October 7, 2011

Recent Trends in Stimulant Medication Use Among U.S. Children

stimulant use.JPG
is this a joke?

A study, Recent Trends in Stimulant Medication Use Among US Children finds, surprisingly, that 3.5% of kids under 18 got stimulants, vs. 2.4% in 1996.  Holy crap!!   The reason this is surprising is that 3.5% is about 10x smaller than I thought it was.  American Journal of Psychiatry?  Did I move to Romania?

Then the article informs me that I am both racist and color blind: most stimulants are going to white kids (4.4%), not black kids (3%),  and about hispanics I was WAY off, I was certain the number was close to 133% but apparently it's only 2.1%. Huh?  Does this study include the 48 states of America that have Americans in them, or just Guam and parts of the Virgin Islands?

The article pretends to be shocked by this "steep increase," and then tries to explain it by putting some nouns and verbs next to each other hoping you'll be impressed:

The significant increase in stimulant utilization in racial and ethnic minorities and low-income families indicates an increased recognition of ADHD... social and cultural factors continue to play a significant role in ADHD treatment utilization.  Parents of Hispanic and African-American children are less likely to report ADHD than parents of white children...(15)

That last sentence, referenced with "(15)", sounds like the conventional wisdom I heard in residency: "African-Americans don't like to admit depression", excluding those in the packed waiting room. (1)  But when I eventually (2) found study "(15)"  I was totally not surprised to find it did not say parents are less likely to report ADHD.  "(15)" was a survey of parents asking them if they had been told by a doctor or school that their kid had ADHD.

The reason that 3.5% of kids are on stimulants is that their doctor neglected to give them Risperdal.  The kid who got Ritalin at age 6 and it helped carried that Ritalin into the teen years, hence the growth among adolescents; but any new kids coming through the pipe don't get stimulants, they get something else, by which I mean everything else.

Note the big jump at 6 years old, from 0.1% to 5.1%.  Yes, certainly symptoms become more prominent, but also they become prominent at school; schools have an interest  in medicalizing the problem, both practically (calm that kid the hell down) educationally (diminished expectations) and economically (schools get more funding.)   Stimulants are the natural first line drugs.  Well, they were, anyway.

This ridiculous article pretending to be amazed at the increase in stimulants is there to prevent the heart attack you'd experience if you looked at another study that has a graph in it:


prevalence of illness.jpg

Unless you believe bisphenol-A or global warming is changing the genetics of kids born after 1990, then the correct and terrifying way to interpret this graph is that one in every four kids is considered by adults to be in need of psychiatric treatment; and only 3.5% get put on stimulants.  The other 20% we can assume are receiving psychoanalysis. 

Maybe they need the meds, maybe they don't, the question is if these are the same kinds of organ donors that existed in 1896, what happened to them before psychiatrists?  Did they eat each other?  And if they are, in fact, more "psychiatric"  than they were in 1896 and bisphenol-A isn't to blame, then what is the other possibility? 

And as that huge number of psychiatric patients grow up to become either unemployed adults, or at least the children of unemployed parents, will they

a) experience spontaneous and permanent remission of symptoms
b) be treated with psychoanalysis
c) .....


-------


1.  The conventional wisdom is backwards.  The black patient isn't resistant to admitting he has depression, he is resistant to the white doctor's attempt at labeling him depressed, and consequently marginalizing him, diverting attention away from the social factors over which the doctor is nervous to discuss and powerless to change.  "You have depression" is the nimble dance around the question of whether a white doctor can understand a black patient's life.  It is a delicate thing to say to a black woman that perhaps her man isn't worth a damn, as she just said out loud to you but you're not sure if you're allowed to echo back, maybe these kind of relationships are culturally appropriate?  It's tough to know when most of your information about black people comes from Martin Luther King quotes and The New Yorker

Lacking any common language to bridge racial, economic, or sexual divides, clinicians hide behind the invented terminology of psychiatry.  Medications become the physical manifestation, the proof, that the language is real.

2. Whenever I see a reference to a statement that seems insane to me, two things will be true:

  1. It will take me as long to get the study as it did to conduct the study, i.e. 45 minutes.  No hyperlink.  No free access.  Then I have to go into the university's PubMed, which takes me through three windows to Science Direct or some other outlet.  Why, oh why, can't I just click "(15)" in the original paper and immediately see it?  Because:
  2. It will turn out to be actually insane, and the only part of the reference that will support the statement will be the title.


