ADHD Nation

Experts Alan Schwarz and Sarah Cohen write in their latest NY Times Article, ADHD Seen in 11% of US Children as Diagnoses Rise . . . “that breaks down to one in five high school age boys in the United States and 11 percent of school-age children over all having received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.”

As a parent of a 24-year old son, now working several jobs, yet who was recommended in the fifth grade by his teachers to see a doctor to confirm their suspicions that he had ADHD and needed treatment, including medication, it seemed like a lifetime sentence. The boy’s offense was an overdose of energy and shortness of attention or focus in class. To my wife and I, it seemed a judgment given off the cuff, especially when one of the teachers confessed he had adult ADHD as well.

Yet, there is comfort in numbers. And Schwarz’s figures show “that an estimated 6.4 million children ages 4 through 17 had received an ADHD diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade.” About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin, Adderall or Concerta, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety, occasionally psychosis or even death.

Yet, we took our son to see a friend of ours, a young pediatric neurologist, who met with him and agreed he was ADHD and should be on Adderall, a drug which contains amphetamine, and has the potential to become addictive. The surprise was that our energetic son did not like the feeling the drug gave him. Once, when we were walking up a not-too-steep hill in the Berkshires, one that pre-Adderall, would have been a piece of cake for him, this time, being on the drug, he stopped and told me to feel his heart. I did and it was pounding. He felt tired as well and asked not to take the drug. We stopped it immediately and called our doctor friend.

That was the beginning of an odyssey with doctors and drug prescriptions that literally shocked me. Having grown up in the ‘60s drug culture, I knew the effects of these “active ingredients,” including Ritalin, the original speed given to “rowdy boys” in a home for boys in the mid 1930s. It seems their hyper-behavior actually downshifted into calm when given the stimulant Ritalin, a drug that some of my ‘60s friends took to get high. In my college days, I adopted Dexamil to study for exams. It gave me a focus and a buzz that kept me up nights memorizing Latin translations. By dawn, I’d go for breakfast just as the birds were starting to sing and the light broke. So, it was a bit of a trip. If you threw in a few tokes of grass, it all synergized beautifully. Yet it became quite addictive and was a high price to pay to get through Latin—or life for that matter, not to mention my sleep patterns.

My experience seems to be echoed by a Yale doctor. He writes of the volumes of prescriptions and children, “Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

As to my otherwise healthy son, he has always loved to play sports, to follow teams, to ingest statistics like mathematicians ingest formulas. As he grew into a private Middle School, his distaste of Ritalin increased. In a high school specifically for students with “learning disabilities,” the new Concerta was no favorite of his. It made him sleepy and feel drugged. By now an ongoing discussion or disagreement was taking place between my wife and I concerning the use of any of these drugs. She was for them because she believed they helped our son focus. I felt that whatever the positives in focus they were outweighed by the physical and psychological discomfort they produced. My son did not like the mind or body feelings any of the prescriptions from a slew of doctors gave him. Compliance was difficult.

They did not do anything but make him oversleep for classes in college when away from home. And he stopped using Concerta again when he came home. Ironically, years after I left the advertising business where I was a writer/creative director, I had decided to wean myself from any kind of drug, all alcohol, any smoking matter, from cigarettes to pot. And it was the best thing I’d ever done. Perhaps it inspired my son.

Schwarz and Cohen write, “And even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of ADHD to allow more people to receive the diagnosis and treatment. ADHD is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills. I believe they’re speaking of the relationship between dopamine and serotonin in the neuro-system; the first which stimulates focused activity and the second which is a very calming feeling, the one you get after exercising or from meditating.

That aside, the notion to widen the field of ADHD drug recipients seems like a prescription for disaster, and led to my title, “ADHD Nation.” Adults these days have their Paxil, Zoloft, mood-changers, tranquilizers and uppers, even their E.D. highs to enjoy, all graced by a page of possible side-effects. These all serve to make Big Pharma humongously richer, and millions of adults hooked on their own brand of poison. My life without drugs or booze this past decade has been both very productive for me and given me new inner strength. It’s shown my 24-year old son and older son and daughter that one can function substance-free with success.

