299 Transcript

Dr. Jeremy Sharp Transcripts Leave a Comment

[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR.

ChecKIT, available on PARiConnect, is an online library of popular mental health checklists that you can use as a personal inventory. Stop searching the web and make ChecKIT your one-stop shop. Learn more at parinc.com\checkit.

Hey, welcome back everybody. Today is another episode in the ADHD series.

In today’s show, I’m going to talk about medication. I’m not going to dive super deep, similar to all of the other ADHD episodes, but I will talk about the basics of medication, what types are [00:01:00] out there, I’ll talk about the research around medication effectiveness, the downsides to medication for ADHD, some of the myths and a little bit about the diversion of ADHD medication, which is fun to revisit this because that is the topic that I did all of my master’s and PhD and even undergraduate research on- the diversion of prescription medication, specifically stimulant medication.

It was fun to go back and read some of that research and even see how many folks had cited some of my work, which is funny. I hadn’t thought about that in a long time. But anyway, I digress. Let’s jump to the episode and chat about ADHD medication.

[00:02:06] All right, we’re back. Like the other ADHD series episodes, this is meant to be a pretty short summary of largely the research contained in the World Federation of ADHD Consensus Statement, which is a mega meta-analysis that pulls together all the research up until a year or two ago on ADHD. I’ll link that in the show notes. It’s an easy read, lots of bullet points, and is worth checking out. But today, we’re going to talk about the medication side of things.

Quick intro. Y’all know this stuff, but I would feel completely remiss to not briefly summarize the types of medication available for ADHD. So essentially, it falls into two categories. There are stimulants [00:03:00] which are variations of Methylphenidate and Amphetamine or Amphetamine salts, and then there are non-stimulants like Atomoxetine, Guanfacine, and Clonidine.

Going back to the stimulants, Methylphenidate is what is traditionally known as Ritalin. And then there have been many variations thereof, reformulations, and so forth over the years. But Methylphenidate equals Ritalin basically, and Amphetamine salts equals Adderall. And again, lots of different variations there over the years, but those are the basics.

Among the non-stimulants, Atomoxetine, Strattera is the brand name. And then like I said, Guanfacine and extended-release Clonidine. Also, I heard Tenex is used to treat ADHD. It’s not a major medication, but that’s out there as well.

[00:04:00] Research on the different types and their effectiveness is a little bit mixed. Overall, non-stimulants are less well-supported. So, stimulant medication is generally better regarded as more effective for treating the symptoms of ADHD. Non-stimulants, again, are generally showing at best “moderate effects” whereas a lot of stimulant medication may show more significant effects, particularly in reducing the symptoms of ADHD.

Within the stimulants, we can break that down a little bit, research generally seems to trend toward Methylphenidate or Ritalin variations being best for kids, and Adderall variations or Amphetamine salt variations being better for adults, but [00:05:00] it’s a little bit mixed there. There’s some research out there that would say that Methylphenidate Ritalin variations is going to be best for both kids and adults. And when I say best, I’m simplifying, but more effective in reducing symptoms.

Let’s talk about some of the positive effects of medication.

At this point, there has been a wide body of literature supporting the effectiveness of medication in treating ADHD symptoms. The general statistic that gets quoted a lot is that somewhere between 60% and 80% of kids are going to see some improvement in symptoms if they start medication for ADHD, which is huge.

If you’re thinking about the dial of intervention and what’s going to turn the dial the most, 60 to 80% [00:06:00] of kids experiencing some benefit from medication is a large chunk. I hear stories about medication being “a night and day difference”, or like turning a light switch on when it was off. Those types of stories come up for a lot of individuals who start ADHD medication. Not all, but many. 60% to 80%.

Now, there are some other benefits to ADHD medication. There have been several international cohort studies that total, in the millions of kids, that have shown many positive effects of medication. Those include increased GPA, better test scores while taking medication, and also have shown [00:07:00] reduction in some of those lifestyle factors or risks that I’ve discussed in a previous episode. So things like reduction in injuries, concussions, motor vehicle accidents, things like that, teen pregnancy, also showed reductions in suicide risk and substance use among other things.

I really could go on and on about the positive effects of medication and the ways that it helps mediate some of those more risky lifestyle factors of having ADHD. So unmedicated individuals with ADHD are at much greater risk for a number of lifestyle risks.

Like I said, that was a previous episode. So you can go back and check that out, but medication does appear to reduce the risk for a lot of those problems.

[00:08:00] All in all, medication has been shown to be pretty effective. Whenever I am doing feedback with parents who are hesitant about medication, I always say, “Hey, I understand medication brings up a lot of feelings for families. If you have questions or hesitations about medication, I totally get that. Let’s talk about that. All I can do as a clinician is reflect the research. And what we know from the research is that medication is pretty effective for the majority of kids. So I think it’s worth at least considering. You’re welcome to ask all the questions you want and I’ll do my best to answer them.”

I run through a lot of hesitation, but this is one of those places where I can feel pretty confident to say, hey, the research is relatively clear that medication should be helpful in a lot of different ways for most kids. So it’s at least worth considering.

But there are [00:09:00] some downsides, right? Let’s talk about some side effects and other risks associated with taking ADHD medication.

Let’s take a break to hear from a featured partner.

