The 100-100 Effect

“Just tell me one thing so I can get this straight. How much of treating ADHD is medications and how much is everything else. Is it 50-50? 80-20? Give me a number so I can wrap my mind around it.”

100 per centAlex needed me to cut to the chase. His ADHD treatment plans was complex. He was overwhelmed by the recommendations to exercise daily, hire a coach, listen to some ADHD audio books, get more sleep and start some supplements. The idea of medications sounded promising to him, but the trials needed to find the right dose of the right one could take months.

‘How much bang-for-the-buck do these treatments give?’ is a fair question. People with ADHD have already tried hundreds of strategies to improve attention and efficiency that fizzled out—helpful at first, but downhill after that.

I paused trying to think of an answer for Alex. On the one hand, if non-medication therapies were going to successfully treat his ADHD, they already would have done that. He had worked with tutors, therapists, diet and self-help books, but he still had inattention and self-control issues. Medication response can be remarkable, but it sure isn’t the whole story. ‘Pills don’t give skills’ expresses this idea. Physicians can’t just prescribe pills and assume a patient’s ADHD will get better.

Doctors sometimes forget this basic truth, and this is not entirely due to the fact that 90% of physicians don’t have ADHD and don’t understand how much more rigorous the treatment is than the oft-heard ‘just pop a pill’. It’s also due to a quirk with the ADHD research we read. Investigators define successful treatment in scientifically accurate terms such as ‘a 40% or better reduction of investigator-rated DSM-IV symptomatology along with a CGI-I score of at least +2’.

My patients, bless them, never talk like that. They tend to have goals for successful treatment such as ‘get more organized’, ‘study or work at my potential’ and ‘be more thoughtful’ or ‘less frustrated with my children’. Those goals are hard to express in numbers. They have more of a “It’s hard to describe, but I’ll know it when I see it” endpoint.

Alex wasn’t asking me to quote studies, just to help him reach some goals. I was about to say, “50-50” to emphasize that the effects of medications and non-medication therapies are both terribly important, but what came out was, “They’re both essential. It’s 100-100. Neither of them matters much without the other.”

Researchers, of course, have worked on that question, too, and have tried to give us more accurate numbers, but they are fuzzy. It turns out that you can get some–vaguely 30% of the potential response–with medications alone and about the same from intense non-medication therapies. Either therapy on its own misses 70% of the potential improvement. There’s a magic middle 40% that requires both. The whole 100% response requires the combination of both therapies.

So here is the most accurate answer for Alex: it’s a 30-40-30 proposition. I’m glad I didn’t think of that answer, though. since Alex was already overwhelmed and didn’t need an obtuse answer with a long explanation.

I still get asked the Alex question quite often. Where’s the best bang-for-the-buck—is it medications or the non-medication therapies? The best answer is not the scientifically accurate one, but the one that spilled out intuitively that day: 100-100. The best responses come with both therapies done at full-court press levels. Either alone is probably one more disappointment.

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

Posted in ADD, ADHD, medications, treatment
11 comments on “The 100-100 Effect
  1. Lana says:

    ❤️

    Like

    • dalewayne says:

      Haha. I was going to say that I need the other 100% (not Rx) and I couldn’t find the paragraph or remember what was in the list. This I know: I hate exercise. I can’t even remember how to spell it. I also know that taking ADHD medications made me feel like I had put on glasses and I was surprisingly better at reading. I wish I had been able to take it when I was still in school. btw I went to the doctor this morning with my shirt inside-out. Maybe I should have jogged first.. .

      Like

  2. Karen Greenland says:

    Thanks for your thoughts Dr. Mason – always enjoy your writing! 🙂 You definitely do have to invest 100% in both medication and non-medication therapies to get the full percentage benefit/results of treatment.

    Liked by 1 person

  3. Great article! I just shared with my Unclutter.com Organizing Support Group on Facebook. Blessings to you for a healthy, happy new year!

    Like

  4. The Bully says:

    great post (as usual). i will link.
    do 10 % of physicians have ADHD? surprising.
    best wishes
    doug
    by the way, my new book, The Bully, will be on amazon next week. indirectly about growing up with adhd

    Like

    • Great news, Doug! I’d pump you for an advance copy, but you deserve the sale…

      Technically, I don’t know how many US physicians have ADHD, but you and I do, so that’s way more than 10% of everyone in the room right now.

      Liked by 1 person

  5. Elias says:

    Oren,
    Great response and one I would have never thought of. It is very frustrating when parents say they are “giving up” and turning to medications because everything else has failed. But then I have to work on their continuing all the psycho-social-educational interventions. With Meds, a child can now benefit from tutoring or speech therapy.
    I do not know where this dichotomy came from, but it is a big problem.
    Holistic approach is necessary. There are thousands of genes involved and it is really surprising that we are getting as much success with the Meds as we do. But as you so clearly point out, they allow people to work on making their lives better in a more efficient manner.
    Thanks for posting.
    Elias

    Liked by 1 person

    • Oooh, good point, Elias. What a shame for parents to push “everything else” without meds to the point of their own exhaustion, then find out that “everything else” has to be redone with meds. Peace to you.

      Liked by 1 person

  6. […] Dr. Mason- therapy or medication?   The 100% effect. […]

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Oren Mason MD
Oren Mason MD

Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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