ADHD and Medication: Miracle or Madness?

by Heather Threatt

Imagine walking up the front steps of a local elementary school and noticing a man surrounded by children.  As you take a closer look you see him handing out little packages of pills, telling the students “these will make you feel great today- it will help you concentrate better and do your work better…”  You see the kids take the pills and run on into the school before the tardy bell rings.    Outraged, you immediately go straight into the school, but on your way to report this drug pusher to the principal you see the line in front of the school nurse’s office.  As you take a closer look you see her handing out little pills, telling the students “these will make you fell great today-- it will help you concentrate better and do your work better…”    Experts estimate that over two million children are medicated daily for the symptoms of Attention Deficit Hyperactivity Disorder in America.  

Attention Deficit Hyperactivity Disorder, or ADHD, is generally defined as a disorder in which a child displays inattentiveness, impulsivity, hyperactivity, and disruptive behavior to a greater degree than what is considered normal for his/her age.  ADHD is currently a much discussed and widely debated subject among parents, educators, medical professionals, researchers, and drug companies.  Recent reports concerning the safety of children in regard to the medications used to treat the symptoms, and the explosion in the number of diagnoses made and prescriptions written for this disorder add to the growing concern and debate surrounding this issue. 

As a parent with a son diagnosed with ADHD, the struggle over using medication and the ensuing chaos has compelled me to spend countless hours reading and researching this issue.  During the course of my research I have found that everyone involved in this issue has a slightly different focus.  Most parents are focused on the child and his or her success in school and life—although there are some that just want the problem fixed as easily and quickly as possible.  Educators are concerned with students, but remain focused on an orderly classroom and improved academic performance.  Many in the mental health and medical fields have varied focus: on the child, the development of many new and exciting diagnoses, research opportunities and increasing profits from medical visits, hours spent in counseling/therapy, and grant funding.   Drug companies seem to be focused on three things: the idea that ADHD is a medical disorder, making sure that the idea of medicating for ADHD is mainstream and accepted, and of course the millions of dollars in profits generated from the sales of medications used to treat the symptoms of ADHD.  After much research, I have concluded that parents are often pressured directly and subtly into medicating children for ADHD symptoms and while they are seemingly effective, those who benefit are the teachers, peers, parents, medical professionals, and drug companies rather than the child.  

School is generally where a parent first hears the words “Attention Deficit Hyperactivity Disorder.”  Sometimes a teacher takes a parent aside and suggests that parents should have their child tested, other times educators have threatened and intimidated parents into medicating their children.    The student disrupts teaching, bothers other students and causes disorder in the classroom.  Many times, however, teachers are not educated in classroom management techniques regarding ADHD kids.  The quickest and easiest solution is medication.  Children are suddenly quiet and focused.  They don’t interrupt or move around like they did before starting medication.  These are welcome benefits for educators, but unfortunately the side effects are often problematic for the children at home.  Sleeplessness, lack of appetite, rebound --aggressive behavior that occurs in the afternoon as medication wears off-- nightmares, and depression are just a few.  Often doctors will prescribe additional medications such as sleep aids, and anti-depressants to combat these side effects. 

A secondary problem associated with medicating for ADHD relates to the attitude of the child in regard to their “disorder.”  Kids can easily get the impression that they will always need medication to deal with their lives.  They may never learn practical strategies to deal with frustrating, boring, or difficult situations in life without the aid of medication.     There is also the question of these stimulant medications becoming “gateway drugs” as described by Dr. Frank Lawlis in The ADD Answer: How to Help Your Child Now.  Lawlis relates that “humans addicted to methylphenidate and amphetamines are known to cross-addict to cocaine” (73).  Our society’s approach to every problem with a diagnosis and pill for every problematic behavior is reaching new depths when children become the victims.   This especially holds true when the “pill” is a class II controlled substance in the same category as morphine and cocaine.  Children can possibly learn the attitude that the easiest and quickest route is the best solution to life’s problems. 

