The Vatican’s Been Talking About ADHD and the Ethics of ADHD Meds.

Apparently some Cardinals have been having a hard time paying attention in long curial meetings.

Kidding aside, although I am aware that the various Pontifical Councils regularly host scientific conferences on a variety of current medical and social problems, even I was surprised to learn of the large discussion on ADHD and medication that was recently hosted by the Pontifical Council for Healthcare Workers.

One of the presenters has a very interesting summary of reactions to his presentation in which he argued against both the effectiveness and ethics of prescribing medication for ADHD.  His findings–that research shows no real benefit of stimulus-based medication treatment, research based evidence showing medical and psychological problems associated with stimulus-based treatment, and that there are ethical concerns with the practice–raised eyebrows.

Here’s a taste…

 in 1997, Quebec greatly expanded insurance coverage for medications, and in the wake of that change, the diagnosis of ADHD and the prescribing of stimulants in the providence soared, to rates markedly above the rest of Canada. This allowed the researchers to assess whether, as the result of this expanded treatment, the outcomes for children with ADHD in Quebec improved.

Here is what the researchers found:

“The increase in medication use is associated with increases in unhappiness and a deterioration in relationship with parents. These emotional and social effects are concentrated among girls, who also experience increases in anxiety and depression. We also see some evidence of deterioration in contemporaneous educational outcomes including grade repetition and mathematics scores. When we turn to an examination of long-term outcomes, we find that increases in medication use are associated with increases in the probability that boys dropped out of school and with marginal increases in the probability that girls have ever been diagnosed with a mental or emotional disorder.”

Read the rest here.

About Dr. Greg

Dr. Gregory Popcak directs the Pastoral Solutions Institute, an organization dedicated to helping Catholics find faith-filled solutions to marriage, family, and personal problems. Together with his wife, Lisa, he hosts More2Life Radio. He is the author of over a dozen books integrating psychological insights with our Catholic faith. For more info about books, tele-counseling and other resources, visit www.CatholicCounselors.com.

  • Ordinary Mike

    I recognize that the plural of anecdote is not data, but stimulant medication had a powerful and positive effect in treated my Adult ADD, and has greatly improved my quality of life. So there’s that.

  • Hey Nonny, Mouse

    Dr. Popcak,

    I’m wondering whether there might be a difficulty with discerning correlation vs. causation here. Medication-based treatment is surely more likely when children are perceived as “problematic,” since parents will experience a great deal of criticism for as much as accepting a diagnosis of ADHD, much less giving a child psychoactive medication. So it’s not surprising that group would have more challenging outcomes. Did the children improve when medication was withdrawn? That would seem more significant, but I don’t see it here.

    I suppose I should state my perspective/bias up front. I’m an adult with ADHD and chronic major depression who is successfully and non-problematically using a combination of cognitive-behavioral techniques and medication. I did NOT have access to any medications as a young adult because of my fundamentalist upbringing, and as a result endured multiple suicide attempts before finally being helped to understand that God can and does work through science and the physical realm as well as through prayer.

    Thank being said, I am delighted that the Church does examine these claims and present varying viewpoints in the search for truth.

  • S

    I get really irritated at this idea that ADHD is overdiagnosed. In certain groups, especially women, it is underdiagnosed. Read this article about women and girls with ADHD: http://www.theatlanticwire.com/national/2013/04/its-different-girls-adhd/63746/

  • kiwords

    I’m not sure if my first comment went through, so let me try again.
    I’m trying not to get defensive here, but let me just say that correlation is not causation (I bet that’s the first time you’ve ever heard THAT gem). Perhaps the kids who took the most meds had the most serious issues?
    One of my sons takes medication for ADHD, and it’s been a real help to him. He’s made great strides educationally and socially. And his relationship with me and my husband is great. Do you agree with what this report is saying? Are we actually doing more harm than good?

    • Proteios

      Tough to say. These types of data are statistics. Individuals may benefit, but what happens is a medical industry, and lets be honest, MDs over prescribe everything, that throws drugs at a problem before truly understanding the problem will see statistical problems in large populations. The reason is that a list of symptoms overlaps a dozen or more ailments. So throwing a powerful drug at someone will have some effect. When the now masked ailment reveals itself in other ways. New solutions are rarely posited, but dosages, to perhaps an incorrectly prescribed drug are increased. This is accepted as tolerance and more is needed to get the effect. The problem is that this isn’t a cure or treatment it is a false biochemical equilibrium that has been generated. This may not be the case in correctly diagnosed individuals, but deductive reasoning indicates it is highly likely across a population.