See also: The Rise And Fall Of Atypical Antipsychotics
 










Comments

Not a joke. Your bread and... (Below threshold)

October 7, 2011 2:01 PM | Posted by Zahn Pike: | Reply

Not a joke. Your bread and butter.

Vote up Vote down Report this comment Score: 4 (4 votes cast)
You gotta have your kid on ... (Below threshold)

October 7, 2011 2:02 PM | Posted by Donald Atkinson: | Reply

You gotta have your kid on stimulants to be elegible for the ADA accomodations and to be elegible get a check for Disability (and the extra $ for selling the ritalin on the street is a plus).

Vote up Vote down Report this comment Score: 4 (10 votes cast)
Can we get the real TLP bac... (Below threshold)

October 7, 2011 2:13 PM | Posted by ryno35: | Reply

Can we get the real TLP back? Guest posters suck!

Vote up Vote down Report this comment Score: -10 (12 votes cast)
Here is the email of the le... (Below threshold)

October 7, 2011 2:19 PM | Posted by John: | Reply

Here is the email of the lead author:

samuel.zuvekas@ahrq.hhs.gov

Again, Lets send him some similar emails in hope he responds to Alone. My template:

Hi Dr. Zuvekas-

I have found a piece dissecting and condemning your latest important article. After reading it I don't know what to think. Could you please give me some feedback or reply on the arguments presented here about your study?

http://thelastpsychiatrist.com/2011/10/recent_trends_in_medication_us.html

A concerned student,

John

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"The reason that 3.5% of ki... (Below threshold)

October 7, 2011 3:03 PM | Posted by Sfon: | Reply

"The reason that 3.5% of kids are on stimulants is that their doctor neglected to give them Risperdal."

http://en.wikipedia.org/wiki/Risperidone
"It is associated with significant weight gain and metabolic problems, as well as tardive dyskinesia and neuroleptic malignant syndrome."


Blaming those in charge of a child's environment would be rude. Easier to blame something small and helpless and feed it drugs. Danger? They are helpless, ignorant, and easily convinced that everything is their fault by a sweet-voiced doctor whose paycheck relies on ignoring the wellbeing of their patient. Thus there is no danger, no consequences.

"Lacking any common language to bridge racial, economic, or sexual divides, clinicians hide behind the invented terminology of psychiatry."
Or, quite often, flat-out lacking the intelligence, empathy, and desire to understand any patient's problems. Easier to treat a short string of letters than a person. Diagnosis and drugs are used to avoid helping people.

"Chemical imbalance" used in reference to natural depression/stress/etc. due to circumstances is absolute quackery. Yet it is what defines psychiatry in the minds of most people.

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I hope you presented yourse... (Below threshold)

October 7, 2011 3:55 PM | Posted, in reply to John's comment, by TheCoconutChef: | Reply

I hope you presented yourself as a woman.

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Thanks to companies targeti... (Below threshold)

October 8, 2011 5:08 AM | Posted by Poorkids: | Reply

Thanks to companies targeting the teachers now (I saw pens with certain *ahem* pharmaceutical brands at the school director's table), a child is more likely to appear at the doctor's office because some teacher turned doctor is convinced that the kid needs ritalin.

If more parents having this problem... take the meds, throw them down the toilet/sell them/whatever and give their kid some white looking vitamin instead...we might save this generation.

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ryno35. If you're... (Below threshold)

October 8, 2011 12:36 PM | Posted, in reply to ryno35's comment, by Perry : | Reply

ryno35.

If you're referring to Partial Objects, it was established for other voices, yours and mine included. The other voices are as new to TLP readers as is the medium of special interest publishing. The other voices speak for themselves, not as Lonely clones. I had to remind myself of that.

One thing I find appealing about PO is that as a group they look at parts of our culture – often of the popular sort – that otherwise would be largely off my radar. I don't see many of the movies they bring up. Most of the commercials and other Madison Avenue stuff is first exposure to me. (And, of course, it's ALL about me.)

