Medicating children for a host of mental disorders has become very popular in some parts of the USA. More than 8 million kids from 6 months to 17 years of age are on pharmaceutical drugs in this wonderful country. We lead the world in drugging youth for behavioral, cognitive and attention issues. We are once again #1. But from my little office not funded by the pharmaceutical industry, I am not so sure we should hit the streets quite yet chanting āUSAāUSA– USA!āĀ
In this blog I would like to share with parents as well as adults working with children a few not so readily available facts related to medicating kids for behavior issues.Ā I am hoping these facts might encourage adults to be a bit more cautiously curious when it comes to drugging kids. I am hoping that even for adults with kids who have been on ADHD drugs for a long period of time, it becomes apparent there is no time better than the present to stop this practice.
Fact #1: Too Many Unknowns When It Comes to Long-term Use
If you were manufacturing a drug for kids to take daily for several years or more, that your research documents state comes with a possible endless list of serious and life threatening side effects ranging from dependency to depression to death, how long would you want to track kids taking the drug to make sure it was safe and effective for them to take for extended periods of time? Most rational experts truly concerned about the health and safety of kids would probably want to consider conducting several studies that spanned at least a year or two.Ā The possibility exists, however, that those selling such drugs for kids are neither rational or concerned.
You might not be aware of what little it takes for a pharmaceutical drug to be approved for purchase in the USA. Surprisingly enough, for a federal level process, at the end of the day it doesnāt require much. For those in the billion dollar pharmaceutical industry manufacturing drugs for those darn meddling kids,Ā the FDA approval process apparently is even less stringent. Take for instance, the latest ADHD stimulant drug from Shire Pharmaceuticals called Vyvanse.
You see, Vyvanse was approved to be administered to millions of kids for years on end based upon two studies that followed 342 kids six to twelve years of age for three to four weeks. These kids were selected because they met the criteria to be diagnosed ADHD; which is not that hard to accomplish. If you donāt believe me, please take the ātest.”Ā The FDAās approval was based upon reviewing these two studies that only attempted to show that kids behaved ābetterā than their control group counterparts.
There is no mention of medical tests taken during the study to monitor the effects of the drug on the kidsā nervous systems, brain functions, or internal organs. There was also no concern to see how the drugs affect infants, toddlers or preschoolers. Novartis, the makers of Focalin (aka the new and improved Ritalin), submitted two studies as well to the FDA. The studies to get Focalin approved by the FDA followed only 207 kids six to twelve years of age for four to six weeks.
Do you think the FDA approval process is requiring enough research to insure our childrenās safety when it comes to pharmaceutical drugs? As my colleagues Robert Whitaker, Marilyn Wedge, Peter Breggin and many others working to get kids off of pharmaceutical drugs have documented, the pharmaceutical companies know a lot more about these drugs than they care to share or the FDA cares to consider. If you would like to see an example, please watch this video.
Fact #2: ADHD Stimulants are Addictive
Using any search engine, if you type in the words āmedication guideā and the name of any ADHD stimulant marketed in the USA, what you will find is a full disclosure of all of the drugsā side effects. But you also will notice how the pharmaceutical companies first warn that the drugs can cause heart failure, and then they admit the drugs can lead to dependency, which is a nice way of saying they are addictive. This is why they are classified as a Schedule II Controlled Substance similar to meth and opium.
If they were not addictive, why would the manufacturers and doctors recommend seeking medical help before stopping use of the drug? The reason they recommend such procedures is to cover their butts and to help kids slowly wean themselves off of the addictive drugs to avoid withdraw symptoms. Similar to a heroin addict kicking the drug, they medicate the patient with Methadone and slowly lower the dosage level to avoid withdraw symptoms. Does this sound like something a child in preschool or grade school should have to do? Should we really be prescribing drugs, that could quite possibly lead to dependency, for kids just stumbling through the natural child development process and trying to figure out how to act in social settings?
Also, if ADHD stimulant drugs were not addictive, why do doctors have to continually up the dosage of the drug for their young patients as their daily use continues? Because similar to any person using an addictive drug, their system starts to build up a tolerance for the drug and as a result they āneed moreā of the drug. If ADHD stimulants are not addictive, why are students crushing them up and snorting them for a bigger āhighā?
