A recent report from the Center for Disease Control determined that over 15% of children in North Carolina between the ages of 4 and 17 years of age are diagnosed with attention-deficit/hyperactivity disorder (ADHD). This percentage is considerably greater than the already unimaginably high rate of nearly 10% for the country as a whole. The number of children diagnosed with ADHD in the U.S. has been steadily climbing since 1997 following the removal of hyperactivity as a necessary criterion for the disorder. The rate of diagnosed children swelled 22% between 2003 and 2007. The rate has steepened from 3% per year after 1997 to a 5.5% annual increase since 2003. If this trend continues, the CDC will soon be enlarging their overall percentages of children with the disorder.
Two thirds of the children diagnosed with ADHD receive medication. Psychostimulants, such as Ritalin, Adderall, Concerta, Focalin, and others, are the class of drugs most frequently prescribed to treat ADHD. Studies have shown that these medications enhance focus and productivity while reducing hyperactivity and impulsivity. Behavior rating scales completed by parents and teachers reflect significant improvement in approximately 60 to 70% of children receiving stimulant medications. Typically the physicians prescribing medications for ADHD depend solely upon parent and teacher ratings to determine the efficacy of their treatment rather than using objective performance measures. For the majority of diagnosed children, medication is the only form of treatment they are receiving.
Yet researchers have long known that the beneficial effects of the drugs are often limited and are frequently short lived. The best studies performed to date state that there is no long-term benefit of psychostimulant medication on academic or job performance, interpersonal relationships, aggressiveness, antisocial behavior, or long-term life adjustment. On the contrary, there is evidence to show a detriment to complex, higher order cognitive processes such as flexible problem solving and divergent thinking.
One of the lead researchers in the most extensive, publically funded study conducted on the effect s of stimulant medication on ADHD concluded, “In the short run, [medication] will help the child behave better; in the long run, it won’t. And that information should be made very clear to parents.”
This information is not new. Similar conclusions regarding the ineffectiveness of psychostimulant medications have been consistently published since the late 1970’s, with no contemporary, compelling evidence to disprove these results. Nevertheless, medication remains the primary treatment modality for this disorder and is often the only real intervention being offered to children (and adults) diagnosed with ADHD.
Unfortunately, these medications are not innocuous and can produce many unwanted adverse effects. Surveys have shown that children taking psychostimulants rate themselves as less happy, more dysphoric, and less satisfied with themselves as compared to nonmedicated children. Youths who stay on the medication for extended periods of time often display stunted growth. A recent study revealed that stimulant medications may result in decreased responsiveness to positive rewards and increased sensitivity to punishment, a finding that suggests a precipitating risk for depression in long-term users of these medications. Canadian researchers demonstrated a 6% incidence of psychotic symptoms reported after starting stimulant medication. Moreover, some side-effects of the medications, such as motor tics, may not resolve once the medication has been discontinued, most likely due to “kindling” effects on sensitive brain regions involved in movement.
Despite these limitations and risks, most people diagnosed with the disorder depend on the medications they are prescribed to manage their symptoms. As humans, we generally prefer simple solutions and hope to receive the greatest benefit from the least interruption to our lives. However, lifestyle continues to emerge as a major contributor to many of the physical and mental health problems we encounter, including ADHD. Factors such as poor nutrition, food allergies, disrupted sleep schedules, lack of exercise, and inconsistent parenting have all been shown to impact the disorder.
On the positive side, attention appears to be amenable to training and studies demonstrate that some of available attention training techniques result in long-term benefits and lasting improvements in brain functioning. Unfortunately, the people who develop and employ these more effective approaches do not have the marketing budgets of the pharmaceutical companies. However, the word is spreading regarding both the limitations and risks of the medications being forced on our children, as well as the benefits of healthier and more effective approaches. We don’t have to keep failing our children.
Centers for Disease Control and Prevention: ADHD, Data and Statistics (www.cdc.gov/ncbddd/adhd/data.html)
Pelham, William, “MTA at 8 years,” in Journal of the American Academy of Child and Adolescent Psychiatry, (48) 2009.
Whalen, Carol. “Stimulant pharmacotherapy for attention-deficit disorder,” in S. Fisher and R. Greenberg, eds., From Placebo to Panacea, 1997