If, on the other hand, you were suggesting that someone else is penning TLP, then that is different. He wouldn't do that without disclosing it.

I think TLP is keeping himself pretty active. It looks as if he has a day job, he might be collating some of all this into a b--k, he's scripting TLP, and presumably has some kind of life.

But don't trust me. I still drink milk.

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"And as that huge number of... (Below threshold)

October 8, 2011 7:38 PM | Posted by Altostrata: | Reply

"And as that huge number of psychiatric patients grow up to become either unemployed adults, or at least the children of unemployed parents..."

Hence, the rise in mental illness disability claims identified by Robert Whitaker in Anatomy of an Epidemic.

What else would we expect from telling people their brains are diseased, they must obey a psychiatrist no matter what, and giving them powerful psychoactive drugs for years?

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If there is in fact a rise ... (Below threshold)

October 8, 2011 11:22 PM | Posted by information addict: | Reply

If there is in fact a rise in adhd, or other psychiatric disorders in children(and not simply a rise in medication use--although I believe psych meds are both over and under prescribed)I think a very possible reason is Vitamin D deficiency among the kids and their mothers during pregnancy and while breastfeeding. And who is more likely to be deficient, other things equal? People with darker skin.

The messaging to cover up from the sun, likely lead by the makers of the sunscreen products and the dermatologists, combined with reduced time spent out doors (name your reason)has been hardwired into people's brains.

I am not discounting other contributing factors for adhd or other disorders...environment(s) (including vit D and other nutrients) and genes and the interaction between them, etc.

However,as a mother who hears many stories of psychiatric and learning difficulties--aspergers, autism, adhd, anxiety, depression, you name it-- from other families in my circle (and healthy, intact families who are not marginalized and don't even have timely access to a psychiatrist--I live in Canada) I can't help but wonder what the hell is going on (other than the $$$ incentives to prescribe meds) ....and the more I research Vitamin D and nutrition in general, the more I become very concerned. Yes, the economy is in the tank, and certain groups have always been hard done-by... and those factors contribute to mental illness. But these trends have been on the rise for a while now.

Lets look at vitamin D. Check it out. And no, I don't have any monetary interests here. Its important to brain development and many of us in North America are deficient, even if you live in Arizona.

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"Note the big jump at 6 yea... (Below threshold)

October 9, 2011 5:40 AM | Posted by Anonymous: | Reply

"Note the big jump at 6 years old, from 0.1% to 5.1%. Yes, certainly symptoms become more prominent, but also they become prominent at school."

The state of California runs a campaign called "The First Five" aimed at making parents aware of how important a role they play in the first five years of their child's life. Every time I hear about it I can't help but imagine the campaign having the subtitle, "This is the deadline for when our judgement supersedes yours."

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I keep forgetting my name l... (Below threshold)

October 9, 2011 5:41 AM | Posted by Or: | Reply

I keep forgetting my name lately. That ^ was me.

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There should be a law again... (Below threshold)

October 9, 2011 10:43 PM | Posted by Help For Depression: | Reply

There should be a law against giving stimulant drugs to children under the age of 16. I mean really, what are parents thinking. Let's look at the correlation between children with ADHD and poor parenting. Let's look at the root cause of the problem and not just treat the symptoms.

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THX 1138 everyone is taking... (Below threshold)

October 10, 2011 1:33 PM | Posted by Paula: | Reply

THX 1138 everyone is taking something.
We also have a huge unexplained increase in autism.

In the future, everyone will be on medication to alter their emotional state- meaning, feelings are there to inform us at a safe distance not to effect us.
Please watch THX1138. It is going to happen and if we last, Gataca is another great film to watch about god children- meaning un-altered embrios. Fun stuff and all part of evolution. We will all want taller, attractive, calm, smart, healthy and happy children.
Now is like the biggining of medicine where we still blood let but have figured out hand washing to avaoid germs. Genetic changes are the next bump in the road. It will happen.

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ADHD is a real entity and c... (Below threshold)

October 10, 2011 1:46 PM | Posted by Donald Atkinson: | Reply

ADHD is a real entity and can cause serious harm. I agree that many parents/teachers encourage stimulants as a behavior enhancer when they may not be needed but it is inappropriate to throw the baby out with the bathwater.