Studies show that ADHD stimulant medication has basically the same effect on a childās brain as cocaine. The stimulants, similar to cocaine, take over the neurochemicals in our prefrontal cortex that guide how we think and behave. This cognitive coup is accomplished by the stimulants reducing the blood flow and nutrients being sent to the brain by 23-30%. Imagine your local reservoir trying to provide water to your community when only 2/3 full. The impact of the stimulants causes the brain to micro-hemorrhage (bleed) (Ellinwood & Tong, 1996), and research shows such effects can cause more than 50% of the users to develop drug-induced Obsessive Compulsive Disorders. In other words, what some want to sell you as a sign of the drugs helping a child to be less spontaneous, less hyper, and more likely to only focus on one thing, is actually reflective of the mind being medicated to malfunction daily for the rest of their childhood.
Most regretful, families are losing children to such addiction.
Fact #3: There is No Benefit to Long-Term Use of ADHD Drugs
I guess there is one study that gives us some insight about the long-term use of such drugs. The most comprehensive study done on the long term use of ADHD drugs was published in 2009. The study was funded by the National Institute of Mental Health and is often referred to as the Multi-Modal Treatment Study on ADHD or 2009 MTA Study. The 2009 MTA was intended to follow up on the 1999 MTA Study, which claimed that ADHD drugs were more effective than behavioral therapy in the first 14 months of use. But guess what news the 2009 MTA Study publication shared?
After following kids for six to eight years, the 18 authors of the research (of which apparently only two were not being paid on the side by pharmaceutical drug companies) stated the study āfail[ed] to find better outcomes associated with continued medication treatment.ā They went on to say that children still being given drugs by their parents six to eight years later āfared no better than their nonmedicated counterparts, despite a 41% increase in the average total daily dose, failing to support continued medication treatment as salutary.ā Basically they found that after fourteen months the addictive drugsā āeffectivenessā began to dissipate and after three years the drug-treatment advantage was gone completely.
The individuals and groups promoting such drug use have no research supporting the value to keep children on these drugs for extended periods of time. All they really have are a few methodologically flawed studies that claim the drugs effectively treat the behaviors associated with ADHD for a few short months. As to whether taking a drug that basically medicates the brain into malfunctioning and over stimulating a young childās brain so that it is incapable of producing excessive thoughts that lead to exuberance and distraction is beneficial to the child, I will leave that debate for another day.
I know some clinicians and doctors might want to tell you different, but who are you going to believe? Are you going to take the word of the individual wanting to medicate your child so you have to come back every month to have your childās heart, weight, growth and dosage level checked, aka pay for continuous office visits and tests for years on end, or are you going to believe the largest longitudinal study ever completed on the ineffectiveness of ADHD drugs and performed by doctors who work for the pharmaceutical industry? At the least ask your doctor if they have even read the 2009 MTA study, and if not share it with them for discussion purposes. Personally, I am still shocked by how so many who prescribe the drugs have not even heard about the study or the findings.
Summary
The reason I wrote my latest book on Debunking ADHD, is it just seemed surreal to me as to how so many are reliant today upon a drug to do what traditional parenting efforts and inspiring instruction has accomplished quite successfully for centuries? I realize such drugs in theory provide a quick fix for some very challenged circumstances, but just these three facts alone provide several reasons why we should question if it is worth the risk. Plus, who really wants to put children on mind-altering drugs, when decades of research on child development as well as effective parenting and teaching provide so many other viable options?
If you are a parent, grandparent or educator, you know all too well that raising children is one of the hardest demands we will experience in life. You have firsthand knowledge that kids can be quite annoying and trying at times. Despite not yet receiving their Ph.D. in psychology, they are masters of manipulating adultsā brains and nervous systems. No matter how hard we try or deeply we care, it is often nearly impossible to help them understand that their behavior must change, grow or mature. At times it seems equally frustrating to convince them that worrying about the small stuff, which can often lead to anxiety or depression, is something that must be better managed to truly enjoy life and accomplish success. As a psychologist, parent, educator and former problem child, I understand all too well such frustrations and also can understand the allure to the possibility that a pill can fix everything instantly.