I’d like to tell you about a real time saver. ChecKIT is a library of popular mental health checklists hosted on PARiConnect- the online assessment industry’s most reliable platform that you can use as a personalized inventory. No need to search around or purchase from multiple websites. ChecKIT is a flexible one-stop shop safeguarded in a HIPAA-compliant platform. Learn more at parinc.com\checkit.

All right, let’s get back to the podcast.

So the big downsides that were most consistent across the research were number one, sleep. Reduction in sleep efficiency and increased insomnia were two of the [00:10:00] most common side effects listed, which makes sense, particularly with stimulant medication, these sleep problems are not generally happening with non-stimulants, but when you look at stimulant medication, it’s going to keep people up. So those are some of the most common side effects are the ones involved in disrupted sleep.

Similarly, decreased appetite or anorexia and weight loss were also pretty common. Again, this makes sense if you’re taking a stimulant, if you’ve never taken a stimulant of any kind, you could think about what it would be like if you drink too much caffeine, for example, which is a stimulant, I suppose, but when you drink too much caffeine, you’re not as hungry. Your appetite goes down and that is true with stimulant medication as well.

[00:11:00] There is some concern about stunted growth. So this was one of those problems that came up even when I was back in grad school. And the research is a little mixed with this. There is some research out there to say that kids who consistently take ADHD medication may experience a reduction in height of about 1 to 2 centimeters over time.

So the mixed part is that other research has found that that is not true in a different cohort, but even if it were true, studies have shown that the reduced height can be reversed when treatment is stopped. So that is important to know. So the jury’s still out a little bit on this stunted growth question, but if you’re being [00:12:00] conservative, I think that is something that I still will mention to parents, but also let them know, hey, we seem to think that any of these growth issues are going to be very mild, 1 to 2 centimeters is not a lot, and it can be reversed if you stop taking the medication.

The other main risk that came up in the literature was cardiac risk. So high blood pressure in adults. On the other end of the spectrum, there was a slight increased risk of cardiac malformation in babies whose mothers used stimulant medication during pregnancy.

Now, I’m sure you have heard of or will run across other downsides, other side effects associated with particularly stimulant medication, but [00:13:00] these are the primary downsides that are emerging in the literature.

Now on the flip side, the other medications, the non-stimulant medications like Strattera and guanfacine, and so forth, those are different types of medication. That’s not just one class. Strattera is a different type of medication than guanfacine, which is more of a blood pressure medication.

The literature would say that individuals are much more likely to stop taking Strattera because of side effects compared to stimulant medication. Among blood pressure meds like guanfacine, the primary side effect or problem that we hear about a lot is decreased energy and tiredness, falling asleep.

So there are some downsides. There are some [00:14:00] side effects associated with taking stimulant medication in particular.

Now let’s talk quickly about diversion. Diversion means the funneling of prescription medication to individuals without a prescription.

Like I said in the intro, this is the area that I did all of my research on. I started in undergrad with general diversion of all prescription medication, then in grad school focused on diversion of stimulant medication. So this was entertaining to go back and dive into this a little bit. And it turns out that things have not changed much from when I was doing my research in the mid-2000s.

Diversion is still a problem. Diversion of stimulant medication in particular. I should specify that. We’re not talking about non-stimulant medication. Nobody’s diverting Guanfacine that I know of, but diversion [00:15:00] is primarily a problem in college students and primarily a problem with stimulant medication.

They tend to divert medication to increase performance. Stimulant medication allows you to presumably stay up longer, focus more intently, sustain your attention, and increase your self-regulation. So, a lot of the time it is being used for performance enhancement in the academic realm to be able to study longer and study “better.”

The interesting thing is that there is not much research at all to suggest that it helps academic performance. In fact, regular diversion or ingestion of stimulant medication by non-ADHD individuals is actually associated with lower educational attainment, which means that they were less likely to [00:16:00] obtain an undergraduate degree if they were using diverted stimulant medication. So that’s super interesting.

Let’s see. Another, well, before I move on, the implication there, of course, is that if you’re working with college students, there is a secondary market for stimulants. If you’re working with college students, you should be aware of that as a risk factor and a reason to seek an ADHD diagnosis because there is a market, especially in college to sell that medication.

Last thing I want to touch on is, with diversion, we know that drug shopping, which means going around to different pharmacies different doctors, trying to get additional prescriptions for ADHD medication is more common in those who are prescribed stimulants compared [00:17:00] to those who are prescribed non-stimulant medication. We’re not talking about opioids by any means, but compared to most other medications, drug shopping is a lot more common in individuals who are prescribed stimulants for ADHD.

So lots of factors to consider here. Generally speaking, ADHD medication, especially stimulant medication is shown to be effective, helpful, and safe. I think that’s the main thing. I personally have wrestled with this over the years. I’m sure we all talk with parents who don’t want to medicate their kids and that is totally okay. And like I said, a bit ago, I think this is one of those places where we can be relatively confident that the literature supports ADHD medication as an effective intervention.

All right. Stay tuned for more ADHD episodes. I think we have one more. [00:18:00] I’m going to talk about non-medication treatments and other means of moving the needle when it comes to ADHD symptoms. That will be coming up in another week or two. So stay tuned.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcast.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work [00:19:00] and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no [00:20:00] supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

Click here to listen instead!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.