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Regarding footnote 1, there... (Below threshold)

October 10, 2011 5:52 PM | Posted by Anna: | Reply

Regarding footnote 1, there's some truth to your point, but maybe this is just your nimble dance of getting around the real truth—that poor minorities have different cultural criteria and different priorities when it comes to addressing mental illness. And by “different,” I mean those which strike white people as inherently wrong or backwards otherwise incompatible with their views on the matter.

Speaking from experience, white parents medicate and black parents (insert also: Hispanics, Chinese, Russians, etc) “discipline”—in part because they’re beleaguered by circumstance, and in part because they lack the intuition that comes from education, but also, abundance of leisure time to analyze and interpret things. I can’t tell you how many times I’ve seen a black mother publicly whoop her kid for crying or talking back or being hard to control. Sometimes the kid has issues, sometimes he’s just hungry and exhausted. I would also deign to say that it’s impossible to diagnose a problem in your child if you are afflicted by the same problem/are a child yourself.

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I'll be d*mned if I can und... (Below threshold)

October 10, 2011 6:04 PM | Posted by Anonymous: | Reply

I'll be d*mned if I can understand why a discussion of risks contributing to a risk-benefit assessment absolutely must include someone saying "don't throw the baby out with the bath water."

Can we make this equivalent to a comparison to Nazis in political debate, i.e. absurd and irrelevant? (See Godwin's Law.)

Could it be the risks in medicating children with methamphetamine analogs for years are so great that far fewer prescriptions should be written for them? Other medical disciplines respect risk-benefit, why not psychiatry?

Or would that make clinical practice just too difficult?

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"I didn't succeed in life b... (Below threshold)

October 11, 2011 6:45 AM | Posted by Poorkids: | Reply

"I didn't succeed in life because I was an undiagnosed, unmedicated ADHD kid" sounds a lot better than "I didn't succeed in life because I didn't apply myself."

Not that there isn't such a thing but if you have 5 of "those" in your class chances are that 4.5 of them are not it.

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Pediatricians and not psych... (Below threshold)

October 11, 2011 12:48 PM | Posted by Donald Atkinson: | Reply

Pediatricians and not psychiatrists treat most adhd children and they do assess risks and benefits of treatment like the rest of their practice. Kids with adhd are more likely to wind up in the ER with injuries and increased contact with the law. If I generalized most parents only use meds as a last resort. There are the exceptions but they are not the majority.
The reason there is a bump in stimulant use at age 6 is not because the condition does not exist before that time but because the FDA does not recommend use for most stimulants before that time and Pediatricians are not confident going outside recommendations especially with controlled substances. School behaviors do have an effect on referals to pediatricians however especially if inability to attend or complete tasks cause the child to fail.

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What an absolutely brillian... (Below threshold)

October 11, 2011 3:11 PM | Posted by Clarissa: | Reply

What an absolutely brilliant post. It is horrifying to see how many kids are zombified with medication by adults who need the kids to be in a permanent drug stupor to handle them easily.

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Donald Atkinson: What, in y... (Below threshold)

October 11, 2011 9:10 PM | Posted, in reply to Donald Atkinson's comment, by Altostrata: | Reply

Donald Atkinson: What, in your opinion, are the 3 greatest risks recognized by pediatricians to children taking medication for ADHD?

What I mean is risks from the drugs, not risks from climbing trees or risks of disruptive behavior in the classroom.

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Greatest risks--hmmm. The ... (Below threshold)

October 12, 2011 1:20 AM | Posted, in reply to Altostrata's comment, by Anonymous: | Reply

Greatest risks--hmmm. The scariest risk is sudden cardiac death but the risk is no greater than the baseline risk that is in the general population but that is the greatest concern but not a common risk. common risks are decreased appetite leading to failure to gain weight leading to slightly decreased total height as adult ~1cm to 2cm., difficulity with sleep leading to irritibility, and irritibility and aggression caused by the medicaton.
Sure the kids do fall out of trees but they also run in front of cars and get their fingers chopped off under lawnmowers.