But do you really think there is a pill capable of magically transmogrifying such children? Have you ever wondered if such pills are truly a healthy or safe option for kids with behavioral or attention issues?Ā Have you ever thought about the risks of having kids in the prime of their developmental stages take such drugs for extended periods of time? Unfortunately the brochures selling such drugs printed by the pharmaceutical companies, and too often found in the pediatricianās and clinicianās offices prescribing the drugs, do not share the whole truth related to such concerns with the average consumer. Unfortunately, they do not share with us that parenthood is not easy or that the behaviors they want to call symptoms of mental disorder are also typically classified as common behaviors associated with normal child developmental challenges.
These three facts I shared today are related to ADHD drugs, but the storyline is not that different when it comes anxiety and depression meds. There are many more facts that every adult or parent working with challenging children should be aware of when it comes to what they call ādrug therapy.ā And I hope this blog has encouraged you to seek more information. Our kids deserve nothing less.
Not meaning to seem flippant about such a serious matter, but I see there are reasons why it’s called kiddie cocaine.
Report comment
Its way better than than cocaine cause you don’t need to re up every 20 minutes to keep the high going.
Report comment
Thanks again, Michael, for helping to enlighten people regarding the dangers of drugging children. No doubt, someday, our country will be seen as on of the worst societies of all time – forcing little children onto stimulants for profit is one of the most disgusting behaviors I’ve ever heard of, shame on the US medical community.
Report comment
I’ve only recently become aware of what’s happening with children being drugged and am appalled. People really believe the chemical imbalance myth. I’ve talked to 2 people now who were informed it was child abuse not to give their children Adderal or Ritalin for their ADHD, so they put their child in private school. I wish the Justice Dept. would prosecute these child psychiatrist and geriatric medicine predators who are destroying brains for a pharmaceutical kickback. For an education go to http://www.propublica.org Dollars for Doctors and Prescriber Checkup and see the drugs being prescribed. Antipsychotics are bug killers which shrink the brain and destroy memory, and ADHD drugs are stimulants, speed. But thanks for the work you and Dr. Peter Breggin are doing to stop this madness.
Report comment
I want to bring to people’s attention a recent article in TIME magazine that talks about how morally wrong it is to drug our children this way. I think it is very important when mainstream media outlets publish something like this, since most articles they publish sound like drug company ads (which they are).
I’m sorry that I can’t seem to generate a URL, but if you feed this title into a Google search, you will find it. Well worth reading.
Whereās the Moral Outrage for ADHD Mass Medication?
Report comment
http://time.com/3822755/adhd-disease-called-childhood/
Report comment
From the article:
“Scott and Ava asked if I thought Adderall would help Aiden. In the spirit of providing them with all the options, I told them it probably would. Stimulants like Adderall help most children calm down and become more focused. In most cases, the effects of the medication are visible from the first day a child begins taking it.”
repeated a 2nd time,
“When Aidenās parents asked me if I thought Adderall would help their son, I told them it probably would.”
I know we need to tread cautiously, but half-truths may encourage more parents and students to start taking these drugs.
Report comment
Okay… as is often the case on this blog, I agree with the general sentiment but there is an unfortunate tendency to cherrypick and misrepresent data.
Regarding #1, there are MANY studies on long-term use of stimulants. There are not many regarding Vyvanse because it is a new medication, but keep in mind that Vyvanse is lisdexamfetamine, a prodrug of dextroamphetamine, a medication that has been in use since 1935. Focalin is a long-acting formulation of dexmethylphenidate, the D-enantiomer of methylphenidate, which has been in use since 1954. Both have extensive long-term safety data. However, it is absolutely true that medications need only be shown to be non-inferior to existing treatments to be considered efficacious by the FDA. This is a problem not just in psychiatry but in medicine as a whole, and is simply and transparently a strategy by pharm companies to have a steady supply of on-patent products.
