As a parent, I have participated in many discussions regarding the medication of kids for a variety of reasons. I have friends who have kids with serious problems for whom medication has been a godsend, allowing them to function with relative normalcy. Kids who were unable to participate in a typical classroom for one behavioral issue or another.
We’ve also had many discussions about the problem of over-medicating children, and how some schools push for difficult children to receive behavioral meds, whether they truly need them or not. How some of those adult medications should perhaps not be so quickly prescribed for children. We’ve talked about education reform, changes in teaching methods and school culture and administrative philosophies that would allow for wider ranges of learning styles. I’ve heard parents rant about how unfair it is for their well-behaved child to not receive the same level of attention as the “problem kid” in the class commands, and I’ve seen them answered by the parents of said problem kids with an invitation to trade shoes, just for a day.
I homeschooled my own daughter for four years, primarily because we traveled extensively, but also partially because being in a traditional classroom was difficult for her when she was younger due to sensory integration problems stemming from her time in an orphanage. She could not properly filter sound; a quiet classroom drove her crazy because every deep breath or sigh, every shuffle of a page or tap of a pencil was like crashing thunder in her ears. We found that headphones with music worked wonders – and she is still more productive when her brain is managing music AND her studies. Silence remains a problem. She would hum and chatter and tap and drive everyone around her bonkers with her sounds to fill a silent room, but without them, she felt lost. She’s matured out of a lot of it, but the teachers who allow her to wear her earbuds while researching, for instance, consistently get the best work from her. We were told early on that some medications might be helpful for her, but we decided to work with her behaviors and modify those slowly before we took the more drastic step to medicate. Fortunately, she made good progress and we avoided that step, at least for now.
Her dad was most definitely one of those kids who, had there been drugs for ADD and ADHD when he was a kid, would have been on them. He barely made it out of school and was constantly in trouble for disrupting the class, for being the clown, for demanding attention, etc. Had I been his teacher along the way, I’d probably have wanted him “managed” with medication – anything! – as well. But he did squeak through to graduation and is now a successful radio host, making his living as humorist who needs to be the center of attention. We’ve often wondered where his path might’ve led had he been medicated all those years ago, years when, as it turns out, he was merely honing his craft.
I certainly don’t have the answers, and honestly, I worry more about what is causing the seemingly alarming increases in childhood neurological disorders than about how to manage them. I know where my daughter’s came from – what about all the kids who have been well-nurtured since birth, and still wind up with behavioral problems stemming from apparent brain abnormalities or developmental sideroads? Have these conditions always been with us to the degree they are now and only recently been named? ADD, ADHD, autism spectrum disorders, attachment disorders, sensory integration disorders, OCD, dyspraxia, apraxia, and the myriad other learning disorders being diagnosed in this new century? Is it food additives? Is it hostile environmental toxins? The trend towards hands-off parenting from which our culture fortunately seems to be recovering, when babies traveled in plastic buckets more often than in their parents’ arms? I don’t know, but I believe discovering the causes is as important as finding cures or managerial therapies and medications.
And then I read that those medications so many parents have counted on or deeply questioned are proving to be an even greater danger than before. So where do we go from here?
A shame that a very insightful piece of writing was spoiled by the ultimate assertion. The one good study after Nissen's beatup suggested that ADHD sufferers have lower cardiovascular risk than the general population.
Medication for ADHD might not be the be-all and end all, but neither is it unacceptable as the risks associated with medication are far less than the risks associated with non-treatment. The issue is that medication is an affordable first step but is all too often seen as the only step or the last step in the light of the fact that, broadly, proven alternatives are neither commonly available, nor affordable for the people most in need.
Of course these things that you refer to have always been with us ("Those who don't know history are destined to repeat it." Edmund Burke,1729-1797) . However, what is unarguable, is that these phenomena are increasing in both incidence and severity of expression. This points out that the genetic underpinning of such biologically mediated issues is being strongly impacted by environmental influences.
Where do we go?
The paths are many, better nutrition, no empty calories, no unnecessary additives, correct ratios of fatty acids, better quality protein, less fats of all kinds..
Better early childhood education, teach executive function skills at preschool (http://alfin2100.blogspot.com/2007/11/competent-future-teaching-executive.html).
Understand the difference between "attention" and "distraction. Most kids have no deficit of attention, rather a surplus of distractibility.