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From Psychiatric Times <a h... (Below threshold)

October 12, 2011 2:32 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

From Psychiatric Times http://tinyurl.com/3ejgf5f (see citations there):

"....Long-term amphetamine use in childhood is associated with delays in normal development.4 One-third of individuals of all ages who take stimulants for ADHD report significant adverse effects, including insomnia, decreased appetite, and abdominal pain.5 Cases of stimulant-induced psychosis have also been reported.6 Stimulants and other conventional treatments of ADHD in adults are probably only half as effective as they are in children.4...."

Dr. Lake does not mention Changes in Emotions Related to Medication Used to Treat ADHD (see Manos et. al., 2011) or physical dependency leading to difficulties in withdrawal.

It's always interesting to me that every clinician prescribing psychiatric drugs points to an unidentified someone else as an improper prescriber. No one sees their own contribution to the problem. Each believes he or she is prescribing for patients who truly fit the diagnosis and truly need medication.

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Interesting that nobody men... (Below threshold)

October 13, 2011 6:56 AM | Posted by Poorkids: | Reply

Interesting that nobody mentions withdrawals. Or all the kids who are suddenly diagnosed "bipolar" and given risperdal etc. after the amphetamines burn holes on their brains long enough.

Sounds so very harmless, hey give me some. No, it's a controled substance. And here were are snickering at our greatgrandfathers for selling coke with actual coke in it.

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I simply added your web pag... (Below threshold)

November 14, 2011 2:27 AM | Posted by hermes bags: | Reply

I simply added your web page to my favorites. I like reading your blog.linmei/comment201111

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There is every indication t... (Below threshold)

November 22, 2011 3:24 PM | Posted, in reply to Help For Depression's comment, by AntiPReality: | Reply

There is every indication that, regardless of the label, there are individuals with low tonic dopamine, the biological cause of impulsivity and over-reactivity.

You wouldn't blame hypothyroidism on parenting, would you?

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What a terrific article.</p... (Below threshold)

November 22, 2011 3:29 PM | Posted by AntiPReality: | Reply

What a terrific article.

Since anti-psychotics have now surpassed SSRI's and stimulants in sales ($) and are prescribed by the millions (of Rx)'s, the author does a great job expressing what is really going on.

People need good treatment. And some good treatments are available. It is about time psychiatry started to provide it, and understand as much as possible, what they were prescribing, before writing the prescription.

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This post makes a pseudo-sc... (Below threshold)

January 9, 2012 9:19 PM | Posted by sean : | Reply

This post makes a pseudo-science interpretation of an article that is extremely well backed by hard scientific evidence and thoroughly reviewed by editors. I would like to see the evidence and citations to this counterargument rather that just conjecture and opinions.

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I wonder how these figures ... (Below threshold)

January 27, 2012 10:10 PM | Posted by Marie Gronley MD: | Reply

I wonder how these figures would change if kids went out and played outside like they did prior to the video game phenomenon, were forced to use their imaginations to keep themselves amused and make up games, and changed their diets?

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"Note the big jump at 6 yea... (Below threshold)

September 6, 2012 1:25 AM | Posted by Phineas: | Reply

"Note the big jump at 6 years old, from 0.1% to 5.1%. Yes, certainly symptoms become more prominent, but also they become prominent at school; schools have an interest in medicalizing the problem, both practically (calm that kid the hell down) educationally (diminished expectations) and economically (schools get more funding.) Stimulants are the natural first line drugs. Well, they were, anyway."

This is a great point. Pressures to prescribe (and overmedicalize) also come from parents ("please help us, doctor"), big pharma (ham sandwiches to swing clinical decisions), and... other psychiatrists. Look at which adults sought out, screened for, and reported this data. For example.

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A return to normality is wh... (Below threshold)

September 21, 2012 7:45 PM | Posted, in reply to Marie Gronley MD's comment, by Anonymous: | Reply

A return to normality is what would happen.

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This is long, but I'd appre... (Below threshold)

March 10, 2013 3:56 PM | Posted by Jayne : | Reply

This is long, but I'd appreciate a read.

There are other explanations for the increase in stimulant prescriptions besides increased lethargy and pharmaceutical companies.

In the interest of full disclosure, I was diagnosed late (two weeks before I turned 18) with severe ADD. I was able to function fairly well, getting Bs and a few As, taking AP courses, holding a job, extracurriculars, etc. but I was miserable. Medication has solved maybe 60% of the ADD problem for me, and so naturally I am in favor of its use, especially since a major regret of mine is that I was not identified and treated earlier.

