The ADHD Debate: Is My Kid Just Lively Or Suffering From A Psychiatric Disorder?

a child with adhd

by Femita

These days everybody has a child suffering from ADHD among their acquaintances. At least, that’s the diagnosis when kids are hyperactive and have difficulties concentrating. When only the latter (so without the hyperactivity) it’s called ADD, which is more common in girls. ADHD and ADD rates have exploded over the last ten years. The same holds true for prescription rates. In the old days a busy young boy was just loud, now he has ADHD. A girl that had difficulties to focus was called dreamy, now it has ADD.

Some experts worry that normality may be becoming  an endangered species. Recent studies show that 25% of the US population every year qualifies for mental disorder. If you look over the course of an individual’s life, by the age of thirty-two 50% would have had an anxiety disorder diagnosis, 40% a depressive diagnosis, 40% a substance diagnosis. These are enormously large figures. You could argue that maybe people are that sick, but probably the diagnostic system has become much too loose.

A reason for this is that people who are experts in a given area are often worried about missing a case. They think that a person deserves diagnose and treatment. They are worried that if they don’t get the appropriate diagnosis or treatment, their life will be ruined. Experts usually don’t worry nearly enough about false positive cases (people who get the diagnosis, but don’t need it).

This doesn’t take away from the fact that ADHD is a crucial clinical problem that needs treatment. However, it is now getting over-diagnosed causing a false epidemic.  ADHD used to be an uncommon diagnosis only given to very severe cases. The treatments were seen as powerful and to be reserved only to those who really need them.

With diagnosis rates also prescription rates for medication like Ritalin and Concerta have gone through the roof. These are trademark names for methylphenidate, a psychostimulant drug that increases levels of dopamine in the patient’s brains. Dopamine is a neurotransmitter that is naturally released in rewarding experiences and creates a feeling of pleasure. Chemically not unlike cocaine, methylphenidate is a powerful stimulant that increases alertness and productivity.  In many ways it is actually similar to amphetamines like speed.

box of ritalin ADHD drugs
What is less known is that there is no actual scientific proof that medication has any effects on the long term. Only children who also got behavior therapy tend to do better in the long run. Still prescription rates go up every year. The use of ADHD medication has actually doubled over the last 5 years.

This shouldn’t be too much of a problem if it weren’t for the many possible side effects of ADHD drugs. There are both medical and psychiatric risks. Psychiatric risks are especially insomnia and hyperactivity. Medications can also be used in an addictive way and can contribute to anxiety disorders, depression and psychosis. Medically, the most severe side effects are loss of appetite and cardiovascular problems.

Of course a large group of children actually needs medication. These are the more severe cases that don’t function properly without it and would quickly fall by the wayside.  But Ritalin should only be used as a last resort when other treatments like counseling or therapy have failed. In many cases the parents are the ones asking for alternative solutions like therapy or a special diet program because they don’t recognize their child anymore since it started using Ritalin. Many children become less creative and more withdrawn into themselves.

It is not always easy for parents to go in against the advice given by school or so-called experts. Schools often exert a lot of pressure on parents to test their child for ADHD because they like to work with calm and docile students and often don’t have the time and resources to pay extra attention to children who need it. In many cases teachers themselves already diagnose a loud child with ADHD. What they don’t always realize is that the label they put on a child also marks them as a patient suffering from a psychiatric disorder.

kid with adhd
Another powerful force to be reckoned with is the pharmaceutical industry. With the expansion of the diagnosis many people have been treated who are fine on their own. This is very much pushed by the drug companies that want to sell as much medications as possible. As they cannot advertise their products, the industry is looking for different ways to reach the masses e.g. leaflets in waiting rooms or websites that contain self-tests and free information on ADHD. What many people don’t know is that many big informative websites are actually sponsored by drug companies and present ADHD as strictly caused by a biochemical imbalance, while there is no scientific proof for that. Of course they are quick to present their wonder dug: Ritalin.