  • Jack Picknell

    An interesting deathbed confession.
    http://www.worldpublicunion.org/2013-03-27-NEWS-inventor-of-adhd-says-adhd-is-a-fictitious-disease.html

    And an interesting few minutes with someone on the front lines of ADHD treatment.
    http://youtu.be/Yl7Ktpas3kg

  • Kathryn

    I read his commentary, Dr. Greg, so tell me what’s a viable alternative? We pulled our son from parish school, home school him, give him 1 on 1 attention for studies, tutoring and waited eight YEARS before prescribing ADHD med. He was almost 12 when we relented after being told for YEARS that it would help him. The difference now is night and day. He’s able to control those impulses. He’s able to focus on his work and attempt to make some semblance of progress although he’s still “behind”. While it’s not 100% without some side effects, there were side effects to his mental health and well-being as well as our entire family when he’s NOT on the medicine. Whether he outgrows it, hopefully, remains to be seen. We truly hope he doesn’t need this forever because we obviously don’t take it lightly. But without a real, viable alternative, it seems dangerous to push the negative “outcomes” without recognizing that this is a true and real situation that families live. In Christ, Kathryn

    • TheodoreSeeber

      One way to help him outgrow it may be something that I’ve told parents of autistics:

      1. Find an obsession- something he can concentrate on. Doesn’t matter what it is. Most people with ADHD or on the autism spectrum have one- like video games.
      2. Use the obsession to help him with his schoolwork (with my son with CP, we’re using legos to teach him math and engineering).
      3. turn the obsession into a hobby.
      4. find a way to monetize the obsession into a career.

      These four steps represent the journey of every autistic adult I know who isn’t in a mental institution.

    • http://www.catholiccounselors.com Dr. Greg

      Be sure to see the follow up post I did answering your question. Dr.P.

  • oregon catholic

    I don’t think it’s a coincidence that the rise in ADHD mirrors the rise in working moms. Kids feel rootless and have free-floating anxiety without the anchor of a parent that is free to attend to their needs. Home life is rushed and parents are too tired and pulled in too many directions to give kids the attention they need. That is not to say there are not some true cases that need medication, but nowhere near the numbers we have.

    • Gail Finke

      This is simply untrue. ADHD may be overdiagnosed in some particular geographic areas, but as a whole it is underdiagnosed and undertreated. I want to look into this presenter’s work more closely, but as the parent of a child with ADHD I can tell you it is real, it is debilitating, and it has nothing at all to do with single parents, permissive parents, etc. Children in such families have a harder time and probably need more in the way of interventions, but that is true of children with any physical or mental problem. An overwhelmed single mom is not able to spend two to three hours trying to get her unmedicated son with ADHD to finish one simple worksheet — a mom in a two-parent home may be able to do so. The underlying problem is the same. In my experience, people who talk about ADHD being overdiagnosed either don’t know anythign about the research or have a romantic idea about children, confusing the disordered, fractured, racing thoughts of a child who can’t pay attention long enough to finish a conversation with creativity and imagination. They are NOT the same thing.

    • JM

      Hate to break it to you – it is a coincidence. My mother stayed at home my entire life and did an excellent job raising me I felt and feel very rooted to my family – yet I had and still have ADD.

  • Gail Finke

    I do not believe that presenter. Ask anyone with a major mental illness or family member with one what alternative such a person has to psychotropic drugs.

    The la-la land “treat it with kindness and talk therapy, these illnesses are merely alternative brain function” attitude is an insult and a slap in the face to people dealing with such problems. I know someone whose daughter tried to kill herself more than 20 times before her 20th birthday, the first time when she was ELEVEN. Most serious psychological illnesses have co-morbid ADHD, or ADHD symptoms. Perhaps the reason so many people who took ADHD medication had a poor outcome in the Canadian study was that they also had OCD, bipolar disorder, and one or more other conditions. That study would not be valid unless it showed that people who ONLY had ADHD and compared them with unmedicated kids who only had ADHD.