On to the Science:

ADD/ADHD is probably caused by a deficiency in dopamine, a neurotransmitter associated with attention and "rewards". This would explain both the inattention and why many with ADD/ADHD report feeling little to no satisfaction at the completion of a task.

Back in the Bad Old Days, ADD/ADHD children were labeled as "lazy", "stubborn", "stupid", etc. Many, such as my uncle who attended school in the 1960s, were punished severely at home and at school for behaviors they could not control. So one possible explanation is that there are the same number of ADD/ADHD kids as there has always been, but that most were undiagnosed.

Another explanation is increased incidence of birth trauma. Mild hypoxic episodes at birth have been linked to ADD/ADHD, while leaving intellect intact. The rise in multiples and premature births in recent years have increased the number of perinatal hypoxia survivors. This is also one explanation as to why second-born twins, in both identical and fraternal pairs, are far more likely to have ADD/ADHD, dyslexia, NvLD, cerebral palsy, etc.

Further, about 90% of those with ADD/ADHD have dyslexia as well. Therefore, it is quite reasonable to assume that there's a link between the two. While the alternate explanation of "these kids are distractible because they are struggling with reading and get frustrated" at first sounds reasonable, it fails to explain why NvLD children, who are often hyperlexic (or especially GOOD at reading and language) also almost always have ADD/ADHD.

Finally, we have our side effects debate. Some parents fear that medication has longterm negative implications. I'm not going to lie, it does have some, such as increased risk of hypertension and unwanted weight loss. However, failing to treat ADD/ADHD also carries heavy risks.

Untreated ADD/ADHD almost always leads to depression, especially in the teen and college years when more emphasis is placed on academic achievement and life organization. One study suggested that a little over 50% of all teen suicides were completed by those with under-treated ADD/ADHD, and that is probably a low estimate, since many of the undiagnosed would have been listed as not having the condition. When it does not lead to depression, it tends to lead to anger management issues. This phenomenon is more often seen in boys with the disorder, and can include quick temperedness, lashing out at teachers and parents, and frequent fights with peers. Anger does not preclude depression, but it is sometimes seen in its place.

Children with ADD/ADHD are more likely to lie frequently. Most of these lies serve to cover up their deficiencies. ADD/ADHD children are oftentimes punished for their symptoms and told that they can control them. Since they cannot control most of their symptoms, many resort to lying to cover them instead.

Further, those with untreated ADD/ADHD are 3-4 times as likely (depending on the study) to get into an automobile accident.

Also, those with untreated ADD/ADHD are 3 times as likely to abuse drugs. The probable reason for this is that many drugs increase the amount of circulating dopamine in the brain. Dopamine deficiencies are tied to ADD/ADHD. This also explains why those with untreated ADD/ADHD are more likely to be arrested and charged with a crime than those without the disorder.

Medication is not a cure-all. Grades often do not improve, mostly because the child or teen is missing much of the foundation that their peers have. Most, if not all, should receive some form of behavior therapy in conjunction with medication. Neither seem to work on their own.


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I succeeded in life, but no... (Below threshold)

March 10, 2013 4:08 PM | Posted, in reply to Poorkids's comment, by Jayne : | Reply

I succeeded in life, but not as much as I wanted.

As for "applying myself", I took the maximum number of APs my school allowed, held 4 volunteer jobs (3 concurrently), held a paid job (one of 4 teens who were hired) held 5 state offices and a national office in a historical organization, won four merit scholarships (I'm upper-middleclass Caucasian and play no sports), a Book Award, a certificate of excellence from the College Board for my AP scores, and scored a 700 and 740 on my SAT IIs and 1980 on my SATs. This was with both untreated ADD and NvLD, a math-based learning disorder which is essentially the opposite of dyslexia.

Nothing came easy. I ended up with a 3.3 unweighted GPA, I know it would have been better had I gotten the treatment I needed. I'm a nerd who has lived beneath her intellectual potential. My academic, family, and social life would have been better. I also may have been free from the comorbid depression that often comes with ADD.

You can find some excuse to ignore or disregard this comment if you want, I just wanted to speak out on this matter.

