Collaboration Article with Dr. Jill Grayson at Grayson Psychiatry
Written in collaboration with Alyse Bone, LCMHC-QS, RPT
All opinions expressed in this blog are solely those of the authors and do not reflect the opinions of Dandelion Family Counseling, PLLC.
(Alyse Bone, LCMHC-QS, RPT): Let’s start off by describing what ADHD diagnosis is: ADHD is an executive functioning disorder that falls under a neurodevelopmental disorder; this means that a child is born with this brain functioning versus developing the disorder. It is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning and development. It is typically diagnosed in childhood, although symptoms may persist into adolescence and adulthood. ADHD is believed to involve a combination of genetic, environmental, and neurological factors. Differences in brain structure and function, particularly in regions related to attention, impulse control, and executive function have been observed in ADHD individuals.
(Dr. Jill Grayson): ADHD is a neurodevelopmental disorder resulting from the deficiency of neurotransmitters (often norepinephrine and dopamine) in specific areas of the brain. Medications for ADHD target increasing these neurotransmitters.
The decision to use medication for ADHD can be a difficult one for families and once you make that decision there are an overwhelming number of medications to choose from. There are broadly two classes: stimulants, and non-stimulants.
Stimulants are widely used and considered the gold standard treatment for ADHD. There are two general classes, the methylphenidates, and amphetamines. Along with these classes there are differences in delivery mechanisms (liquid, patch, chewable, pill) and timing (long-acting vs short acting) that can affect side effects. Studies have suggested that, based on safety and efficacy, methylphenidates are a better choice in kids and adolescents whereas amphetamine-class agents are better in adults. Four non-stimulants are approved to treat ADHD: atomoxetine, guanfacine, viloxazine, and clonidine. Bupropion (Wellbutrin), while not approved for ADHD treatment, is an antidepressant commonly prescribed off-label to treat ADHD. Sometimes non-stimulants may also be prescribed to use in conjunction with stimulants to help with stimulant crash, provide more control time or to relieve additional remaining symptoms.
It is important to work with your healthcare provider to find the right medication for your family. Prescribing is not as simple as following an algorithm. Two people with ADHD are likely to respond to the same medication in different ways. Some might work well while others either don’t work or they have the opposite effect of the one desired. It is often helpful to make a daily timeline of attentional and behavioral needs of the child. The process of choosing the medication should involve looking at the possible negative side effects so that the benefits and risks can be appropriately evaluated in the decision.
Medications do not cure ADHD; they only decrease/ease symptoms. They work like glasses, making things less “blurry” only when they are worn. They can be extremely helpful in combination with therapy. Just like glasses can help you focus your eyes, medications can help kids focus their thoughts and ignore distractions. Helping kids concentrate better, improves behaviors, and social interactions. When prescribed appropriately and carefully with close follow-up, ADHD medications are safe and effective with minimal long-term risk and even possible long-term benefit. Studies have shown that untreated ADHD has been associated with “poorer long-term self-esteem and social function outcomes” (3) as well as difficulties with academics.
Medications help kids concentrate and focus during therapy so they are able to learn social, emotional and behavioral skills. Then when out in the real-world, medications help them access the tools that they learn in therapy. Medication is not a cure; to be most effective medication needs to be used in combination with therapy to learn and practice skills.
Overall, the collaboration between therapists and psychiatrists allows for a more comprehensive and integrated approach to mental health care, addressing both the psychological and biological aspects of ADHD and promoting the holistic well-being of clients.
From the therapist point of view (Alyse Bone, LCMHC-QS, RPT): Understanding the implications of medication can help support clients and families on a weekly basis. Psychoeducation is beneficial so families feel supported and reminded about the expectations of the medication and therapy combined. With each child this will vary but overall, getting support for ADHD can be a difficult journey. When you have providers that communicate it enhances the support for the child and family and can reduce anxiety and overwhelming feelings that may come with medication side effects, new emerging behaviors, or adjustment related behaviors to medication.
From the psychiatrist point of view (Dr. Jill Grayson): Medication needs to be the right medication and dose to truly benefit the patient. Once you find the right medication, the dose can be difficult to determine; at the right dose the child will be more focused and less hyperactive, but too much medication can worsen unwelcome behaviors or even change some of your child’s personality. As a child grows and develops, dosing will also change. A therapist who sees the patient weekly can be extremely helpful in giving feedback on medications effects, side effects and also help determine the right dose.
Benefits of collaboration (Alyse Bone, LCMHC-QS, RPT):
- Complimentary expertise: A therapist has expertise in therapeutic modalities to address emotions and behaviors. A psychiatrist may also possess some of these skills but has predominant expertise in psychotropic medication (medication that impacts the nervous system or make up of the brain) that will address emotions and behavior through medication management.
- Enhanced treatment planning: A psychiatrist can use information gathered from the therapist to inform medication decisions and support the most effective treatment plan for the client.
- Collaborative care coordination: Due to the nature of therapy being an ongoing process of support, the therapist has the ability to communicate any insights that are noticed throughout the therapeutic process in understanding the client’s response to treatment, discovering any emerging concerns, and making adjustments to medication or therapeutic intervention.
- Monitoring medication effects: Therapist input can help support the psychiatrist in monitoring behaviors, functioning overtime, and effectiveness of the medications. This input can help support the psychiatrist with making informed decisions about medication adjustments or dosages, or alternative treatment options.
- Support for clients in processing medication changes (positive or challenging experiences): Adjusting to medication changes can be a transition whether it is positive or challenging. Understanding the implications of the medication can help the therapist support the client with what is to come and also process this new journey with them.
1 Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 21(3), 192–206. https://doi.org/10.5863/1551-6776-21.3.192
2 Mohammadi, M. R., & Akhondzadeh, S. (2007). Pharmacotherapy of attention-deficit/hyperactivity disorder: nonstimulant medication approaches. Expert review of neurotherapeutics, 7(2), 195–201. https://doi.org/10.1586/14737175.7.2.195
3 ADHD controls. Treatment for ADHD was associated with improvement in outcomes; Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function Harpinval.harpin@sch.nhs.uk, L. Mazzone, [ P. Hodgkins +2 View all authors and affiliations Volume 20, Issue 4 https://doi.org/10.1177/1087054713486516