  • kenofken

    I downloaded and read that report the other day. It’s interesting, but it falls far, far short of offering the sort of data that should lead us to say conclusively “meds don’t work”. To suggest that their use is universally unethical is irresponsible. All that the study demonstrated with any clarity is that sudden and widespread (and largely non-expert) prescribing, almost certainly in the absence of comprehensive treatment, led to poor outcomes. The patients in question did not even adhere to any medication regime consistently over the study time, with many going off an on again almost at random at different ages.

    That’s a rotten data environment in which to attempt to make a definitive conclusion about whether medication, as a whole, is sound therapy. Imagine if you will that those same doctors started prescribing antibiotics almost randomly based on vague complaints and incomplete case histories and didn’t pay much mind to which antibiotic or which dose they employed, and the patients just sort of took them when they remembered. Of course they’d have poor outcomes, but would we be talking about discarding antibiotics as a treatment modality? Of course not.

    Considerations of meds in ADHD should be a highly individualized one, and not one driven by ideology, either religious or quasi religious ideology against meds or pharm industry ideology which says everyone should be on them. The bottom line should be finding what works for a given patient. Meds are not sufficient treatment by themselves, and they may or may not be useful tools for a given case. They are only useful when the exact formulation and dose is carefully tailored to that person at a given time in their life.

  • JM

    I think they are getting at this, but the issue isn’t neccesarily the medicine, it is probably the tendancy to give someone with ADD/ADHD the medicine and leave it at that. As in there is no other therapy, skills training, addressing of other issues that the ADD/ADHD may have been masking. If doctors have gotten an influx of new patients with ADHD in Canada, I can understand if many just gave patients the pills and did little else due to the number of other patients to see, or parents pressed for time may have pushed for the quick fix of pills and encouraged little additional therapy. That I think is the main ethical issue in not only ADHD drugs but with any psych drug therapy – the drug can not be the only treatment. Fortunately this isn’t as much of an issue with other problems (like depression) but it still can be.

    And it is not just on the doctor, many parents can find it difficult to accept their child has a problem and would like to just have a doctor give the kid a pill and be done with it. Whenever I talk about ADD around my mother she still will say “Oh, you don’t still think you have that do you?” She has been an incredible mother to me and I have never doubted her love for me, but that just shows how even the best parents can have a hard time with this diagnosis for their child (even their adult child).

    I am currently fortunate enough to be blessed with a doctor who refuses to just give me the pills. If she is going to give me medicine for my ADD she requires me to have regular appointments with her and to get additional therapy when needed, . When I first was diagnosed with ADD as an adult I only saw the doctor when my refills ran out and that was for only ~10 minutes. If I had stayed with that doctor I probably would have contributed to any statistics that said people on ADD/ADHD medicine have a high correlation with other problems because I wouldn’t have gotten any help for them.

  • http://drgrcevich.wordpress.com/ Stephen Grcevich MD

    Dr. Greg…it’s good to see the issue of ADHD on the Vatican’s radar screen. One issue I’d like to see the church consider is how Catholic schools might do a better job of welcoming and including kids with ADHD, and how the church might help families of kids who have difficulties with self-control to attend Mass on a more regular basis. I’m a child and adolescent psychiatrist…all too often I have families coming through my office with kids who are unable to attend church because their children have a very difficult time sitting still or remaining quiet during an activity that’s really designed for adults. I also come across too many families of kids with ADHD who would like to provide their children with a Catholic education but can’t because many parish schools aren’t equipped to support them…especially when they have learning disabilities (5X more common among kids with ADHD) and other emotional/behavioral disorders. That’s something the church can address independent of one’s views on the long-term safety or effectiveness of medications for ADHD.

  • VLL

    Meh. My brother was given Ritalin. He was over medicated, and it caused permanent personality changes, and not for the better. I sometimes wonder if they didn’t just give him the drug as a disciplinary measure rather than a real ADD diagnosis. That this is done should give ANYONE chills.

    We were horrified to discover he’d spent nearly five years in constant pain, but because of the nature of the drug he was unable to remember to tell us this fact. It didn’t occur to him until they finally stopped dosing him, and he noticed that the pain went away.

    He did used to be– energetic, opinionated and difficult, but there were many things he cared about. He was good with his hands and constantly curious. He could have made a fantastic living as an Engineer– as he was very technically proficient. Now he doesn’t care enough to really have opinions– or curious enough to follow his interests. His voice has no affect. All he cares about is driving very fast and playing video games. I’m worried about him.


CLOSE | X

HIDE | X