To finish on a positive note, once there are no more products to market and everything will be generic, probably rates will go down again. This is important as over-diagnosing is not only bad for the false positives, but also for the severe cases of ADHD. They could miss out on the attention and care they really need.

Alison

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{ 4 comments… read them below or add one }

Chris Neville December 9, 2010 at 5:06 pm

The adhd debate is not an easy one. On one side I feel like medications are necessary, but on the other side kids have done OK without them for over centuries. Maybe we have to rethink or schooling system instead of drugging or children, who knows..

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Amy Hagerup December 9, 2010 at 5:32 pm

I really agree that we don’t know the long term effects of some of these drugs. Even short term effects like appetite-loss, stunted growth, difficulty sleeping, and headaches are hardly worth it. I personally am using great nutritional supplements instead of adderall for my daughter. Thanks so much for all your research. Blessings, amy

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Keith Wilcox December 9, 2010 at 6:52 pm

It’s so true. These big companies sell us drugs and doctors have incentives to diagnose ADHD without fully vetting the drug or caring if the kid will actually be helped by it. It’s all about the money. Unfortunately, the kids who might actually have a problem get ignored because there are so many who are diagnosed for nothing apart from being a normal kid (lively). does a disservice to the diagnosis. Nobody takes it seriously anymore.

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AlisonM January 12, 2011 at 10:37 am

As someone who has lived with ADD for a lifetime, I have to disagree with the article on a few points. First, it is a myth that it is being overdiagnosed and that medications are being overprescribed. More non-hyperactive children are being diagnosed, which is good, because the disorder encompasses a lot more difficulties than you would imagine from the symptom list in the DSM. In addition, our ranks are also swelled by the adults who are finally being diagnosed after decades of not knowing what was wrong with them.

Second, methylphenidate and ampetamine salts have been studied for over 40 years, enough to have a pretty good grasp of the results of long-term use. Administration of these medications in children seems to inhibit growth, but reduces adult height on average by less than 1cm. It also increases a different kind of growth – brain mass in the frontal lobes of people with ADD is significantly smaller than normal, but adults with ADD who were treated with methylphenidate from childhood show an adult brain mass in this area that is much closer to normal than that of untreated ADD adults.

What I do agree with is the importance of counseling and skill-building. Many things that neurotypical individuals take for granted, cognitively, behaviorally, and socially, are completely counterintuitive for people with ADD. They do not all of a sudden come naturally simply upon taking a pill. I think the greatest favor we could do for our ADD children is to understand the way their brains work and teach them how to play upon their individual strengths and compensate for their difficulties, and how to function best in a society whose structure is not ideal for them.

ADD is a spectrum disorder with a wide range of affect. Some people will function perfectly well with some behavioral adjustments. Some people will be able to make those adjustments with the help of medication. Some will be so severely affected and/or suffer from comorbid disorder(s) that even with multiple medications and therapies, they cannot care for themselves.

In the ADD community, though, we have a mantra: “Pills Plus Skills.” Learning the behavior adjustments and coping mechanisms that help us function (and sometimes even thrive) is essential to success, whether we are medicated or not. Therapy for ADD is noninvasive and safe, and sometimes works well enough on its own. Medication carries risks, but is sometimes necessary in order to be able to utilize the skills therapy is trying to teach. Medication alone may be like a rubber raft in the middle of the ocean – you’re not going to drown, but you don’t know how to get to shore; if you didn’t get the therapy before you started it, you need to add the therapy now.

I speak from experience – mine, and that of many other adults and young adults with ADD. Children don’t have the means to express the complex differences from normal that they experience, but we do. For myself, having gone through most of my life unmedicated and failing at therapeutic fixes, then experiencing medication in my 40s and finally making the improvements that eluded me until then, I can say with certainty that medications would have made my formative years and my life as a whole significantly better. Had I been given the choice, I would not regret medicating my ADD one iota.

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