Disassemble the stigma to improve ADHD results

“Mom, is having ADHD something I’m sad or worried about?” My 9-year-old son asked one day when he picked him up after school.

At that moment, my mind competed in hundreds of possible situations that might have prompted this question. My husband and I have always been open and honest about his diagnosis and have included him in discussions about his treatment, including feelings for his indications and side effects.

We have done our best to avoid and deal with the social stigma associated with Attention Deficit Hyperactivity Disorder (ADHD) and to provide him with a meaningful response to the situation.

“No, having ADHD shouldn’t make you sad or worried! Why did you ask this question? Did something you need to know happen?” I replied to.

“My friend was crying in the playground today. When I asked him why he was crying, he said it was because his brother was diagnosed with ADHD. I told her everything was okay. I Also has ADHD and is doing well. He may have to take medicine. He may have to go to a special class, but don’t worry as everything will work. Please, “my son replied.

“Mom, do you think I said the right thing? Is there anything else I should say? Why did her brother have ADHD, so she was so sad that she cried?”

What powerful question comes from such a boy? At that moment, I realized a significant amount of social stigma that had to be unpacked with my son. Misunderstandings about diagnosis reduce the credibility of healthcare providers and delay or hinder the treatment of patients suffering from this disorder.¹

This situation further focuses on the 2021 theme of ADHD Consciousness Month: Rebuilding ADHD: Discovering New Perspectives. It reminded me of my role as a pharmacist’s mom in educating the community as well as the family and the importance of advocacy.²

Like other psychiatric disorders, the diagnosis of ADHD has been significantly developed and improved over time, from the initial mention in DSM-II to the current repetition in DSM-V.³ Further digging, ADHD had the disability features first mentioned in the text by a German doctor in 1775. This evolution of diagnosis has been criticized for its subjectivity and reports of increased prevalence.

Criticism of the subjectivity of diagnosis can be countered in the following ways: First, a variety of trained professionals agree on the existence of well-defined standards. Second, diagnosis is a useful prediction for defining future comorbidities, improving future outcomes, understanding patient-specific responses to treatment, and defining features that indicate a consistent set of causes of disability. It is a factor.

The perception of increased prevalence is due to advances in both management and clinical practice that lead to increased diagnosis.¹ In addition, a meta-analysis of 135 studies involving approximately 250,000 children and adolescents over 30 years shows that prevalence is stable between 5.9% and 7.1%.^Four

Prevalence decreases significantly as patients mature into adulthood, with reported adult prevalence ranging from 2.5% to 2.8%. This trend is further accentuated by the reduced prevalence of people over the age of 50, with reported prevalence ranging from 1.5% to 0.02%.

There are also specific gender and race differences between groups. The prevalence of young blacks (aged 18 and younger) is reported to be 14%, with boys having a 2: 1 higher prevalence than girls.

As pharmacists, we play an important educational role in helping patients and parents understand that the cause of ADHD is the accumulation of genetic and environmental risk factors for most individuals.¹ This information is of great help in gaining an understanding that factors other than direct patient management are likely to be the cause, rather than individual shortcomings.

Pharmacists are an easily accessible community resource that can help break down traditional stigma associated with different things.

We can help patients recognize treatment in the context of chronic disease management.

We can help children and parents understand treatment options that have benefited and those that have not.

You can support the community by providing a clear message that ADHD is not inherently negative.

Restructuring diagnostics into a solution-based mindset can change the stigma surrounding ADHD. This enables treatment planning, risk mitigation, and evolving treatment.

Patients can be encouraged to seek multimodal therapies, including behavioral therapies combined with the currently established gold standard of drug therapy.

Patients can be informed of the increased risk associated with diagnosis, especially comorbidity such as substance abuse.

Treatment should be indicated over time, thus explaining the importance of continuous clinical follow-up throughout the course of the disorder.

References:

1. Faraone SV, Banaschewski T, Coghill D, etc. World Federation of ADHD International Consensus Statements: 208 Evidence-based Conclusions on Disability. Neurosci Biobehav Rev.. 2021; 128: 789-818. doi: 10.1016 / j.neubiorev.2021.01.022
2. ADHD Awareness Month. Available: https: //www.adhdawarenessmonth.org/
3. Posner J, Polanczyk GV, Sonuga-Barke E. Attention deficit hyperactivity disorder. Lancet.. 2020; 395 (10222): 450-462. Doi: 10.1016 / S0140-6736 (19) 33004-1
4. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA 30-year estimation of ADHD prevalence: updated systematic review and meta-regression analysis. IntJ Epidemiol.. 2014; 43 (2): 434-442. Doi: 10.1093 / ije / dyt261
5. Martínez-Núñez B, Quintero J. ADHD Multimodal Treatment (MTA) Update: 20 years of lessons. Actas Esp Psiquiatr.. 2019; 47 (1): 16-22.