Schwarz and Cohen seem to agree, “While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates—diversion long tolerated in college settings and gaining traction in high-achieving high schools—are particularly dangerous, doctors say, because of their health risks when abused.” I wholeheartedly agree.

It seems, “The findings were part of a broader C.D.C. study of children’s health issues, taken from February 2011 to June 2012. The agency interviewed more than 76,000 parents nationwide by both cell phone and landline and is currently compiling its reports. The New York Times obtained the raw data from the agency and compiled the results.

“ADHD has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes—a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.”

What’s more, “The C.D.C. director, Dr. Thomas R. Friedan, likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.” Amen.

“We need to ensure balance,” Dr. Frieden said. “The right medications for ADHD, given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”

As I suspected, “Experts cited several factors in the rising rates. Some doctors are hastily viewing any complaints of inattention as full-blown ADHD” they said, while pharmaceutical advertising emphasizes how medication can substantially improve a child’s life. Moreover, they said, some parents are pressuring doctors to help with their children’s troublesome behavior and slipping grades.” Ironically, drug advertising was one phase of the business that I stayed away from.

“Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of ‘How Doctors Think,’ has said, “There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal—if they’re not sitting quietly at their desk. That’s pathological, instead of just childhood,” said Dr. Groopman.

He elaborated on these facts by saying, “Fifteen percent of school-age boys have received an ADHD diagnosis, the data showed; the rate for girls was 7 percent. Diagnoses among those of high-school age—14 to 17—were particularly high, 10 percent for girls and 19 percent for boys. The data showed that about one in 10 high-school boys currently take ADHD. medication.”

Schwarz and Cohen add, “Rates by state are less precise but vary widely. Southern states, like Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showed about 23 percent of school-age boys receiving an ADHD diagnosis. The rates in Colorado and Nevada were less than 10 percent.” Maybe it’s something in the environment or in the adult culture that affects the numbers.

On the other hand, “The medications—primarily Adderall, Ritalin, Concerta and Vyvanse—often afford those with severe ADHD the concentration and impulse control to lead relatively normal lives. Because the pills can vastly improve focus and drive among those with perhaps only traces of the disorder, an ADHD diagnosis has become a popular shortcut to better grades, some experts said, with many students unaware of or disregarding the medication’s health risks.”

They can also, as Schwarz writes in an earlier story, Drowned in a Stream of Prescriptions, destroy a student’s life with an overwhelming addiction, in this tragic case for Adderall. This is a heart-breaking story about Richard Fee, worthy of your attention, whether or not you are a parent, and it lambasts the members of the medical psychiatric community for their laxity in realizing that their ongoing prescription of the drug led this energetic, gifted student into depression, psychosis and taking his own life in the end.

To that end, “There’s no way that one in five high-school boys has ADHD,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary ADHD researchers in the last 20 years. “If we start treating children who do not have the disorder with stimulants, a certain percentage [of them] are going to have problems that are predictable—some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”

Also, I can personally testify to the fact that, “An ADHD diagnosis often results in a family’s paying for a child’s repeated visits to doctors for assessments or prescription renewals,” and it can be quite costly, even for a middle-class family.

“Taxpayers assume this cost for children [is] covered by Medicaid, who, according to the C.D.C. data, have among the highest rates of ADHD diagnoses: 14 percent for school-age children, about one-third higher than the rest of the population.”

Several doctors mentioned that advertising from the pharmaceutical industry that played off parents’ fears—showing children struggling in school or left without friends—encouraged parents and doctors to call even minor symptoms ADHD and try stimulant treatment. For example, a pamphlet for Vyvanse from its manufacturer, Shire, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”

As an ex-adman, I can say it is ads like this to treat ADHD that have more than doubled sales to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health. Those numbers provide a powerful reason for misrepresentation of results and diagnoses.

