ADHD(attention deficit/hyperactive disorder) is a mental disorder that has been widely diagnosed among children in the past thirty years. Defined as abnormal or excessive motor activity, increased inattentiveness compared with peers, and impulsive behavior. Most often observed in boys pre puberty, and girls during and post puberty, ADHD diagnoses have been rapidly increasing. Parents increasingly try to address ADHD in their children through pharmacological treatment to not only mitigate immediate symptoms, but also to improve overall quality of life, especially in social interactions. ADHD is most prevalent in children, and meta-analysis has shown that up to 65% of adults who were diagnosed with ADHD at children still show symptoms of the disorder. ADHD effects approximately 5% of the global population, and about 4% of adults. Studies on the short term effects of treatment for the symptoms of ADHD have been numerous, and show efficacy in symptom reduction, but the long term effects of treatment has not been studied in depth.
ADHD was first identified in 1798 by Sir Alexander Crichton. One of the first in a breed of new scientists looking to study mental disorders and psychological anomalies, Crichton produced three books on different categories of mental disease. In his second book, Crichton examined attention and the difference between losing focus and an inability to focus normally. He defined a range of attention levels within healthy people and even a range within individuals depending on environment. He then examined two kinds of abnormality in attention that are now defined as ADHD. According to the American Psychiatric Association, ADHD is defined as “difficulty sustaining attention in tasks or play activities,” and Crichton’s definition of the lack of attentiveness he observed is that “[ADHD] renders [a patient] incapable of attending with constancy to any one object of education.” The similarity in the current definition and Crichton’s description makes it clear that he was studying the same disorder that is prevalent in our culture. Crichton also accurately described the reduction in symptoms with age that we know to exist today.
It wasn’t until 1937 that the idea of treating these disorders with stimulants became a possible. Charles Bradley was treating a loss of spinal fluid in one of his medical trials with the stimulant Benzedrine. He noticed an improvement in some of the children in regards to school work and attentiveness. Today, drugs like Ritalin, Adderall, and Concerta are prescribed to approximately 3.5% of adolescents under 19, and prescription rates have been rising steadily over the past 10 years. Because of the chemical similarity of these stimulants to street drugs such as Methamphetamine, these drugs, Adderall especially, have high propensities for abuse. When taken in higher doses or ingested in a non-conventional way (i.e. snorting), these drugs can cause spikes in dopamine levels different from the moderate introduction of dopamine that is the goal of treatment through stimulants. Euphoria produced by these spikes along with appetite suppression and increased wakefulness all contribute to the high rates of abuse with these drugs.
In my limited experience, public perception of these drugs is fairly poor. They are seen as “smart pills” which allow the wealthy to give their children a step up and access to heavy pharmaceuticals at an early age. Many also believe that they are overprescribed and that ADHD is over diagnosed. I have heard many people quote a 50% rate of ADHD among youths, and that 30-35% of high school students are prescribed stimulants. In actuality, the rates are much lower. Only about half of those diagnosed with adolescent ADHD are prescribed stimulants, as many cases are considered mild, and can be managed with psychological treatment and behavioral changes.
ADHD and behavioral disorders like it have effected children and some adults for hundreds of years, since the early days of mental and psychological medicine. It wasn’t until the 1980’s that students who used to be written off as disruptive or simply “bad” in a classroom setting began receiving diagnoses of ADHD. Today, millions of children lives, both at school and at home, are made more “normal” by treatment for attention disorders. Although these medications appear to have fairly minimal long term effects, and an overall beneficial effect on patients’ lives, the use of drugs like these begs the question of the efficacy of our education system. Is the solution to these “unruly” students always to push expensive behavior modifying drugs? Or is the increase in usage of these drugs a sign that education reform should allow children to deal with these disorders without pharmacological intervention?
Modifying behavior of children through drugs is always going to be a thorny issue, but as of now, ADHD medication seems to be working.
Figure 2: Courtesy of NIH
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