Regarding #2, it is well known that stimulants are addictive. That’s why they are schedule #2, why they require a paper script from a doctor (not electronic or phone), and why they should be the responsibility of parents, not kids. Doses are increased because children get bigger and require more medication for the same blood level. Stimulants will indeed get you high if you snort or inject them, somewhat like cocaine, but not if you take them as prescribed; and there are several formulations of stimulants (e.g. the Daytrana patch) specifically designed to prevent this type of diversion and abuse. Stimulants do NOT cause OCD in 50% of the children who take them; rather, if you read the article Dr Corrigan refers to, 50% of these children had increased compulsive behaviors, described as “subtle and transient,” and which did not come remotely close to meeting OCD criteria. Obsessions and compulsions are actually remarkably common even among normal children, such that subsyndromally they are not even regarded as pathologic. Regarding the reductions in blood flow to the brain, the linked article is a three-page essay by a nonprofessional, citing outdated research, on a website, “Neurosoup,” that is apparently devoted to psychotropic drugs and sharing “trips” with other users. And regarding fatalities, the linked article describes an intelligent young man exploiting incompetent physicians and becoming addicted to prescription stimulants. It brings into question one practice’s prescribing patterns and the too-common diagnosis of adult ADHD, but it is not otherwise a reflection on the medications themselves.
Regarding #3, please look at the study for yourself. Basically it is saying that receiving 14 months of treatment with stimulants, and then STOPPING, did not significantly improve outcomes 8 years later. Neither did intensive, multicomponent behavioral therapy, by the way. What this article shows us is that stimulants do not permanently cure ADHD, particularly if you’re not taking them — surely this is not surprising. However, when you look at studies of children with ADHD who have been maintained on stimulants during childhood and adolescence, you find that their behaviors and academic performance are remarkably better. Medication only works if you’re taking it.
Finally, I wish that we could stop accusing parents and physicians of “drugging” their children. It is needlessly inflammatory and basically shows that we have already made up our minds about this and are not interested in any arguments to the contrary. It might be helpful if we talk about problems in prescribing trends, the structure of mental health treatment, &c, rather than accusing parents and physicians who are, for the most part, trying to do what’s right for the children in their care.
Report comment
Ok, now who is blowing smoke up who’s ass? I see that both the author and his responding critics are obviously at odds. So, where to begin…I would imagine that the author is a newer member to the psychiatric community-he seems to be under 50 at least, and his ideas are coming from a newer understanding of psychology; that is quite self-reflective it seems. The fact that the author states that he was also a problem child leads me to believe that maybe he knows from first hand experience what it is like to be on the prescribed end of the doctor patient relationship. Its seems ironic that I’m seeing this push back against the traditional psychiatric drug therapy routine, from new psychiatrists that grew up in the guinea pig generation, where these drug therapies were initially tested. Concerning MT’s response, it is obvious this person is one of the devote (concerning mainstream psychiatry), and is stubbornly going down with a sinking ship-and let me tell you it is taking on water fast. The fact that MT’s best defense is to attack the authors specific citations and resources (as being shoddy unworthy sources) says nothing to the validity of their assertions-there are in fact many respectable citable sources that back up the authors statements (I don’t have the time to list them),but the evidence is growing every day…or rather is being uncovered. MT’s argument only shows that these die hard old guard head shrinkers are running out of magic tricks, and people are starting to see them for what the are…charlatans.
Report comment
“Pay no attention to the man behind the curtain, I AM THE GREAT AND POWERFUL OZ!”!!!!!!!!!!!!!
Report comment
Hi MT – I looked through your post (thanks for the effort) and decided to look up one of your objections to see, if it had any merit. I looked at your comment to #3, where you claim that the article by Molina et al only looks at the effect of 14 months of medication 8 years down the road. If that was what the article was actually saying it would, I think, be a good objection.
But looking at the article this is not what it says. I quote:
“[…] with one exception (math achievement), children still taking medication by 6 and 8 years fared no better than their nonmedicated counterparts, despite a 41% increase in the average total daily dose, failing to support continued medication treatment as salutary […]. Additionally, failure to find better outcomes associated with continued medication treatment occurred despite the arrival of improved long-acting stimulant medications […].”
This pretty much goes against your assertions, MT. Can you point to one of the studies you mention about children who have been maintained on stimulants during childhood and adolescence and their academic performances?
Report comment
Sorry, MT, but I don’t think your accusation of “cherry picking” holds up, especially as to #3. As Jonathan points out, the study did not stop treatment at 14 months, but it allowed people to choose which treatment they wanted to use, and they compared those who continued or added stimulants to those who discontinued or never started them. The three- and 8-year followups showed the same thing: it didn’t matter whether kids used or did not use stimulants, the outcomes were the same for all groups.
