Beliefs about Medication Treatment & Concerns
about Loss of Self
For many individuals with ADHD the symptoms and problems associated with
the disorder persist into young adulthood and beyond. In cases where
an ongoing positive response to medication occurs, and where there are no
significant adverse side effects, treatment that persists across many years
of development could thus be helpful.
However, such ongoing treatment with medication is the exception rather than
the rule. In fact, among those individuals with ADHD who start on medication,
estimates from a representative community sample suggest that the average
duration of treatment is less than 3 years. This may be one reason
why documenting long term benefits of medication treatment has been difficult.
It is not uncommon for adolescents to protest the use of ADHD medications
and to express a desire to stop taking it. An adolescent may feel he/she
no longer needs to use medication and that it is no longer helpful.
He or she may also have concerns about what it means to use medication to
help manage their behavior and feel that it changes them in ways they do
not want to be changed. Because adolescents and young adults have far
greater influence over treatment decisions than children, their beliefs about
medication treatment are likely to be an extremely important factor in their
willingness to continue this treatment. Thus, although such beliefs
may play an important role in treatment adherence, research on this issue
A study published recently online in the Journal of Attention Disorders
provides a careful look at this issue among college students with ADHD [Pillow
et al., (2012). Beliefs regarding stimulant medication treatment effects
among college students with a history of past or current usage. Journal
of Attention Disorders. DOI:10.1177/1087054712459744
]. The authors
were interested in examining whether beliefs about medication treatment were
related to whether students who had used medication previously continued
to use it in college.
Participants were 193 students (60% men) who self-reported receiving a diagnosis
of ADHD and a history of using stimulant medication. These students
completed a 50-item survey to learn about their beliefs about stimulant medication
treatment in 4 different domains:
Improved attention and academics
- Items on this scale assessed the
extent to which students believed that medication helped with managing attention
difficulties and improving their academic performance, e.g., improving grades,
helping them stay on task, and helping them keep school-related priorities
Loss of authentic self
- This scale assessed students' belief
that using stimulant medication changed them in some essential way, i.e.,
that it prevented them from being their true selves. The types of changes
asked about included "making me less expressive in artistic pursuits", "taking
away important parts of who I am", "decreasing my ability to laugh and joke
around with others", and "keeping me from being successful at things other
- This scale measured the extent to which
students believed that medication enhanced their social functioning, e.g.,
"helps me get along with others", "allows my true personality to shine",
"enables me to get others to see me as I see myself". Thus, it was
a counter to the idea that medication resulted in the loss of some essential
aspect of self.
Common side effects
- Items on this scales evaluated students experience
of side effects associated with stimulant medication, e.g., "decreased my
ability to get a good night of sleep", "caused me to lose my appetite", "makes
me more impulsive".
Participants were also asked about their general attitudes towards using
As noted above, the researchers were particularly interested in how medication-related
beliefs differed between college students taking ADHD medication and those
who had chosen to stop using it. Compared to those taking medication, those
who discontinued use...
- were less likely to believe that medication improved their attention and
academic performance; However, the majority still believe it was helpful.
- were more likely to believe that it resulted in a loss of their authentic
self; When this occurred, it was evaluated very negatively.
- were less likely to believe that it resulted in any social self-enhancement;
- had less favorable general attitudes overall towards the use of stimulant
In contrast to the differences found on these scales, current medication
users and non-users did not differ in their reports of common side effects.
Summary and Implications
Results of this interesting study provides useful information concerning
the decisions adolescents and young adults make about whether to continue
using stimulant medication to treat their ADHD.
An especially interesting finding was that nearly 40% of students who discontinued
medication reported concerns that using medication compromised their true
self in some essential way. Such concerns are likely to be an important
reason why many adolescents and young adults elect to stop taking their medication,
even when they perceive it is helping with attention and academic performance.
Do physicians address such concerns with the individuals they treat?
I am not aware of any data on this issue but would be surprised if this was
regularly addressed. One implication is that clinicians should recognize
that adolescents may harbor such concerns, and provide an opportunity to
explore and discuss these issues. Providing a forum for adolescents to voice
such concerns could be helpful in mitigating them, thus reducing the likelihood
that medication would be discontinued prematurely. Parents should also be
attentive to the possibility that their child has such concerns and could
also be extremely helpful to their child in thinking about such issues.
The concerns that many students expressed about medication suppressing a
valued aspect of their self also highlights the importance of studying this
issue more carefully. It would be easy to dismiss these concerns as
erroneous accounts of how medication actually affected them, but the fact
that many students felt this to be the case is important. It would
be helpful to learn what contributes to such beliefs and how to best address
them when they arise. It would also be interesting to study whether
such concerns emerge even earlier in development as there is no basis for
assuming that younger children would not harbor similar feeling.
Finally, it is important that these findings not be used as evidence against
the appropriate use of medication. Although some may argue that medication
treatment should not be used if it leads many to believe that an essential
aspect of themselves is being lost, an equivalent number of participants
believed that medication enhanced their social functioning and enabled their
true personality to come through. Thus, the findings highlight the
importance of understanding the beliefs that each individual holds about
medication treatment, as these will vary considerably and can play an important
role in their willingness to continue.