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: 3 (7 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: 5 (11 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: -9 (13 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:

[email protected]

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?

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

A concerned student,

John

Vote up Vote down Report this comment Score: 7 (11 votes cast)
"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.

Vote up Vote down Report this comment Score: 6 (8 votes cast)
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."

Vote up Vote down Report this comment Score: 4 (4 votes cast)
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.

Vote up Vote down Report this comment Score: -1 (1 votes cast)
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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