This belated post is especially for Debora, who asked for my impressions about ADD/ADHD medications for children. (Disclaimer: I am not a doctor, nor do I play one on television.)
Medicating kids or adults for ADHD is a sticky topic. Everyone has opinions! Like many topics of heated discussion, usually everyone has several good points to make, and there are always a few people who take things to absurd extremes. So let’s look at these points individually. (I’ve boldfaced the points, so if you’ve already reached a state of analysis on that point, you can skip to the next one.)
Does ADD/ADHD even exist? Is it just some scam made up by drug companies to make money?
Some years ago I received an email from someone who had decided the latter. I replied back with the following, which I have updated to reflect new information:
I find it interesting (alarming? saddening?) that you say you “don’t believe in ADHD.” Doubtless there have been/are some children who mis-diagnosed with and treated for ADHD and this is a real shame. Equally tragic are those children (and adults) who missed diagnoses and struggle through life.
Objective evidence for ADD includes PET brain scans that show marked differences in the frontal lobe operations of people with and without ADHD. There is also evidence for a mostly genetic basis.
It is not a result of laziness, rebelliousness, bad parenting, or diet. About 60% of the people with ADHD do not grow out of it. (Those who do seem to “grow out of it” may be demonstrating that children don’t all mature at the same rate.) Although the some of the symptoms of ADHD can at times be present in anyone, it is both the 1) degree and 2) consistency over time to which these symptoms manifest themselves that allows for the diagnosis.
The prescription medication I am taking is a time-release combination of dopamine and norepinephrine, which are neural transmitters (chemicals involved in the transmission of electrical impulses from one nerve/brain cell to another.) With the medication I don’t jiggle all the time, bite my nails less, interrupt less often, don’t daydream or mentally wander off-subject in class or during meetings, and can focus on studying for 90 minutes at a time, instead of 5 or 10 minutes. Early on (without knowing about the diagnosis or medication) my daughter remarked to me, “Mom, you actually SAT through a whole movie!”
And yes, the medication is an amphetamine, and it is curious to note that with the medication, I can get to sleep more easily and have less hand tremors! I also drink a lot less coffee, which implies unconscious attempts at self-medication with stimulants. This is in direct contrast to what would happen for an ordinary person taking an amphetamine. It affects me differently because I am wired slightly differently. (More objective evidence: a different physical makeup of the body results in a different physical reaction.)
To be prescribed medication, I visited not only a psychologist, but also a psychiatrist, had to undergo interview testing (which paperwork hubby also had to fill out, in lieu of a parent) and my wretched school history was also gone over. I did not undertake this diagnosis lightly, but after having struggled with school for 35 years (!) and consistently getting poor evaluations despite being smart and working hard.
If ADD is real, and I have it, why wasn’t I diagnosed with it earlier? Because it wasn’t added to the Diagnostic Statistics Manual (DSM) until the early 1980′s, after I had (through much struggle) managed to graduate high school! An earlier diagnosis was charmingly called “Minimal Brain Damage” and had different criteria (it was thought to be caused by physical trauma from birth or accident). The hyperactivity part was a separate diagnosis. It is not that ADHD didn’t exist earlier, but that the specific name and diagnostic criteria didn’t exist. This is one of the reasons why there were “suddenly” more children (and adults) being diagnosed with ADHD.
But what if someone says they “don’t believe in ADHD.” Think on this: some people have asthma and take medication to treat the symptoms. Most people don’t “grow out of” the asthma, nor is it imaginary. It has a direct impact on how well a person can function at times. What if someone said to you, “I don’t believe in asthma”? What if they said, “You just wheeze because you are out of shape. That’s just an excuse. You just need to TRY HARDER. If you practiced or exercised more you could do just as well as everyone else.” What would you tell them?
Oh noes, labels!
People hesitate to get testing because they are worried that diagnoses will mean that there are “labels” assigned to their children. But think about this: what kind of “labels” are already assigned to your child? Are they helping him, or preventing him from being helped? Will the label actually give him less of an education because it refers him to different but unequal education?
What does the label mean to you? A person is not the label given to them. Furthermore, if you fear your child being labeled, what does this say about your own attitudes? Do you fear that the identification of a particular kind is a stigma? If your child is that particular kind of person, does that make them less of a person or a not-good or not-okay person?
Sometimes there are other things that will occur in addition to ADHD, such as sleep issues, handwriting problems (dysgraphia), [central] auditory processing disorder (APD or CAPD), nonverbal learning disorder (NLD or NVLD), Asperger’s or tics. These are technically known as “comorbid” conditions, a term which I find awkward. Sometimes things like APD are misdiagnosed as ADHD, simply because there are overlapping categories of effects, and people are more familiar with ADHD. But don’t panic. I certainly don’t mean to scare you; it is not an overwhelming percentage, by a long shot. Just be aware that other issues may surface over the years, and don’t let schools act like everything is due to ADHD, and/or that a student is limited to one diagnosis.
The good news is that being really bright can also be “comorbid” with ADHD! (-: Indeed, these “twice-exceptional” students can be hard to diagnose, because the smarts and the disabilities tend to cancel each other out. Plus, people can get so over-focused on remediating the behavioral problems that they forget there’s a smart and really bored kid … smart + bored + bouncey + inquisitive = ____ Well, it depends partly on the teacher; the result could be a stellar student, or one who is just known for “being a problem” instead of “having specific problems”. ::sigh::
Is there too much over-diagnosis? Is there too much over-medication?