The Raine study in Australia showed similar results when children’s outcomes were compared based on long-term stimulant use or avoidance. In fact, the kids taking stimulants were more likely to repeat a grade by something like a factor of 9. Additionally, there was a study in Quebec that compared outcomes after a change in medical coverage allowed the widespread use of stimulants for the first time. Kids who took stimulants did not out perform those who did not on any measure. Girls who took stimulants were more likely to experience emotional problems like depression and anxiety. Finally, a comparison of outcomes for Finland vs. the US showed that the rates of ADHD to be similar, the US rate of stimulant use to be massively higher, and the social and educational outcomes to be no different between the countries.
If that’s not enough, there is the OHSU medication effectiveness project, which reviewed over 2000 different studies, basically the entirety of the literature on ADHD that they could find, and there was no proof of any improved outcome on any measure, except a small improvement in the rate of serious accidents for stimulant users.
The data is in. Stimulants don’t improve long-term outcomes. They just don’t.
—– Steve
Report comment
“receiving 14 months of treatment with stimulants” It doesn’t stop at 14 months.
When you pick your son up from college because he has experienced psychosis for the first time in his life. You find out that he has been awake for days and taking Adderall like candy.
You then look around the community and you find that just about everyone knows someone who has had a child or young adult that has suffered real bad side effects from these amphetamine class of drugs. Some catastrophic!
More power to the ADHD kids that don’t take drugs because you will rule the world.
Report comment
Thank you Michael Corrigan. Keep up the good work.
Report comment
Hi Jonathan — you are right, I missed that line in the study. I will say that this study also notes that “Inferences about potential advantages that might have occurred with continued long-term study-provided treatment are speculation” (p. 496) simply because of the nature of the study. Treatments were indeed terminated at 18 mo.; some of the patients continued medication, while many of those in other study groups started them in the subsequent years, such that by 6 and 8 years, “group differences in medication use were no longer significant” (p.488) — which is to say, about 50% of the kids, regardless of their initial treatment, were taking stimulants. Altogether this study is just not equipped to judge long-term benefits, and does not claim to do so. There is actually a huge deficit in research into long-term benefits beyond 2 years, but there are many studies following for 1 – 2 years with positive results, e.g.:
http://www-ncbi-nlm-nih-gov.ezproxy.welch.jhmi.edu/pubmed/21699268
http://www-ncbi-nlm-nih-gov.ezproxy.welch.jhmi.edu/pubmed/24305033
To “blah” — not “old guard,” just a young practitioner in the field with a commitment to evidence-based treatment. Child psychiatry as a field is in no serious danger of being phased out, at least until some other field can prove themselves competent in caring for seriously mentally ill children; and stimulants will remain the treatment of choice for ADHD until we find something better. Atomoxetine, venlafaxine, bupropion and clonidine all have their place but none have been as effective as stimulants. Making changes to the school environment is great and very effective for mild to moderate ADHD, but (1) they are not available to most American children, and (2) they are not adequate for the treatment of children with severe ADHD, who, without medications, will severely disrupt their own education regardless of environment. It would be wonderful if stimulants could be phased out by superior treatment — it would also be wonderful if antidepressants, antipsychotics, antihypertensives, cholesterol lowering drugs, and opioid pain medications could be phased out as well. We’re just not there yet.
Report comment
Hi MT – I’m not sure you’re interpreting the article correctly. But I haven’t got the time at the present moment to reread it. Still, I read the following line:
“[…] children still taking medication by 6 and 8 years fared no better than their nonmedicated counterparts.”
… as indication (by the use of the word ‘still’) that they are referring to a group of children who have been more or less continuously on medication.
It’s very unfortunate that, as you mention, there is a lack of longterm research in the whole field of psychopharmacological medications.
I unfortunately cannot follow your links further than a registration-wall. Perhaps you could provide the titles so I can reach them in some other way?
In your previous post you mention: “However, when you look at studies of children with ADHD who have been maintained on stimulants during childhood and adolescence, you find that their behaviors and academic performance are remarkably better.”
Are these the studies you are linking to? Because by your description they certainly sound like they are fairly longterm and have strong conclusions.
