The following article was first published on the Faith and Medicine Foundation website at Faithandmedicine.foundation and was published on March 23rd, 2024.
ADHD treatment is not without some level of controversy. I believe this is for several reasons which deserve exploring:
Patients generally have either strong positive or negative experiences with ADHD medications either personally or in the lives of those they love.
ADHD medications, specifically the stimulants, are controlled medications with an abuse potential.
Our understanding of educational pedagogy as well as ADHD has changed over the years.
Christians are tasked with stewarding our bodies and minds well, to the glory of God (1 Corinthians 6:19-20). We are told to be sober-minded (1 Peter 5:8-9) and are aware that psychiatric medications have the potential to alter our minds and bodies in potentially negative ways. We are also to avoid addiction; commanded not to be dominated by anything (1 Corinthians 6:12).
In light of this, at my practice, we assess the use of medications through the lens of three aims, all of which culminate in the glorification of God. I commend this process to anyone as they assess the use of any of the good gifts of common grace God has given this side of heaven.
At my practice, we utilize psychiatric medications and therapies insofar as they help patients:
Grow in their knowledge of God
Be confirmed into the likeness of Christ
Become more effective for the Kingdom
This, we believe, leads to the glory of God, which is the chief end of mankind (Westminster Shorter Catechism, Question 1).
Let us then evaluate the three primary concerns listed at the beginning of this article in light of these aims.
There is a variety of experiences with ADHD medications.
It should seem obvious, but isn’t necessarily common practice, that there is no “one-size-fits-all” approach to psychiatry. This is why reading reviews online regarding particular medications and therapies online is dangerous. What was a “miracle medication” for one patient made the other feel “flat, unemotional, and ineffective at work”.
When we start psychiatric medication in patients, it is important that we carefully select and educate on the risks and benefits of the medication, warning signs to look out for, reasons to follow up. We also need to adjust medications appropriately, avoiding rapid escalations of therapy and listening to patients when they verbalize unpleasant side effects to a selected med.
ADHD can be debilitating, and the potential for medication to be helpful can impact work performance, interpersonal relationships, and one's faith walk. I once sat across from a middle-aged man who lamented with tears his inability to keep his mind focused on his morning devotional. He knew the importance of beginning his day in scripture, but the second he sat down his fidgeting meant he couldn’t sit still for long. He switched to listening to scripture audio but found his thoughts wandered to whatever he was seeing around him: seeing the washer, “I forgot I need to fix the washing machine”; the fridge, “I forgot to pick up milk when I was at the grocery store”; his dog, “when was the groomer’s appointment? Yesterday? I forgot to take him.”
When we started medication, he was skeptical. He felt he just “needed more discipline” and using medication was a cop-out. Three weeks later in my office, he recanted. “I can finally sit down and read and did you notice I wasn’t 15 minutes late for this appointment?”. He was more present in his conversations with his wife; she felt truly heard when she spoke to him. His effectiveness at work, at home, in his church skyrocketed.
I wish all experiences were like this, and a good number are, but there are enough negative experiences with these medications that keep us from making any universal statements about treating ADHD.
Stimulant ADHD medications have an abuse potential.
A young man had been on ADHD medications for the last few years. They worked well, until they didn’t. Each time a medication was increased, its effectiveness lasted only a few weeks and he would need a dose increase. Eventually, the dose was at a therapeutic maximum but seemed ineffective.
Attempts to try to decrease the dosages left him unable to perform at work or school; he was in danger of losing his job. In desperation, he found an illegal source to acquire additional pills.
Now, years later he sat in my office facing the impact of high dose stimulant use on his heart. There were several things to lament in this case. Not the least of which was the improper prescription of stimulants to someone who was exhibiting unusually rapid tolerance.
Other times young adults in their college years get arrested for selling their prescription, called “diversion” in medicine, to peers wanting to pull all-nighters to study or finish papers.
Complicating this picture is the fact that stimulant use has been associated with a decrease (see also here) in addiction in those who have ADHD. Starting illicit drugs is highly correlated with decreased impulse control, a hallmark symptom of untreated ADHD.
The use of medications that have an addiction potential is one of stewardship. We cannot make blanket statements about the morality of a substance because it has an addictive potential. Alcohol is a great example for which scripture doesn’t prohibit but exhorts us to use wisdom in its use.
Another consideration is the application of non-stimulant medication for ADHD, which doesn’t carry an abuse potential and may have a better side effect profile than stimulants.
Our understanding of educational pedagogy as well as ADHD has changed over the years.
Within the last decade, the terms “neurodivergent” and “neurotypical” have entered conversations when discussing ADHD, Autism Spectrum Disorder, and various learning disorders. The move is based, in part, on thinking differently about how we educate our children, structure our work environments, and understand neuroscience.
We began to see the ways ADHD and ASD among others, though presenting problems in daily functioning also seemed to cause patients to think in different and creative ways.
Though this shift is new to the secular world, it is not new to the Christian. We have been instructed in scripture to view our various “weaknesses” as strengths (2 Corinthians 12:9-10). We see not only God’s grace and provision for us in our struggles but the ways our struggles have been purposed for his glorification.
My patients with ADHD are some of the most creative, imaginative, often outgoing/extraverted people I know. One of the classic screening questions for ADHD is feeling “overly active and compelled to do things, like you were driven by a motor?”. When patients identify with that phrase I point them to the energy they have that others lack and encourage them to utilize this in their vocational calling. Medications can be an important part of harnessing that energy for good.
In addition to changing the terminology we use when describing ADHD, we have begun to rethink how we organize education. We now see sitting still for hours looking at a whiteboard or quietly reading as not necessarily normative. I have been encouraged to see teachers at all levels incorporating movement, play, collaborative group work, frequent task switching, among others as methods of educating.
The goal of ADHD medication is not to create student zombies content to sit for hours without moving. The goal is to maximize each person’s unique giftings (often rooted in weakness) while, to the best of our ability this side of heaven, stewarding medications if appropriate to help with our weaknesses.
Bottom Line
In order to determine whether medication is appropriate for ADHD in the lives of Christian patients, we must understand the variety of experiences both personally and in the lives of loved ones they come to the exam room with, the benefits and risks of medication on our bodies and minds, and remember that God has uniquely made each person and specifically gifted and equipped his children for his service. Medication, when used with the goal of growing in the knowledge of God, conformity into the likeness of his Son, and in effectiveness for the Kingdom, is a rightly oriented approach to stewarding the good gifts of science and medicine. That may look different from patient to patient and requires wisdom and prayerful consideration.
Adam O’Neill, PA-C is a Psychiatric Physician Assistant and owner of Adam O’Neill & Associates, author of The Mind after Eden: Psychiatry in a Post-Fall World, The Patience of Hope: Encouragement for the Sufferer through the life and ministry of George Matheson, and The Mind for His Glory: A Theory of Applied Christian Psychiatry (forthcoming), and serves as executive director for the Faith and Medicine Foundation. He is a member of Capitol Hill Baptist Church in Washington, D.C.
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