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Sure it exists, as in peopl... (Below threshold)

March 10, 2013 6:52 PM | Posted, in reply to Donald Atkinson's comment, by Dovahkiin: | Reply

Sure it exists, as in people have symptoms that relate to that disorder, but no one has been able to find anything biological to show that drugs are effective or needed. Something can quite easily be a behavioral problem without being a biological problem that we need to drug kids for. In fact, until a biological reason for a behavioral problem surfaces, there's literally no reason to assume that the problem is best solved by medicine.

I have all the symptoms of ADD, not the hyperactive stuff, and I never thought to seek treatment until age 25 or or. But even then the question must be asked -- was this some neurochemical issue with my brain or is it that I never learned how to cope with ADD-like symptoms? In other words, are the problems that we're labeling ADD more likely to be the result of a kid not learning how to motivate themselves to do school work, or a parent allowing too much TV (video games were fairly new and didn't really take off until I was about 12), or not playing enough sports. And it seems like we're leaping straight at the drugs mostly because to not leap at the drugs would mean that somebody didn't do their job. I just don't see that as a good enough reason to drug a kid with brain drugs. I'd say the same with depression -- before I want anti-depressants, I think we need to make sure that A) my life circumstances are such that I'm not supposed to feel that sad (AKA my mom just died 3 weeks ago and I still have the desire to cry), B) that the depression could never be treated by talking about the things that triggered the depression. But that takes time. effort. And it might mean that the person we're seeing doesn't immediately get better. So drugs it will be.

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The problem with your reaso... (Below threshold)

March 11, 2013 8:10 PM | Posted, in reply to Dovahkiin's comment, by Jayne : | Reply

The problem with your reasoning is that it fails to take into account the idea of Parsimony. Parsimony is the scientific principle that the simplest explanation is likely to be the most accurate one.

If it is a motivational or environmental problem, then it must be a coincidence that it happens more frequently in second-born twins, preemies, those who had a traumatic birth, those whose mothers used opiate-based epidurals (opiate-based epidurals are rarely if ever used now, because it can cause hypoxia in infants and breathing problems in the mother), and those with a family history of the condition. This is an astounding statistical anomaly, the chances of that being the case are probably one in millions. Possible? Yes. Probable? No.

Further, it fails to take into account children who actively try to compensate for their symptoms and apply themselves to their work.

With regard to scientific evidence-low dopamine is definitely linked to ADD/ADHD. There have been documented cases of people who had normal dopamine levels but then had them fall following illness or even injury. These people tended to display symptoms of inattention and depression.

Also, some nonmedical treatments for ADD/ADHD can help relieve some symptoms, though they do a poor job of it. If ADD/ADHD isn't real, these techniques would not work at all.

Ultimately, I think the mere idea that there are aspects of our own minds that are beyond our control terrifies us as a species. We want to believe that we can choose how we think and act, completely. In a way, we can.

No one would choose ADD. It's hell. I wasn't off playing computer games when I should be studying-I couldn't do anything without zoning out. It's almost like when you're asked to think of something when you first wake up after staying up too late the night before, only that's how you are all the time, regardless of sleep or time of day. I zoned out when I was doing things for fun as well as school. I have difficulty maintaining hobbies I WANT to cultivate. It's not a get-out-of-jail-free card, it's a life sentence.

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I"m not saying that no one ... (Below threshold)

March 12, 2013 8:56 AM | Posted by Anonymous: | Reply

I"m not saying that no one has a medical issue, I'm saying that in most cases, it seems like the initial consultation is a 5 minute writing of a prescription for medication. It would be one thing if the doctor was actively checking for other issues, or checking dopamine or other such things. And the fact that schools are actively telling parents to go get their kids medicated is somewhat troubling as well.

I think I have a fairly mild case, I'm functional without meds, except for having trouble on timed activities. It's an issue, and it has held me back, but I'm also not on board that the FIRST recourse should be to drug the kid with stimulants so he can sit in the seat for 8 hours. I think drugs are a last resort. But then again, I'm able to function for the most part. In a severe case that doesn't respond to giving a kid coping skills (I have a notebook that I use as a second brain so to speak) then yes, drugs will likely help.

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