosis is usually initiated due to concerns raised by family members or educators. Since ADHD is such a common condition, there is a protocol for the turn of events that have to occur leading up to the diagnosis, with some slight variance between practices.
According to The Center for Adolescent & Young Adult Health, current practice with ADHD diagnosis and treatment begins after a concern has been raised with the initiation of a neuropsychological evaluation. From there, the patient is referred to bring their diagnosis to one of two places, either their primary care physician or a psychiatrist in order to develop a treatment plan.
As a patient, I have experienced this protocol first hand, and through that I have gained a unique perspective of the procedures. My experiences along with my continued education in Integrated Health Sciences has led me to a deeper understanding of the gaps in the process, and the ways this system could be improved.
The most prominent treatment in place for ADHD is medication. There are an abundance of medications out there to treat ADHD, most of them being stimulants such as adderall, adderall XR (amphetamine and dextroamphetamine) that individuals receive from either their primary care physician or a psychiatrist.
As research on this condition continues to progress, it is becoming clear that ADHD is not a unidimensional disorder, so how can it be treated by a unidimensional method such as medication? Operating from the biopsychosocial model, medication has only addressed one aspect of illness, and there are still two that are left vacant, which are where the gaps are found
Coming from an angle of someone who has ADHD and has been helped tremendously from ADHD medication, I am the last one to bash it, but I am here to criticize it. There is a tremendous lack of knowledge of alternative treatment options that can either be used in place of medication or be used in combination with medication to achieve the best outcome for the individual.
If you ask a ten different people with ADHD to explain their symptoms to you, you will probably get some overlap, but each individual will give you different answers. This is because no two people experience it the same. It makes sense because as human beings we may all have similarities, but we all have individual differences as well. So my criticism is that we are trying to treat a multifaceted condition that is substantially different case to case by one solution, which is medication.
Whether is it used as an alternative option to medication, in combination with medication, or simply a recommendation for people who suffer from ADHD, alternative options in the realm of lifestyle adjustment such as diet, physical activity, sleep, and behavioral therapies should be an integral part of treatment. As of now, operating from the medical model, this is not a part of treatment at all. Operating from the biopsychosocial model, these things would be considered an important aspect of treatment, and the fusion of more than one approach would be essential for best treatment.
The last gap in the system is during post treatment. At this point, a patient has been diagnosed, treated, and sent on their way with a medication that is supposed to treat their ADHD. In most cases, there will be follow up phone calls or check ups after the initiation of treatment where they will be asked how the medication is working for them. If it is working well, they will then go back to seeing their doctor or psychiatrist only when necessary, and if it not working well, they will adjust the medication until they find one that works for them.
Circling back to reflection on my own experience, this was where one of the major holes was for me. I was prescribed adderall XR, my doctor selected this medication due to the fact that one of my siblings was on it, and sometimes that can be an indicator that it would work for me too. I felt relieved that I was struggling less with my symptoms of ADHD, especially in school, and everything was good for awhile.
After about a month of being on the medication, my anxiety and depression increased, my appetite was descending, I was having trouble sleeping, and I started crashing. This was the part that my doctors did not prepare me for. I kept taking the medication because it was sufficiently helping me academically, but my overall wellness was diminishing and I felt overwhelmed in every sense of the word.
Eventually, I reached out to my doctors for support. They addressed everything I told them as a separate issue, and not as being related or caused by the medication. They recommended that I see a therapist, but gave me no instrumental tools of my own on how to continue taking this medication that was helping me so much or how to combating the side effects I was facing. Although I didn’t realize it at the time, there was a lack of support and advocacy during that experience and I was forced to figure out how to manage everything I was going through on my own via trial and error, which I should have never had to do.
Our doctors are prescribing us these medications, so shouldn’t they be equipped with all of the tools necessary to ensure that us, as the patients, are getting the best treatment, outcomes, and maintenance possible? I will not say that there is no support and advocacy for patients seeking treatment for ADHD, but there is a considerable lack throughout every aspect of the process.
Best Practice: Proposal
On the basis of research, the existing model, the treatment in place, my education in integrated health sciences, and my own lived experiences with ADHD, I am proposing five touch points to fill the gaps in ADHD treatment.
1. Education of the patient or the patient’s caregiver
First and foremost, there should be a discussion about the neuropsychological diagnosis and the health professional must ensure that the patient fully understands the diagnosis and suggested treatment
2. Individual evaluation
Health professionals must look at the whole person in order to reach the best treatment plan. They can do this by looking at all pre-existing conditions, getting blood work to make sure there are no underlying issues, and administering a self – evaluation.
3. Lifestyle evaluation
Administer patients with a lifestyle evolution that encompasses questions about their diet, physical activity, and sleep.
Following the evaluation, provide patients with the existing guidelines relevant to their age and provide suggestions based upon their individual differences, and offer them resources that give them lifestyle choices specifically catered towards people with ADHD. (i.e. the mind diet).
4. Create a treatment plan
With all things considered, discuss the best treatment plans for the patient. Give the patient multiple options based upon their diagnosis, individual differences, and lifestyle.
If medication is a part of their treatment plan, ensure that the patient is fully aware of what the medication is and all of the potential side effects. Regardless if medication is a part of their treatment plan, integrate options of lifestyle recommendations or adjustments, and behavioral therapy that can be used alone or in combination with medication.
5. Support & advocacy
Ensure that the patient feels like they have an adequate understanding of everything covered during the appointment. Schedule a follow up appointment and confirm that the patient knows how, and that they can contact the medical office if they have any questions or concerns.
Provide the patient with guidance and encouragement to take advantage of any resources relevant to them (i.e. the accessibility office here at PSU), and give them a referral to therapist if they are interested.
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