3 |
Increased Stimulant use and FDA alarm |
The prevalence of stimulant use and the warnings.
s the rate of prescriptions for stimulant drugs for ADHD and ADD has escalated, it has become an increasingly controversial area of treatment. Statistics for usage show that 9.3% of 12-year-old boys and 3.7% of 11-year-old girls take these drugs. About 2.5 million children between ages 4 and 17 take ADHD drugs according to a federal survey. Boys are twice as likely to be on them as girls according to Medco chief medical officer, Robert Epstein (36).
It is not only children who take ADHD drugs. As of 2004, adults under age 45 were 46% more likely than they were four years ago (3% to 4.4% usage) to be taking stimulants.
Approximately one in 100 adults aged 20 to 44 were on ADHD medication in 2004, up from approximately one in 200 in 2000, according to prescription records for 2.4 million people insured through Medco, Epstein reports. The surge in adult use came amid growing direct-to-consumer advertising and the Food and Drug Administration's approval for the first time of drugs to treat adult ADHD, says pediatrician Andrew Adesman.
As might be expected, drug sales are making increasing millions for drug companies as a few statistics illustrate. Sales of ADHD drugs rose from $759 million in 2000 to $3.1 billion in 2004, according to IMS Health, a pharmaceutical information and consulting firm (36).
However, this is not setting well with the FDA. On February 10, 2006, an FDA panel requested the strongest warning on Ritalin, Concerta, Adderall, Adderall XR, Methylphenidate and Metadate because they may be linked to an increased risk of death and injury. The “black box” warning was recommended after hearing about the deaths of 25 people, including 19 children, who had taken the drugs (37).
It is important to realize that all of the stimulant drugs prescribed for ADHD/ADD are closely related to some illegal street drugs. These include dextroamphetamine (Dexedrine: street name, “dexies”), methamphetamine (street name: crystal meth), and, of course, cocaine. It is indeed an irony that we imprison people for making or selling drugs that are very similar to the drugs we prescribe for ADHD children. The FDA is saying these drugs are not safe. Yet, schools clamor to get kids on the drugs, doctors readily prescribe them, and parents willfully submit because they don't know what else to do.
A research report in the Archives of General Psychiatry states,
Cocaine, which is one of the most reinforcing and addicting of the abused drugs, has pharmacological actions that are very similar to those of methylphenidate (Ritalin, Concerta), which is now the most commonly prescribed psychotropic medicine for children in the U.S. (38)
The long-term outcome for children is another story that has often been overlooked. A report on a comprehensive follow-up study at Montreal Children's Hospital discovered that
…At the end of five years, hyperkinetic children who received drugs (either Ritalin or Chloropromazine) did not differ significantly from children who had not received the drugs. Although it appeared that hyperactive children treated with Ritalin were initially more manageable, the degree of improvement and emotional adjustment was essentially identical at the end of five years to that seen in a group of children who had received no medication at all. (39)
Known side effects for stimulants are weight loss, insomnia, reduced stature, ticks, “zombie” demeanor, stomachaches, genetic changes, moodiness and death. Improving homework and schoolwork is not worth these risks, especially when more effective, less risky alternatives are available.
In sum, the research is clear that for some children stimulants can be helpful, at least in the short-term. But, no one would claim they cure ADHD. The effect wears off when the drug wears off and stops masking the real problem. Drugs just control the symptoms. Stimulants merely postpone dealing with the real behavioral and attentional problems.
It should come as no surprise that children have always misbehaved. One can read quotes from the Roman Empire of parents believing their children are behaving worse than they did at the same age. Past centuries spouted theories of “wicked” children being possessed by the devil. Twentieth century theories ranged from children being brats who needed discipline to having malfunctioning brains.
Since the 1960's, there has been the trend away from looking at interactional dynamics for emotional or mental problems and instead creating theories about the “hard wiring” of brains, taking any hope of change away from parents. In relatively rare cases, this “hard wiring” theory is probably accurate, such as with schizophrenia or autism. In the vast majority of cases, however, such as with ADHD, it is not at all accurate.
Starting in the 1950's, when psychotropic drugs first came onto the scene, common problems in living have been increasingly labeled as brain dysfunction problems rather than interactional problems or just part of the human struggle. There are pills to make you sleep, to brighten your mood, for sexual performance, or if you have twitchy legs at night. There are pills if you are anxious, if you are depressed, are obsessive compulsive, or have panic disorder. Add to the list pills for problems with attention—ADHD. Of course, one only has to look at who is getting paid off to figure out how the brain malfunction theories, as well as a belief that normal problems can be fixed by a pill, have skyrocketed in popularity. This is the result of the convergence of our cultural fascination with modern medicine and the awareness by business interests, i.e. drug companies, that there is a ton of money to be made by selling you an effortless cure. Taking a “magic” pill is a lot less work than changing interaction patterns or personal behavior, so the appeal is even greater. The drugs for “problems in living” REALLY took off when drug companies were allowed to promote their wares on TV.
In the case of ADHD, rather than helping parents see the problem with their parenting strategy and offering true remediation solutions, the medical community helps place the problem (blame) with the child by offering diagnosis and medication to treat the diagnosis. Parents are often told by professionals that their child “can't help himself,” or “should not be pushed too hard,” further rendering them helpless. For other not-as-responsible parents, this is license for them to distract themselves from the real issues and relieve them of any responsibility to change their behavior.
Meanwhile, the child is forced into packing the freight for solving a problem that is not really his. He is only doing what, for the moment, is in his best interest. Rather than being a defect, it is a clever strategy.
This medicalization of ADHD is not a sinister plot by doctors or drug companies, but the natural shaping of their perceptions toward what will most likely pay them (drug companies and doctors) off. They can sell drugs and see many kids as patients. This phenomenon is well researched and documented in a wide range of content areas unrelated to ADHD or medications (40, 41, 42). This same perceptual phenomenon will be discussed later in the “ADHD: the spread of an infectious Deficit Meme” section.
It is the goal of this book to take fixing ADHD children out of the hands of drug companies and back into the hands of parents where it belongs. Careful observation of behavior and coaching parents to take charge has shown me that the “defective brain theory,” which leaves parents helpless, and children unchanged, is entirely wrong. The goal of this book is to challenge the old myths and show you a more useful and accurate description of ADHD and how to help your child.