Report comment
Apologies, here are direct links to the studies:
http://www.ncbi.nlm.nih.gov/pubmed/21699268
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235029/
I think I was myself speaking out of a misunderstanding. I had apparently understood that long-term evidence exists where there is none. I’ve been looking but still cannot find any studies going beyond two years. Evidently I overstated the case for long-term benefits, for which I apologize.
The bottom line regarding the article in question, for me, is that it is not designed to assess long-term efficacy of continuous medications; and aside from comments in the discussion (which, I think, argue that long-term medication did not provide benefit, yet on the same page admit that the study could not have detected benefits anyway), they did not include this in their data — for example, how many children in each group were on medication by the end, or comparing all of the children who were on medication at the end point with all the children who were not. As far as I can tell, the paper’s most important finding is that self-limited behavioral or medication interventions did not have persistent benefit at 6 to 8 years; medication aside, this also seems to show that behavioral therapy, which is usually regarded as having long-term benefits even after completing treatment, unfortunately did not do so in this case.
Report comment
But it also found that both groups did make improvements in symptoms, regardless of treatment or lack thereof. Which kinda suggests that formal “treatment” may matter less than other variables, such as the school structure, parenting styles, “fit” between parents and kids personalities, and simply allowing for the child’s development over time. We know from developmental psychology that kids develop different skills at different times and are still within the normal range of development. Is it possible that the main “cause” of most “ADHD” is the unrealistic expectation that all kids will be capable of performing the same level of academic work at the same time and in the same kind of setting?
Supporting this is the fascinating finding in a Canadian study that waiting one year to admit a child to Kindergarten reduced the “ADHD” rate by over 3o%! Think of it – almost a third of all cases go away if you admit the child to school a year later. Why are those kids getting drugs?
Similar results have been found in other studies:
http://www4.ncsu.edu/~msmorril/EvansMorrill_ADHD.pdf
Report comment
I think there is a lot of assuming that there are clear data for the longterm use of a lot of medicines… when there actually isn’t. At least that’s how it appears in mainstream thinking. I wonder how all this assuming comes about…
Thx for the links!
Report comment
There is evidence from a number of sources over the years that putting these kids in open classroom environments where they have increased control over their activities and schedule almost eliminates any disruptiveness in the classroom environment. We used this with our two ADHD boys and they had no serious difficulties and never used medication, even though both would have been in the moderate to severe category in terms of hyperactivity and oppositional behavior. The fact that such environments are not available is not an excuse for putting kids on drugs unnecessarily. I would ask and expect that you as a young and evidenced based practitioner would be interested in helping assure that kids in schools across America have this kind of environment available, rather than allowing our society to medicate healthy children because they don’t conveniently fit in to the standard classroom model.
The other confounding factor you’re not mentioning is that “severe ADHD” is often actually the result of or compounded by historical or ongoing traumatization. The DSM criteria do not attempt to distinguish the cause of the “ADHD” behavior, hence many traumatized kids are labeled “ADHD” and prescribed stimulants, which often make the situation even worse, since stimulants can exacerbate anxiety, depression, and aggressive behavior. Kids whose behavior is so provoked are often labeled with yet another “disorder” and given even more drugs, rather than removing the offending stimulants. I speak from experience on this point, as I work with foster kids, who have an ADHD diagnosis rate that is 4-5 times the general population. Clearly, if “ADHD” is purely biological, we would not expect to see this kind of differential rate of diagnosis. The obvious conclusion is that traumatized kids are frequently being diagnosed with “ADHD” and their actual needs are being obscured or neglected by their diagnosis and treatment plan.
—- Steve
Report comment
The open classroom model is great, and I hope that there are not mental health experts arguing against its use. The challenge is bringing it into wider use. Part of working in mental health is (or ought to be) advocacy for patients, so I quite agree with you and would do what I can to support these. I am not convinced that open classrooms work for ALL children with ADHD, and as you know the diagnosis requires that the child is having problematic symptoms at home as well. The use of medications can indeed be minimized but not, in my opinion, ruled out entirely.
The problem of comorbidity with ADHD is a real one. DSM criteria are atheoretical, that is to say, they do not speculate (in the criteria) on the origins of ANY psychiatric disorders. A competent provider ought not make a diagnosis exclusively on DSM criteria, but rather should be taking a thorough personal and psychiatric history, which hopefully would bring a history of trauma to light. Admittedly this does not always (or often) happen outside of academic medical centers; but if the root cause of a child’s symptoms are trauma-related it would be substandard treatment to only provide them with stimulants.