The profit may also come at the expense of a young Adam Lanza, who was diagnosed with Aspberger’s and autism. Does anyone understand the effects of the medication given for those psycho-physical conditions? Does anyone know what effect so-called therapeutic drugs had on James Holmes, who is facing the death penalty for the killings attributed to him in the Aurora, Colorado, movie theater? Photos of him as he entered his doctoral program show a soft-spoken humble young man. His initial court photos show him with reddish orange hair and other-worldly stare. So shouldn’t we be protecting our populous by not encouraging young people to get involved with exotic or seemingly everyday drugs for ADHD?

Ironically, when my son wanted to join first the U.S. Coast Guard then the Navy, having been ADHD was an immediate deal-breaker for both, even though he passed the Navy’s written test, and submitted a letter from his present doctor that he hasn’t taken any ADHD medication in years and is functioning without it. If these various drugs are so successful, why do the Armed Forces of our country immediately refuse anyone who has taken them? Moreover, one recruiter asked him to lie and say he never took the drugs. I advised my son never to perjure himself; never, or he could end up in a Navy brig for several years. It begs the question, why are the Armed Forces so regressive in the middle of this ADHD drug-fest, indicating a deep skepticism about the drugs, along with a stigmatizing of any individual who ever took them? Why is MEPS (the Military Entrancing Processing Station) against ADHD and the medications used for them? Appeals are generally pro forma and unsuccessful, yet my son has persevered and submitted one through a retired medical officer who works pro bono to have MEPS reexamine certain cases.

Yet, “Criteria for the proper diagnosis of ADHD, to be released next month in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders have been changed specifically to allow more adolescents and adults to qualify for a diagnosis, according to several people involved in the discussions.” Again I ask, is the ADHD stamp a life sentence?

“The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cell phone or losing focus during paperwork, that emphasize that ADHD is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”

”An analysis of the proposed changes published in January by the Journal of Learning Disabilities concluded: “These wording changes newly diagnose individuals who display symptoms of ADHD but continue to function acceptably in their daily lives. Given that severe ADHD that goes untreated has been shown to increase a child’s risk for academic failure and substance abuse, doctors have historically focused on raising awareness of the disorder and reducing fears surrounding stimulant medication.” It doesn’t seem that way in the real world.

A leading voice has been Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder. But in a recent interview, Dr. Hallowell said that the new C.D.C. data, combined with recent news reports of young people abusing stimulants, left him assessing his role. Particularly in the Richard Fee case, this was a relevant notion. Despite Fee’s behavior becoming more and more erratic, one or another psychiatric professionals kept prescribing various amounts of daily Adderall for him, as if to overrule the judgment of the previous doctor. As his father predicted, “You’re going to kill my son with this drug.”

Whereas Dr. Hallowell for years would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said last week, “I regret the analogy” and he “won’t be saying that again.” And while he still thinks that many children with ADHD continue to go unrecognized and untreated, he said the high rates demonstrate how the diagnosis is being handed out too freely.

“I think now’s the time to call attention to the dangers that can be associated with making the diagnosis in a slipshod fashion,” he said. “That we have kids out there getting these drugs to use them as mental steroids—that’s dangerous, and I hate to think I have a hand in creating that problem.”

Perhaps, it’s not just Dr. Hallowell who has had a hand in creating that problem, but over-anxious parents, teachers with little patience, physicians looking for fees, and the society as a whole—with a lack of patience and understanding for its most precious asset, its children.

Jerry Mazza is a freelance writer and life-long resident of New York City. An EBook version of his book of poems “State Of Shock,” on 9/11 and its after effects is now available at Amazon.com and Barnesandnoble.com. He has also written hundreds of articles on politics and government as Associate Editor of Intrepid Report (formerly Online Journal). Reach him at gvmaz@verizon.net.