Understanding Attention Deficit Disorder (ADD/ADHD): To Medicate or not to Medicate?
Introduction to Attention Deficit Disorder (ADD/ADHD)
Attention Deficit Hyperactivity Disorder (ADHD), also known as Attention Deficit Disorder (ADD), has become increasingly prevalent in children and adolescents as the years have passed. Reports show that more than two million school-aged children are diagnosed with this neurobehavioral disorder that may transition with them into their adult lives (“ADHD-A Public”). ADHD is an important public health concern because it causes impairment in school performance as well as in socialization habits (Lesesne, Perou, and Brann). While there are many different ways to treat ADHD, such as counseling, therapy, and prescription medication, which is seemingly effective in helping children improve concentration, the question remains: should very young children, known to be naturally "hyper," be medicated for this condition? Currently, the effects of many drugs have not been studied in young children, which also leads to the question of whether the Food and Drug Administration (FDA) should more stringently regulate the use of stimulant drugs given to children.
Although ADHD does not have an exact definition, a large number of scientists agree that ADHD is a biologically based disorder of the nervous system. People with ADHD show “symptoms of impulsiveness, inattentiveness, and hyperactivity” yet different problems are seen in children than in adults (“Preschool Attention” 1). According to a diagnostic manual that the American Psychiatric Association composed, there are three types of ADHD: inattentive, hyper-impulsive, and combined. A person that is diagnosed with ADHD “has trouble focusing on activities, organizing finishing tasks, and following instructions” (Bren). A child that is diagnosed with ADHD is said to be constantly running around and constantly active. He or she shows excessive emotions and usually speaks out of turn as well as says inappropriate things. Adults tend to multitask, are always restless and always act on impulse (Bren).
People with ADHD tend to have behavioral problems that sometimes lead to serious consequences. Children diagnosed with ADHD tend to visit the emergency room more often than those who do not have ADHD. Adolescents with ADHD are said to engage in risky behavior more often than those without ADHD and are also more likely to drop out of school. Adults with ADHD suffer from depression and anxiety more often than those adults without ADHD (Bren). According to Russell Barkley, director of psychology at the University of Massachusetts Medical Center, “90 percent of ADD children are academic underachievers, 25 percent are held back at least one grade, 36 percent don’t finish high school (compared with 9 percent of the general population) and more than half have no friends during childhood” (qtd. in Koch). Statistics illustrate that 72 percent of boys and 68 percent of girls in juvenile detention centers suffer from ADD or ADHD. Those affected by ADHD are said to have higher auto accident rates and speeding tickets than those without ADHD (Koch).
ADHD and its Challenges: Diagnoses and Misdiagnoses
ADHD is a social problem that leads to many health and safety concerns. There are an estimated 2.5 million children and 1.5 million adults currently taking stimulant drugs to treat ADHD (Ginsberg). According the National Institute of Mental Health (NIMH), it is estimated that 3 to 5 percent of children residing the United States have ADHD. In other words, it is as if 1 out of 25 or 30 children have ADHD. Nora Galil, M.D., a psychiatrist in private practice in Washington, D.C., claims boys are also more commonly diagnosed than girls but this is rapidly changing. The reason boys are three times more likely to be diagnosed than girls is because symptoms are more easily recognized in boys. Boys are more active whereas girls tend to daydream and therefore go unnoticed (Bren).
The over diagnoses of ADHD as well as the over use of stimulant drugs to treat ADHD is a social problem affecting society today. Critics argue that the over diagnosis of ADHD causes the over prescription of stimulants, which pose serious health risks in the long term. On the other hand, ADHD experts and scientists say that while over diagnosing may occur in isolated cases, a greater number actually go undiagnosed and, therefore, go untreated (Koch). Over diagnosing ADHD is a common problem because currently no one test is able to determine if someone has ADHD but rather a specialist has to make the diagnosis. Paul Andreason, M.D., a drug reviewer in the FDA’s Division of Neuropharmacological Drug Products states that since many health professionals believe that ADHD is being over-diagnosed, the history of patients should be considered by doctors before diagnosing them. Diagnosis is usually based on a comparison of “a person’s pattern of behavior against a set of criteria established by the American Psychiatric Association” (qtd. in Bren 3). A specialist can be a number of professionals such as a psychologist, psychiatrist, or even a developmental or behavioral pediatrician. ADHD is the most common diagnosis for children 3-5 years old, but not much is known about effects of medication on this age group (“Preschool Attention” 1).
The overdiagnosis and misdiagnosis of ADHD can cause harm to the child that is being diagnosed. While it is said that some stimulants help children with ADHD function better, the same stimulant might cause a child without ADHD to have negative results. According to Raymond Woosley, M.D., Ph. D., a clinical pharmacologist and vice president for Health Sciences at the University of Arizona, a child that is misdiagnosed may have a negative increase in blood pressure since a regular increase is seen normally in ADHD children that are taking stimulants. Woosley recommends that a child’s blood pressure and heart rate should be monitored closely for safety reasons (Bren 6).
Though there is speculation of overdiagnosis, the American Medical Association’s (AMA) Council on Scientific Affairs noted that there is an insufficient amount of evidence that points to overdiagnosis or misdiagnosis. A reason given for the rise of diagnosis was because the diagnostic criteria have been broadened and therefore more people are being diagnosed (Koch). A great number of times, children are diagnosed with ADHD when in reality they might just have dyslexia or something as simple as vision problems (Koch).