I hope it did not seem that I was arguing for a purely biological model of ADHD. I wouldn’t argue for a purely biological model of ANYTHING in mental health that does not have a very clearly established brain pathology (e.g. Huntington’s). I’m sure that many different factors contribute to a child’s developing ADHD, and treatment has to address all of these. I would hazard a guess that higher rates of ADHD among foster children is not just a diagnostic artifact; it could also be that certain experiences, exposures &c raise their risk for the illness later in life, much as repeated early childhood trauma raises risk for borderline personality, or early childhood bereavement raises risk for major depression. Treatment for ADHD ought to be multimodal; but again, in at least some cases this will not succeed without medications.
Report comment
Of course, I am a proponent of flexible planning for every case, as no two kids are alike. My biggest beef with the DSM is that it lumps together kids that aren’t very similar. I appreciate your recognition that effective trauma screening is rare (a recent survey of boys in California residential treatment centers found that over 85% had trauma histories, but I think it was less than 20% who actually had this documented in their records!), but this suggests that most kid in the community are getting substandard treatment. Unfortunately, when enough practitioners engage in substandard treatment, it becomes standard treatment, much to the detriment of the clients being served.
To be quite honest, I am not a believer that “ADHD” is a disease in any real sense of the word. It appears to be a social construct designed to describe and isolate kids who behave in certain ways that are inconvenient for the adults around them. Fitting the criteria for “ADHD” shows nothing except that you fit the criteria, as there is no solid evidence that this cohort of kids has anything much in common other than being difficult for the adults to manage. Only by doing a much more thorough analysis does one ever find an real physiological problems (like FAS/FAE or low iron or sleep apnea) or psychological underpinnings (like current or past trauma) or social causes (like poor or inappropriate school structure or limited parenting skills or developmentally inappropriate expectations). The act of diagnosing appears to absolve most clinicians from giving any further thought to possible diverse causes or creative treatment approaches. While there clearly is a phenomenon that “ADHD” describes, calling it “ADHD” seems to preclude any further thought from any but the most responsible clinicians.
—- Steve
Report comment
Of particular interest to me is that by labeling a set of behaviors ADHD, it appears we’ve stopped looking for underlying causes. I am a firm believer that the behaviors that are labeled ADHD exist and are not always responsive to parental or environmental modifications. I’m a believer because my daughter clearly met all the criteria for an ADHD diagnosis.
By changing, the food we eat, and removing chemicals from our household (and school), all of my daughter’s symptoms disappeared. She did have a chemical imbalance., but it wasn’t caused by a shortage of Ritalin. It was likely caused by a a deficiency in metabolism. The research is still developing behind why food dyes, salicylates, gluten, casein and other things have a neuroliogical impact, but they do for many who are being diagnosed with ADHD. Our next steps are to see what is possible to heal the underlying metabolic issues. Until then, we won’t exposure her to food and chemicals that are neurotoxic for her. Medication is recommended as a first line strategy for ADHD. As long as that continues to be the recommendation for pediatricians, many, many children will never have their underlying issues identified.
Report comment
I was one of those parents who dutifully drugged my son at the urging of his school and his pediatrician. In unrelated matters, it was around the same time my husband was put on ssris for GAD. How far I have come since that time..
My son was medicated at the age of 6 yrs old. At first he was put on vyvanse, then guanfacine then clonadine. All taken in combination.
Yes, he was surely able to sit still but he also became withdrawn, underweight, obsessive compulsive & depressed. Like many things psych related, the changes are slow & insidious. Because he was able to function ‘normally’, the drugs were considered successful. As the years went by, he failed to gain weight or grow in stature, which, in turn limited his ability to play sports or make friends outside of the online gaming community. He was often bullied at school & had no real way of expressing his feelings or emotions about what was going on.
I was watching the news the day of the Sandy Hook massacre when a picture of Adam Lanza came across the television screen. It absolutely took my breath away, I was staring at a pic of my son. It was then a light bulb went off in my head and with record speed, I was able to connect the dots regarding my son’s meds, his behavior, how duped I had been and how essential it was I get my son off all meds as quickly as possible. I can’t explain the feeling of suddenly knowing, but I just knew.