Deciding whether or not to take medications is a big issue. Doubtless there have been/are some children who mis-diagnosed with and treated for ADHD, and this is a real shame, if not possibly dangerous. Equally tragic are those children and adults who missed diagnoses, and struggle through life, feeling like they are lazy, stupid, etc. (Readers, feel free to “raise your hand” and comment!)
Although Ritalin and similar meds are amphetamines, they do not have the same affect upon the ADHD brain that they do upon the NT (neurotypical, i.e. “normal”) brain. If a person does not respond well to medication, it might be the formulation (type of medication; they’re not all the same), the dosage, the diagnosis (other things can share some of the symptoms ADHD), or the person just might be someone who doesn’t respond well to the meds.
Some people are concerned that, “we don’t know enough about these medications and how they affect kids”. (Some of those are people who feel that nothing but 100% surety is enough, which is unreasonable because hardly anything in life is that sure.) In truth, stimulant meds have been in use for about fifty years, so most of the effects are pretty well known, even the long-term ones. Plus, research keeps plugging along and we discover new things.
One of those things is that although there will be a few people with Tourette’s or tic disorders may have an earlier onset of tics when treated with stimulant meds, that does not mean that stimulant meds will cause tics or Tourette’s, nor even necessarily aggravate them. Personally, I’ve always had some tics, and they have become more pronounced over the years (as have other issues, such as nearsightedness, tinnitus, arthritis). I went off the ADHD meds for nearly two years, and realized that there wasn’t really much difference in the tics, but that I really did better with the meds, so I went back on them. That may seem like a long time, especially since the meds wear off so quick. But tics will wax and wane and the types of tics tend to change and repeat over time, so a longer time period helps determine if the results are just those normal ups and downs or a real trend (this is what the stats people refer to as “regression toward the mean”). It’s also notable that although stress does not cause tics, stress can aggravate tics. Entering puberty can also trigger Tourette’s or tic disorders; merely being diagnosed with ADHD and getting the stimulant meds, and then developing tics does not mean the meds caused the tics. Of course, my personal story doesn’t mean squat (“testimonials are not data”), but I could pull up the research paper titles if anyone really wants to know.
“Take this pill – it’ll make everything better” – NOT.
There is also the simple fact that medication does not completely resolve the problems associated with ADHD.
The first few weeks on the meds, it is amazing! You can get things done, sit still, pay attention, whee! People around you notice. They like it when you are on the meds. You get concerned; you want them to like the “real” you, not the medicated you. Well, big news: YOU ARE STILL YOU. The medication does not change your core personality. You are perhaps a bit less frantic you, and perhaps a bit more attentive. As for myself, I am still the same nutz person I have always been. (Classic disclaimer: “Your results may differ.”)
And after a while … you notice that although the meds help, you still have some problems. Part of those problems may be issues of organization, study habits, work habit is, et cetera; actually, those can now be dealt with more effectively with the meds, as you learn or re-train yourself.
I tried a week off the meds. I felt like, “Oh, I really don’t need them; they don’t help that much.” And then I got comments like a class feedback form saying, “Instructor should consider switching to decaf coffee” — and I HAD been drinking decaffeinated coffee — yikes! Um… Well, now I understand why some people go off their “crazy-meds”; they feel like they are just fine! And then things start sliding downhill…
The meds of course don’t “cure” the problems, nor do they remove them — they make it easier to be more focused and get less distracted, and can help settle down some of the impulsivity and boing!boing!boing! (That said, I’m still a leg-jiggler, and just tell my students, “fidget quietly!”)
Research tells us that usually works best is a combination of meds and counseling or teaching of coping strategies. (We’re not shocked when other research also tells us that the same is true for depression — antidepressives make it easier to be interested in and make use of counseling.) The meds make it easier for the person to assess and understand what sort of things are going on, to implement strategies, and to evaluate progress. It can be helpful to brain-storm ideas and solutions with other ADHD people, assuming the conversation doesn’t get too off track. Alas, some of those ADHD chat boards are pretty useless, as they are such pity-parties, gah!
Things like ADHD, Asperger’s, NVLD, APD, Tourette’s and so on all have some similarities of frontal lobe processing that is referred to as Executive Function. EF includes planning, prioritising, initiating, being aware of what one is doing, assessing what one is doing, correcting actions (troubleshooting), and inhibiting wrong actions or distractions. Doing all these things at once requires juggling a lot of thoughts in short-term and active processing memory; they use up a lot of cerebral RAM. Unfortunately, getting those aforementioned coping mechanisms implemented and whatnot requires … Executive Function! Oh, the irony.
Some people react badly to medication. If one does not work, do consider trying another. Side effects can be seriously not-fun business; I had numerous side effects to two different medications. I had never before had side effects from meds, but then I realized that all I had ever had were ordinary analgesics and antibiotics. I have since had side effects from still other kinds of medications (including mundane things like blood pressure medication).
It has also been found that some drug-abusers are undiagnosed ADHD and were self-medicating with stimulants. Moreover, the happy reverse it true; persons prescribed with the correct meds end up with fewer problems with drug addiction.
Well, it is a loaded issue. Ask sixteen people, and you will get sixteen different opinions. But I’ll warn you, ask someone with ADHD and you probably won’t get a short answer!