Pediatric ADHD?

By Umesh Jain

In the November 7th, 2011 Pediatrics Journal, a comment was made about the excessive and needless prescribing of antibiotics for children particularly for respiratory infections when the vast majority are of viral origin. The long term sequalae may not be obvious but the amount of money spent on this needless treatment ran into the hundreds of millions of dollars and then there was the issue of long term immunity as “super-bugs” might be the result. But it heralded something that seems endemic amongst pediatricians: the quick fix strategy. Whether it is antibiotics or broncho-dialators or steroids or psychostimulants, they seem to be quick on the draw to prescribe and to look for a quick outcome.

I don’t know if it is the nature of their busy practices, their lack of understanding of the alternative options, the time it takes to do adequate holistic based interventions or the basic success in medical treatment absolving them of responsibility for any other course. But we also have a public that wants fast cures too. This is not just a medical problem. “Fix my child.” It is the immediate need to deal with, what seems to be, a crisis. Everyone is in a rush. I swear, the system feels like it is being run by an ADHD engine.

That is not necessarily bad, crisis management and high goal directed interventions do work. Patients like it. However, the medications work so successfully (as well as their substantial placebo effect) that it reduces the urgency to make fundamental changes in other areas. If I can stop a child who is wheezing in 15 seconds, why would I need to get rid of the cat? In the world of ADHD, where is the urgency to do lifestyle management if the meds improve functioning so dramatically. In fact, non-stimulant options force the lifestyle changes because they don’t work that quickly. At the end of the day, maybe it is the parent and/or the doctor who wants to sleep at night and put the problem to bed.

I’m not anti-medication. I’m all for effective treatment. I am for holistic-based care and ensuring that the non-medical agenda is also highlighted with importance. For the public, let’s not get drawn into the quick fix and step back and look at the bigger agenda. Remember to ask questions because that is the only way to ensure that the best treatment options are being delivered.