Recognise that there is a vicious cycle of incarceration and antisocial behaviour that is very much correlated with ADHD. Prison reform, together with understanding, treatment and self-empowerment will go a way to breaking the cycle.
Educational reform (http://en.wikipedia.org/wiki/Ken_Robinson_%28British_author%29) and (http://edu.blogs.com/edublogs/2009/02/ken-robinsons-the-element-reincarnating-creativity.html)
The list is longer than I have either time nor capacity for but it is wrong to throw the baby out with the bathwater.
Erich and I have had some differences of opinion on this in the past – always polite disagreements, of course. I have always had ADD, and so has my brother. We were diagnosed back before it was called that, and received different types of intervention from the school systems. For me, a regular visit from a child study psychologist, and the purchase of a self-paced reading program helped a great deal. My hyperactivity was controlled by giving me enough to do so I'd be productive instead of disruptive. My brother was sent to special ed until high school, and received the same educational and social lessons as the mentally challenged kids did. I don't think I need to tell you which one of us functions better in the real world right now.
However, if Adderall had been available to me as a child, I'm quite certain that I would not only be a well-functioning adult, but a successful professional. Why? Because the medications allow me to think of one thing at a time. I used to have to study to music as well, and, just as your daughter does, in order to shut out everything else. Everything in the world captured my interest, so the music would put a sound wall between me and whatever was going on outside my room. In addition, I would be working consciously to ignore the music itself by doing my homework. I had to deliberately ignore the music so I could pay attention to my work. It was incredibly difficult, and I couldn't take a break until everything was done because it was such a hard mental state to achieve.
Now, while I am still ADD and think that way, I can reduce the number of pointless things I do, finish things I started, and sometimes even discern whether I should or should not do something BEFORE I start it. I can tell you exactly when the medication is beginning to take effect, and exactly when it's wearing off, simply by reading a book. Without medication, I can read page after page and absorb none of it – if I become aware that my mind has been off someplace else, I'll have to read and re-read the same paragraph, page, or chapter multiple times – or just give up. When it's entering or leaving my system, I do far less re-reading, and at full effect, I can devote my entire attention and actually absorb and process what I read.
That being said, I still agree that behavioral and psychiatric medications are being overprescribed, and often prescribed by doctors who are not properly trained or experienced in the mechanisms of these meds. It's a big decision for both the doctor and the patient, because different medications might act on the same brain chemicals or receptors, but not in the same way, or not in the same way for each individual patient. There are mental and behavioral indicators that help identify what treatment would be most appropriate, and these can be nuanced or dependent upon their combinations. Without the understanding of the effects of the various meds or the particular imbalance indicators of the patient, a doctor can easily prescribe a drug that's cheap and seems to help, rather than what is truly needed.
This is where you run into people taking a medication and having little or no relief, or having a potentially serious reaction. Plus, if the medication does nothing, it can take months to find that out, followed frequently by very unpleasant withdrawal symptoms even if the patient transitions to a different medication. Been there, done that. Wouldn't wish it on anyone.
In between the view that mental illness is imaginary or treatable entirely without medication, and the view that a prescription is the cure-all, or the first (or only) line of attack, is where I stand. Patients and parents need to advocate for themselves by first understanding their problems, learning about all the various therapies, finding a doctor whose knowledge is specifically strong regarding your or your child's condition, and trying therapies in order of invasiveness/reversability until a solution is reached.
Mindy: My understanding is that childhood behavioral and neurological disorders are not on the rise- we just have more open and aware diagnostic standards. Decades in the past, there was no asperger's syndrome to encase the more functioning autistic. There was no widespread diagnosis of ADHD- and there was no adult ADD.
See the journal articles cited in this section of wikipedia's epidemiology of autism article to read a bit about why the increase in autism diagnosis may have occurred. Increased diagnostic ability accounts for much of the rise. I suspect this is the case with ADD and ADHD too.
There are also benefits for a struggling child to attain an ADHD/ADD diagnosis. Depending on the school district, a child with ADHD may have access to tutors, may be given extra time to complete tests, or have other special allowances that make the diagnosis rather sought-after. In my high school career, I did know a few low-performing students who sought out and were saved from expulsion by an ADD/ADHD diagnosis. I don't know whether it was a lucky and genuine diagnosis in these cases, or if it was a misled conclusion made possible by the more wide criteria.
