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The Practice of Medicine: No Longer Just Drugs

by Dr. Jay Tarnow

Many significant changes have been taking place in medicine, and I think it is important to report on them. My column has been named “Medication Corner” for years, but today medicine is going beyond just medication, so I plan to keep up with these changes. As you have all heard me discuss, my philosophy of psychiatric care has always been BioPsychoSocial, a systemic approach. I don’t believe in treating children with medication alone, because there is no medication that cures ADD/ADHD…yet! Children are developing organisms and need to cultivate new skills at each developmental stage in order to be ready for adulthood. This is why I believe that we must teach children with ADD/ADHD self-management skills. Psychiatry is on the move. We are now developing more than medicine to have biological effects on the brain.

Prior to the Decade of the Brain (1990-2000), it was widely believed that our neural networks remained static as we aged. However, advances in neuroimaging techniques led to the introduction of MRIs and PET scans, which in turn demonstrated that rather than being static, our brains exhibit plasticity – that is, the ability to reorganize neural pathways based on certain types of stimulation. This means that the brain continuously adapts and adjusts as we encounter new situations and tasks throughout our adult lives, not just during childhood as was previously believed.

The environment plays an important role in plasticity because the brain is shaped not only by genetic factors, but also by a person’s surroundings and actions. The brain reorganizes itself and forms new connections after exposure to unfamiliar situations - this is how we learn new tasks and ideas. This concept is important to think about when considering working memory, a key executive function that can be described as the ability to hold information “online” for brief periods of time. Working memory has been found to be an essential deficit of ADD/ADHD.

 It is necessary for things like controlling attention, planning and organizing activities, reading comprehension, mathematical reasoning, keeping instructions in mind, resisting distraction, and self-managing areas of daily life. Many ADD/ADHD-affected individuals report having problems with these tasks.

Deficits in working memory can be manifested in many ways. Affected adults may frequently arrive late to work, underestimate the time required to complete a task, experience difficulty dealing with more than one task at a time, be easily distracted, or have problems concentrating under pressure. procrastinate constantly, have problems completing homework without supervision, fail to listen or participate during group projects, have problems following instructions, be disorganized, experience learning difficulties, interrupt others frequently, or be unable to maintain attention.

But this is no reason to be discouraged – quite the opposite, in fact. The brain’s plastic nature makes it possible to improve working memory and attention, offering hope for ADD/ADHD-affected children and adults who are seeking an alternative to the medication-only approach to treatment. Following an appropriate training program can be of invaluable benefit by guiding you in the process of teaching your brain (or your child’s brain) how to compensate for the difficulties you experience in daily life. Successfully completing such a program can lead to improvement in functioning by altering the brain in several ways – increasing activity, boosting the speed of neural pathways, and creating new pathways. Some participants even report being able to decrease the amount of medication required to manage their ADD/ADHD.

With all the attention that plasticity and working memory are now receiving, various new training programs that claim to improve working memory and attention seem to appear every year. I encourage you to explore these options, but to do so with caution, because only certain programs have been proven through scientific research and are backed by MRI-documented data. The same scientific rigor exercised in trials of medication effectiveness must be used to evaluate these new brain-changing programs; many programs claim to have benefits, but lack adequate scientific evidence to support their claims.

           by Dr. Jay Tarnow

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