That was the last day my son was medicated. I stopped him CT. I was aware of the side effects & dangers & kept a close eye on his BP & potential serious side effects He suffered withdrawals for about a year but they were manageable. Mainly obsessive thoughts like the tune of a song he would repeat over in his head for hours, he was very emotional, weepy and he was exhausted. Physically, he had chest pain for nearly two years (which I had checked out) that gradually decreased with time. He slept quite a bit that first year.
Within a year of stopping, he grew 7.5 inches and went from 60 lbs to 120 lbs. He is now 14 yrs old and is a happy, normal kid. He was able to share with me how he felt while taking the meds after sometime without them. He said “Mom, I thought about killing myself everyday but the meds kept me from being able to tell you.”. My son never needed any medication. There was nothing EVER wrong with him other than the fact he was a bit hyperactive. At six years old, I’d say something is wrong if your kid isn’t hyperactive!
In 2.5 yrs we’ve from a medicated family to a med free family. It’s been the most difficult experience of my life and one where the medical community offered no support or help. During this time I was also dealing with a husband who’d been on ssris for five years. I was forced to quit my job & dedicate myself to healing my son & my husband. It was a 24/7 commitment. It’s truly up to the individual to educate themselves & wing it as they go along. Most families are locked in once they start stimulants and/or psych meds, they lack any guidance on how to get off the drugs and are most ALWAYS discouraged from doing so.
Report comment
Thanks for sharing that story. When I end up having kids, drugs will not be an option. I can at least say that I went through the trials and tribulations as a protection against such nonsense. I too didn’t know how to express myself even though I was articulate. The dexedrine made me quite reticent and intoverted–result being hostile and often depressed for being so bottled up. When I stopped, a my “Self” completely spread wings…was much happier, spontaneous, and free-spirited. Had to deal some impulse control, which is really just self managment…but it took a while of getting to know what was correct behavior or not. That was trial and error that everyone goes through though. Definitely worth it. I also grew a couple of inches, stopped getting acne, and was more interested in exploring new things–that was at 21. I am 32 now, with 2 bachelors degrees, a master’s in progress, and several other certs and skill sets that cater to my interests.
Drugs, ha, well, perhaps as an adult using them with discretion, but a child or adolescent that is rapidly growing and learning about the world…that is hell. As a kid who was also drugged at 6 with Ritalin, and who made the decision on my own to stop…I am grateful to know there are parents like you who would have the intuition to protect your son even if it opposed “doctors orders” and diagnosis of a “disorder”.
Cheers
Report comment
Correction above, it was around the same time I was getting my husband OFF ssris that he had been prescribed for GAD.
Report comment
Question: Does anyone know if there is enough of a plasticity mechanism in the brain to recover or rehabilitate the effects of these kind of drugs?
I was put on Ritalin when I was 6 (I never actually took a whole dose–they had to break it into pieces or I wouldnt swallow it, and I even spit that out often without them knowing :P) until I was around 11, and then Dexedrine from 15 to 21. I basically said “f*** you to taking it after an allergic reaction from the antidepressant i needed to take because the Dex made me depressed. It landed me in the ER with my throat closing and swollen face…awesome, I know…why would I want to stop that routine, huh. Turns out I was misdiagnosed with ADHD being one of the guinea pigs in the height of the knee-jerk ADD diagnostic phase of psychiatry.
Anyway, I am 32 and have not taken anything since, but have really wondered “what would I have been like as a kid, and what would be different now?” Dont get me wrong, Im doing just fine, graduated on the Dean’s list with 2 Bachelor’s degrees, and am in graduate school now. But I have still been thinking what it would be like to try these new and improved versions of Dex, like Vyvanse, right now. I hate Dex by the way…it made me over think and over analyze everything under the sun, and my free association thinking was almost non-existent. I suppose I just felt good about even the most boring of tasks, and felt “smarter” about what I was doing…even though I guess I have no real proof that I actually was. Since I’ve technically “deteoxed” and have been all natural me for the past 11-12 years, I wonder if the effects were undone.
Does anyone know if the downregulation of dopamine receptors is repairable?
Thanks for your time.
Report comment
* “detoxed”
Report comment