It is extremely difficult to diagnose children ages 3-5, because children that age group are known to naturally be hyper or inattentive. In order for children to be diagnosed as having ADHD, they must display severe, persistent, and frequent symptoms that are described in the American Psychiatric Association’s diagnostic manual. Symptoms must also demonstrate that behavior children display is “inconsistent with developmental level” (“Preschool Attention” 1). It is recommended by the American Academy of Child and Adolescent Psychiatry that in order for children of all ages to be diagnosed with ADHD, doctors should perform psychiatric evaluations of the child, as well as have interviewed the child’s parents, and have monitored the child in a variety of settings (“Preschool Attention” 1).
Attention Deficit Disorder: Research and Controversy
The controversy of ADHD has been around for many years. Not only is the disorder of ADHD controversial but so are the different forms of treatment. The first report regarding the benefits of stimulant medication in treating ADHD was published by Charles Bradley in 1937, but it actually spoke about the benefits before the definition of ADHD had even been known. Bradley mentioned that the use of amphetamines helped children that had been hospitalized for disturbed behavior (Wolraich, McGuinn, and Doffing 18). In 1947, some researchers at the Wayne County Training School in Northville, Michigan, discovered that some common symptoms in children that were mentally retarded. The symptoms consisted of hyperactivity as well as distractibility. Because of such findings, children that were overactive and were distracted easily were called “minimal brain damage” and even “minimal brain dysfunction” (Koch). By the 1960s those two terms stopped being use, as there was never any evidence that showed brain damage. Ritalin was the first stimulant used to treat those with hyperactivity in 1961(Koch). In the 1970s, 62 double-blind, placebo-controlled studies were being reported. Since then, more and more studies on stimulant medications have been carried out and recent results show that the use of stimulant medications is effective in helping treat children with ADHD (Wolraich, McGuinn, and Doffing 18). Ritalin, otherwise known as methylphenidate hydrochloride, is “a short-acting compound with an onset of action within 30-60 minutes and a peak clinical effect usually seen between 1 and 3 hours after administration” (Schwartz 67). These types of stimulants are said to decrease the overactivity of motor functions as well as impulsive behaviors (Schwartz 67). Also, more research in the 1970s was focusing more on “attention deficits” as being the cause of behavior problems but members of Congress questioned whether scientists were just trying to medicated children with a great amount of energy. Current controversy surrounding treatment of ADHD has to do with stimulants being overprescribed. In February 1998, the International Narcotics Control Board (INCB) reported that the use of stimulants “may often just be the easy way out of a complex problem” (Koch). Although some parents do choose to medicate their children automatically, a great number of parents have sued the school districts for trying to get their ADHD child to take medications. Some school districts told parents that children with ADHD would not be allowed into the classrooms unless they were medicated because if the child was disruptive, they would disrupt the learning of the other children. Debra Jones, president as well as the founder of Parents Against Ritalin (PAR), claims that a reason that school districts are trying to get children medicated is strictly economic. Schools receive extra money for every child that is classified with ADHD (Koch).
The first hearing to try to get sponsorship on research for the use of behavior-modification drugs on elementary school children was held on September 29, 1970. At this hearing, when asked the question why high energy levels in children was considered a “disease,” John Holt, an educator and author, stated, “We consider it a disease because it makes it difficult to run our schools as we do… for the comfort and convenience of the teachers and administrators who work in them” (qtd. in Koch). After hearing such a statement, the subcommittee became concerned that schools were pressuring parents to administer stimulants to their children in order to lower their energy level (Koch).
With the rise in popularity of ADHD, people started to wonder in the 1970s whether or not ADHD, or what was then called Attention Deficit Disorder (ADD), was actually a disorder. Although there were many doubts, more than 2000 scientific articles were published by the end of the decade. That American Psychological Association (APA) first listed ADD in its third revised Diagnostic and Statistical Manual (DSM) in 1980, and that decade soon saw a rise, just like the 1970s, in research pertaining to ADD. Thomas Armstrong, author of The Myth of the A.D.D. Child, noted that in every DSM that was revised after 1980, ADD was being defined more broadly every time especially in the most recent DSM, (DSM-IV), published in 1994 (Koch).
The FDA and Attention Deficit Disorder
The FDA is the gatekeeper of new drugs being accepted into the marketplace therefore the U.S. relies on them to fulfill their responsibilities in helping keep consumers safe (Miller 19). The FDA was first established in 1962, and is currently funded by billions of dollars yearly in order for it, with about ten thousand employees, to carry out research to evaluate new drugs (Miller 4). In the mid-1980s, Vice President George Bush, began a governmental study to speed the process of drug approval. The Bush Administration believed that the best way to speed the process was to have nongovernmental experts evaluate the drugs. A pilot study was put in place to see if the new process would be effective but when the Clinton administration came to office, interest in the FDA declined (Miller xxvi-xx). Currently, the FDA does not test the drugs; it only evaluates and approves them after receiving data about them. The FDA consists of more than 40 advisory committees that are composed of experts outside of the FDA. Committees were created so that they could help the FDA with their product development and evaluation. It must be kept in mind that committees do not have any power and are there just to give the FDA a thorough report of research (Worsnop).Continued on Next Page »