Medications used for the treatment of ADHD have also been the object of much scrutiny recently because of the possibility of more serious side effects.  In January 2005, a press release from the FDA concerning Strattera, the newest and first non amphetamine drug for ADHD, stated that “The labeling is being updated with a bolded warning about the potential for severe liver injury following two reports (a teenager and an adult) in patients who had been treated with Strattera for several months, both of whom recovered” (New Warning 1).  It goes on to say that the liver injury may be so severe that a transplant may be needed and that the actual number of incidents could be greater than mentioned because of the lack of reporting (New Warning 1).  The other medication that has received much publicity is Adderall XR.  The sales of Adderall XR were suspended in Canada in February 2005 because “20 people, 12 of them children, had died suddenly in the United States while taking the drug” (Harris 2).  The deaths were due to heart attack and stroke related problems.  This information comes from a recent article  in the New York Times about Senator Charles Grassley, who has been investigating the Food and Drug Administration, and calls attention to the possibility that  FDA officials might be “too cozy with drug makers” and might be “slower than their counterparts in other nations to acknowledge drug-safety problems” (Harris 2).  The sale of Adderall XR in the U.S. has not been suspended, but the warning labels have been changed to reflect the possibility of sudden death.   I am astounded that parents who are inundated with how effective and essential medication is in the treatment for ADHD, are expected to make a reasonable determination to use medication and to weigh the risk/ reward factors —when one of the risks is the possibility of sudden death. 

The pressure to use medication first and as the primary treatment for ADHD comes from every direction.   The powerful drug industry seems to have a hand in nearly every source of information available to parents.   They even employ visual rhetoric on their websites, using a smiling and happy family to illustrate the family that uses medication to treat ADHD, and of course the loner in black clothes, obviously miserable and unhappy to illustrate the child that is left untreated (unmedicated). 

          

Fig. 1 This photograph is used on the     Fig. 2  This photograph is on the same

          website www.adderalxr.com under                 website under the “Consequences

          the “Treatment of ADHD” link     of untreated ADHD” link

Each of these powerfully influential websites, agencies, and companies should be required to do a “full disclosure” just as those involved in the stock market have to reveal their interests or biases during television interviews.  When a concerned parent clicks on adhdinfo.com, they are entitled to know that the website is sponsored by Novartis, the makers of Ritalin.  When visiting or joining CHADD.org, parents should know who funds the resource center.  Parents have a right to know about all of the research findings, not just the ones that bolster the medication position. 

While researching, I found that those on the pro medication side of the debate formed a sort of circle of influence that is almost frightening.  To begin with, the only intensive study of the treatment of ADHD was done by the National Institute of Mental Health in 1999.   This study is complex and difficult to summarize but the NIMH does so by stating that “combination treatments and the medication-management alone were superior to intensive behavioral treatment and routine community treatment” (NIMH 20).   This study was pivotal for drug companies because it has ultimately resulted in an explosion in ADHD medication sales.  This NIMH study is under scrutiny by some in the medical field because of some fundamental problems.  Dr. Peter Breggin, a renowned psychiatrist, author, and expert in psychopharmacology has written an analysis of the study and pointed out some rather interesting flaws.  He points out that it  “was not a placebo-controlled, double-blind clinical trial” and that “the blind classroom raters found no difference in any of the treatment groups” (Breggin 2).  This means that there were no children that were given a placebo, and that the uninformed classroom observers recorded no recognizable behavioral differences in the children that were medicated versus those who were undergoing therapy.  Breggin also relates that “Overall, no academic improvement was found as a result of any treatment and no differences were found among the treatments” (5).  There are many other flaws included in the study, but perhaps the most unsettling is that  “the children did not rate themselves as doing better on the drugs than on any other treatment” (Breggin 3).  This seems to be the most disturbing—that the children themselves did not feel that the medication helped them. 

Each of the drug company websites, AdderallXR.com (Shire Pharmaceuticals), ADHDinfo.com (Ritalin, Novartis), Concerta.net (McNeil), Strattera.com (Lilly),  mention the study done by the NIMH as the evidence and assurance that using medication is necessary for treatment.  Each of these websites also mention CHADD.org, a national resource center for children and adults with ADHD.   Upon visiting CHADD.org, it states on the website that it is “funded through a cooperative agreement with the Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (AD/HD) affects how millions of children and adults function on a daily basis. The NRC was created to meet the information needs of both professionals and the general public” (National Resource).   The CDC gave CHADD $750,000 in 2002 to set up this national resource center.  Interestingly the circle starts to close here as you dig deeper and find that CHADD has also received over one million dollars in donations from Novartis, the manufacturer of the drug Ritalin since 1994 (“Medicating” 4).   Parents of newly diagnosed kids look to these sources for guidance, advice, and help.  These agencies do provide services and information to the public but upon extensive research I have realized that much of the information may not be as straightforward and reliable as one would hope for or expect. 

