Figure 1:https://en.wikipedia.org/wiki/File:Adderall_bottle_and_capsules.jpg
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
For more information on ADHD please visit:
http://www.pbs.org/wgbh/pages/frontline/shows/medicating/experts/explosion.html
http://www.biomedcentral.com/1741-7015/10/99
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563970/
At first, it seems rather counter-intuitive that ADHD is treated with stimulants. It's like giving a "hyper" kid some caffein. It would be helpful if some mechanism in which stimulant helps treating ADHD can be explored. Also, the drug abuse problem as mentioned in the blog is a serious one. I'm aware of many instances where students fake ADHD to get prescription for these drugs. There are also those who sell their ADHD drugs to make extra money. I think it would be great to follow up on some social complications that might arise if ADHD becomes more prevalent as well as the usage of stimulants drugs for its treatment.
ReplyDeleteAn interesting article especially because I was an unruly student in primary school myself. But I am of the opinion that ADHD medication may be prescribed too frequently (however, my opinion may change after knowing the diagnostic tools implemented to test for ADHD). In elementary school, I was a highly energetic child that never seemed to get tired. So when I was forced to sit in class for 8 hours of the day with the occasional 30 minutes recess, it's no wonder why I was so unruly. One look at me during class time and I probably showed signs of ADHD, but I believe I was being a kid trying to release excess energy.
ReplyDeleteSo, I would be interested to see how ADHD is characterized/tested in a young child and how doctors differentiate between true ADHD and a child's need to burn energy. Maybe ADHD is being misdiagnosed in some of these younger patients?
I am not sure whether "ADHD medication may be prescribed too frequently," and think that we have to defer to actual research findings when we look to make such statements. What I do know was that I was regularly tested for ADHD by my elementary school's psychologists despite a series of negative findings. Reflecting on my own experience as a member of my fourth grade class and on the gender disparity in ADHD diagnosis, I wonder whether or not the primary school system that seems to be the locus of diagnosis is simply less tolerant of the behaviors of little boys than it is of the behaviors of little girls.
DeleteI do believe that ADHD is in fact over diagnosed in young children who show the amount of energy Rehman had as a child. However, I think there is a balance doctors need to find between over diagnosing versus under diagnosing. Over diagnosing may be resulting in unnecessary medications for young, energetic students, but on the other hand there are children who may benefit tremendously from a diagnosis of ADHD because of the increasing resources in schools that are available to students with attentional deficits. Without a diagnosis, students might fall through the cracks and fall behind. I would also be interested to learn more about the criteria used to diagnose children with ADHD.
ReplyDeleteI think that the idea of under diagnosis as a threat to the achievement of affected students raises some complex ethical questions about quality of life and the roles that doctors play in deciding what the end game in patient treatment should be. Is it really that important for every ten-year old to sit still seven hours a day in school? I don't know anything about education, child psychology or parenting, but don't think that we should put our educational system on a pedestal as the standard by which we judge when young children are falling behind in life.
DeleteIn my opinion, this article is missing a few important aspects of the ADHD phenomenon: the societal impact and the implications of overmedicating. Society's impact on the diagnostic criteria defining ADHD has created the "ideal person" as a byproduct. Should children not fit the 'sit quietly and behave perfectly' model, they are displaying what has, in the past few decades, been indicative behaviors of ADHD. Considering the increasingly competitive nature of academic institutions, it makes sense that people are trying to find ways to improve their performance and become the model student--it just so happens that ADHD medication is the tool for the job. If the societal definition of what it meant to be successful (be a good student by paying attention and sitting quietly, always be focused on your work, etc.) were to be restructured, there would be a significant decrease in the number of kids and individuals who are considered "outside of the norm," and thus receive an ADHD diagnosis. Additionally, the implications and long term effects of pharmacotherapy are important to consider. By medicating a child whose brain is still developing could have detrimental long-term effects on the individual; because the ADHD phenomenon is relatively recent, studies that look into the long-term effects have not really been done. Who's to say that by medicating children, processes in their brains are not being affected and causing the perpetuation of the disorder? This article presents an interesting case, but I feel that the author missed some important considerations when assessing the culture of ADHD today.
ReplyDeleteIn my opinion, this article is missing a few important aspects of the ADHD phenomenon: the societal impact and the implications of overmedicating. Society's impact on the diagnostic criteria defining ADHD has created the "ideal person" as a byproduct. Should children not fit the 'sit quietly and behave perfectly' model, they are displaying what has, in the past few decades, been indicative behaviors of ADHD. Considering the increasingly competitive nature of academic institutions, it makes sense that people are trying to find ways to improve their performance and become the model student--it just so happens that ADHD medication is the tool for the job. If the societal definition of what it meant to be successful (be a good student by paying attention and sitting quietly, always be focused on your work, etc.) were to be restructured, there would be a significant decrease in the number of kids and individuals who are considered "outside of the norm," and thus receive an ADHD diagnosis. Additionally, the implications and long term effects of pharmacotherapy are important to consider. By medicating a child whose brain is still developing could have detrimental long-term effects on the individual; because the ADHD phenomenon is relatively recent, studies that look into the long-term effects have not really been done. Who's to say that by medicating children, processes in their brains are not being affected and causing the perpetuation of the disorder? This article presents an interesting case, but I feel that the author missed some important considerations when assessing the culture of ADHD today.
ReplyDeleteI thought Rehman's comment regarding the article was interesting. I do think that the increased diagnosis of ADHD in many children could just be due to excess energy and restlessness while sitting in a quiet, classroom environment for many hours. Not only does this reflect issues within the education system, as Connor suggests in his final paragraph, but also conflicting issues regarding modern parenting. Some parents may not know how to deal with hyper, young kids, so they try to "cure" their restlessness by turning to drugs and medication. I don't necessarily think this is the way to go, especially when many of the kids are still growing and the intake of unneeded medication may have harmful effects on their bodies.
ReplyDeleteThough I agree with your point about the morals of over-prescription, I think that it's important to acknowledge the other side of the argument as well. Medication can actually be a huge benefit to not only the family of the patient, but also the patient themselves. As an immediate result of the proliferation of over-prescription and abuse, many have assigned a stigma to the use of medicine to help your child focus. ADHD is a very real, very valid disorder that can greatly limit a child's success and happiness. Why not use drugs to let ADHD patients reach their full potential? I think that education in the future should still emphasize the drawbacks of abuse, but should also focus on removing this dangerous stigma.
DeleteI would need to read more research before giving a fully informed opinion, but I work with kids in the classroom all the time and seeing them sit in the same seat for 7-8 hours a day can be difficult. Recess and lunch times are shot, and even those can be very rigidly structured. The last summer camp I worked at kept beating me in the head with 'Kids need structure! Structure structure structure!" And while this is true to an extent, I have yet to see a more effective method to having kids pay attention then letting them run outside and tire themselves out for an hour. I would imagine these constraints have either led to the rise of ADHD, or led to the rise of doctors and educators believing their kids have ADHD. In any case, I'm not opposed to giving students drugs to help their focus, especially if they really need it, but it's really a basic solution that doesn't do anything to help the core problem.
ReplyDelete