There are benefits and drawbacks to our improved awareness of such disorders. It is easier for struggling students to find the help and understanding they need. I suspect it is also easier for a functional but unusual child without a disorder to be pigeonholed and forced to take serious psychoactive drugs.
Erika, while there might be some truth in the idea that autism spectrum and PDDs are more common because they are being diagnosed better than in the past, I suspect that only explains part of the increase. The fact that the defining criteria for autism, autistic spectrum and PDD-NOS were expanded several years ago was once blamed for the increase, but statistically speaking, those changes don't account for the continual increase in the rate of new diagnoses.
Statistics do not show cause and effect, but can indicate where more research is needed. While research in some countries (notably France and Germany) is focused on understanding the pathology of these developmental illnesses, it seems that in the US, England, Australia and New Zealand, the research is working hard to discover an autism gene. Which is kinda like shooting your gun, then finding where the bullet hit and painting the bulls eye around the bullet hole.
I have been tracking autism research for over a decade because my oldest son, who is now 15, regressed into autism at 18 months. The most promising research indicates a combination of genetic and environmental that interact to cause an autoimmune dysfunction, possibly involving the 5ht5a serotonin receptors (largely concentrated in the Purkinje cells of the amygdala) and causing a receptor specific sub acute form of encephalopathy.
Part of the problem in most of the English speaking countries is that everything observed by the parents is rejected as anecdotal if it doesn't fit the hypothesis of the researchers.
Another problem is that, since autism, ADD and similar developmental problems are defined as a group of symptoms, there may be (an probably are) more than one pathology involved. But to dismiss the increasing rate by claiming were are now better at recognizing the problem is a curt and naive way of blowing off the concerned parents.
There are at least two distinct developmental disorders called autism. The first one, sometimes called Classical Autism is apparent within days of birth and is associated with underdevelopment of the amygdala and fewer but notably larger Purkinje cells.
The second, infantile autism is marked by normal development for several months, followed by a regression period lasting usually about three months marked by loss of communication skills, and increases in irritability, insomnia, diarrhea, agitation, stereotypical movements, and blood serotonin levels.
Except for the insomnia, most of the symptoms match the symptoms of hyperserotonemia, and the first treatment applied involves using SSRI's to further increase the serotonin levels.
Infantile autism regression usually occurs around 15 to 18 months. The fact that this regression occurs shortly after the MMR vaccine is explained as being coincidental fails to account for much smaller groups that regress shortly after taking the vaccine booster shots. I guess that is simply another coincidence.
However a special court in the US recently ruled that there is no medical evidence that shows vaccines as a causative agent in autism. On the other hand, many researchers who have found any immune mediated pathology tend to get fired from the universities that do their research at and their work never gets reviewed, so it seems that the pharma industry (who fund most of this research) doesn't want to know if autism is caused by an auto immune dysfunction possibly out of the fear that it might implicate some of their products.
Interesting responses so far. Alison, I totally agree that many kids (and adults, including quite possibly myself) benefit from these diagnoses and the properly prescribed medications. I didn't mean to imply otherwise – but the overmedication or unnecessary medication of some can give the entire area of research a black eye, and I don't want that to happen. I am not against pharmaceuticals appropriately used, but I also do not entirely trust big pharm, either. I'm intrigued by what you all are saying . . .
A lot of the problem is that in the US, medicine is often more concerned with treating the symptoms without trying to understand the cause. So often the doctores, who are trying thweir best with th emisinformation provided by the pharmacy reps, end up using a "cut and try" method of medication.
My older son is currently on three medications, two are off label (prescribed for their side effects ). one is an antipsuchotic approved for schizophrenia and bipolar disorder, another is an antiseizure drug for epileptics and the third is for ADHD. He is autistic, whith no history of seisures or schizophrenia.
As I've noted elsewhere on the blog, there is much research from European sources that indicates the involvement of a specific serotonin receptor (5ht5a) as an important factor in autism. There are no medicines manufactured by any of the drug companies that target this receptor. There is a herbal remedy that affects the 5ht5a receptors and an illegal hallucinogen that also affects the 5ht5a.
Of course there is little incentive for the drug companies to develop a specifically targeted med when they sell 4 times as many drugs that attempt to address the symptoms.