These drugs that are used for children’s symptoms have only been in use for a limited time.  Most children that have been on psychotropic medications have not even reached middle age, or had children yet.  The possibility for many serious health problems seems inevitable in light of the problems already coming to our attention.    It may be true that these medications are successful—if success is defined as a quiet, controlled classroom, but it can’t possibly be worth the price.  It seems that ultimately we arrive at the main driving force behind the drastic increase in ADHD diagnosis—money.  Drug companies are reaping enormous profits from the incredible increase in ADHD diagnosis. The New York Times article mentioned previously states that “Shire sold $759 million of Adderall products in the United States last year and $10 million in Canada”  and that “last year, doctors in the United States wrote more than 23 million prescriptions for the four most popular drugs used to treat attention deficit disorder” (Harris 3).  These companies should possibly be forced into spending a portion of this money funding research into other methods of treatment for ADHD, and improvements to the educational system in regard to these students.  They should also be held accountable for the subtle, but powerfully successfully marketing campaign that has resulted in phenomenal profits and a whole new market for drug companies—our children. 

Fig. 3 A young boy “trapped” inside

       of a Ritalin prescription bottle.

Parents face extraordinary decisions concerning their children as they grow and experience life.  They have to deal with everyday issues, but sometimes they deal with grave problems, such as serious injury, and/or illness.   ADHD is a unique situation for parents because it generally only affects the child in regard to his or her success in school, but is represented to the parent as a very serious issue.   Influenced by  an educational system that values the quiet, controlled classroom, a  medical profession that exists to diagnose and treat, and a powerful pharmaceutical industry that has done an excellent job with research, advertising, and propaganda; parents often yield to the “experts” to the detriment of their child.   There is no “quick fix” for ADHD.  It is madness to give children medication that is in the same class as morphine and cocaine to combat behaviors that, with work, can be reduced or controlled.  Parents and children have to do the hard stuff—they have to educate themselves, try new things, and seek support from others who have been through the same issues until they find success.  This success isn’t necessarily defined by good grades, or perfect conduct reports.  It can be a family that becomes closer as it works through this difficult problem. It can also be the child who has learned about hard work and perseverance—but most importantly it is the realization that, even though some people may not fit into what our culture defines as the norm, they have value and can contribute much to our society.

Works Cited

“A Critical Analysis of the NIMH Multimodal Treatment Study for Attention-

Deficit/Hyperactivity Disorder (The MTA Study).”  Breggin, Peter R. 2000. New York. <www.breggin.com/mta.html>. 2 April 2005.

Gardiner, Harris and Benedict Carey. “Senator Says F.D.A. Asked Canada Not to Suspend

Drug.” New York Times 11 Feb. 2005, late ed.: A18. New York Times Online. ProQuest.

ProQuest. Central Piedmont Community College Library, Charlotte, NC. 9 Mar. 2005.

Lawlis, Frank. The ADD Answer: How to Help Your Child Now.  New York: Penguin Books.

2004.

“Medicating Kids: The Business of ADHD.” Ed. Gold, Ben. April 2001. Boston. Frontline

<www.pbs.org/wgbh/pages/frontline/shows/medicating>. 2 April 2005.

National Institute of Mental Health.  Attention Deficit Hyperactivity Disorder.  Bethesda, MD.                                                                                   

           2003 (NIH Publication No. 3572)   <http://www.nimh.nih.gov/publicat/adhd.cfm#intro>

National Resource Center on ADHD. Children and Adults With Attention- 

Deficit/Hyperactivity Disorder. 19 Mar. 2005 <www.chadd.org/nationalresourcecenter>.

"New Warning for Strattera." 17 Dec. 2004. U.S. Food and Drug Administration. 19 Mar. 2005

<http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01335.html>.

Images:

Figure 1:  www.adderallxr.com/treatmentofadhd

Figure 2:  www.adderallxr.com/treatmentofadhd/consequencesofuntreatedadhd

Figure 3: http://www.canoe.ca/Health0003/09_ritalin.html