Why are Millions of Children in the United States on ADHD/ADD Medications? Long term implications?
ADHD/ADD: Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder is one of the most diagnosed neurobehavioral disorders in children. It is defined as an impairment of function in 1 or more of the areas of Academic, Social, and Emotional areas. Diagnosis must occur before 12 years of age, and it must be for at least 6 months and above. It must also cause impairment in different settings.
It can be broken down into the 3 categories of Inattentive/Hyperactive/Combined. Within the inattentive type, children can have issues with detail, instructions, organization and tasks. Within the hyperactive area, they may fidget, become very talkative, and look as if they are always on the move/restless among other descriptions. In the combined type, there is a combination of both.
The cause is not definitively known, but research has shown possible deficits in a gene that may make it difficult to process Dopamine in the brain. Others say there may be genetic predispositions to this illness passed down from parents.
It can be diagnosed as early as 4 years old, and it is said to persist into adulthood, but just may become more manageable. Diagnosis normally involves a questionnaire filled out by the parent, and or teacher, ie. Vanderbilt Assessment, and others. It should also include a thorough family history, medical history, and physical exam, in order to rule out co-morbidities, or other potential issues that may cause impairment.
It has now become a very common complaint/concern for parents coming in to visit with their pediatrician, or health care provider. They may come in after they have had multiple concerns from a teacher, or after they have had much difficulty and consternation, when trying to help their children to focus, and complete a task for school, recreation or many other areas in home life, that just seem to be a constant struggle.
Treatment may include, especially for the pre-school age: 4 to 5 years old, a trial of Behavioral therapy, in best case scenarios. Then, if Behavioral therapy does not work, it is possible that a child this young, could even be placed on stimulant medication; however, this is not the usual case thankfully.
Medications include Stimulants: the top 2 being Methylphenidate derivatives (ie. Ritalin, Concerta), and Amphetamines (ie. Adderall, Vyvanse), with Non-stimulants following (ie. Guanfacine), and then Alpha-2 agonists following as well (ie. Clonidine). Stimulants are targeted to work mainly on 2 key chemical neurotransmitters: Dopamine, and Norepinephrine.
The Non-stimulants work on Norepinephrine, and the Alpha 2 agonists, work indirectly on the Pre-frontal cortex of the brain.
Dopamine is the chemical messenger of Pleasure/Reward/Satisfaction/Motivation/Movement, among other duties.
Norepinephrine (Noradrenaline): Is the "fight of flight" chemical, that also plays a role in increased Arousal/Attention/Alertness/Memory/Sleep Wake cycles/Mood/and Maintenance of Blood pressure.
The big key to know about stimulants is that they have well known side effects, and can carry a very high potential of physical, and psychological dependence as well as addiction. They are Schedule 2 Drugs that must be controlled, and prescribed only with the permission of a qualified medical professional because of this risk.
Now if this risk is the case, I think it is important, that we ask ourselves: "Why are millions of children in the United States on stimulant medications? Do all these children have ADHD/ADD? When we compare the prevalence of diagnosis, and prescription usage with other countries, we are at the top for the numbers of prescriptions and diagnoses, and still climbing. Why is this?
Now please understand, there are situations where children with certain neurological conditions/exposures/traumatic events effecting cognitive function/pre-term births, or other insults to their brain; really and truly have a hard time focusing and performing a task to completion. In such cases like these, the risks, need to be weighed, and decided upon after much consideration, and should involve a specialist for an in-depth evaluation, in order to ensure that we are doing the best thing for our children.
With this said, stimulant medications, and in fact any medication; with potentially life changing effects, should be given out with a light hand, and should be the rare exception, and not the normal. Side effects include potential for abuse, chemical and physical dependence, inappropriate usage/chronic abuse, cardiac irregularities, increased blood pressure, appetite suppression, weight loss, growth decline (small but still potential), and even more potential long-term effects.
If this is the case, again; why are so many children, in the United States, on these medications?
Have we considered the several factors that could lead to difficulty in academics, restlessness, impaired function, performance, and task completion? Can food choices, (GMO products/Highly sugar laden fast foods/Chemical exposures/pesticides/non-organic food choices) be causing a problem in the daily function of our children? Why not consider, food as being are main medicine. Why not provide highly nutritious food options, rather than medications first?
What is the home situation like? Do our children, have a safe and secure environment, where they can thrive, concentrate when necessary, and grow?
Are they allowed to watch whatever they feel like on TV/being exposed to "reality" shows which depict non-realistic, fast paced, and often immoral undisciplined lifestyles? Do they get to play whatever game they want, whether inappropriate or not, featuring alternative realities not consistent with real life?
Are we really taking time to check in on our children's concerns and homework, or do we leave it up to the teacher to make sure our children are on track?
Are teachers being left with large class sizes, and feeling crunched under curriculum requirements and constraints?
Do we feel overwhelmed because of our work/busy lifestyles, that we want to have a "quick fix" for the teachers' constant complaints of our child "not sitting still", "not listening" or having failing grades? Do we just want to have something of a "boost" to help them to pass their standardized tests?
These are not questions of blame, but questions of consideration that we all need to ask ourselves as parents, given the responsibility to care for our children.
There are definitely challenges when raising children, and keeping them on track academically, socially, mentally, and as growing young persons with their own individual walks in life. However, the decision to medicate should be a rare option, and not the norm.
What long term side effects do these medications have on the brain? Especially so, in children, that may not even have ADHD, yet still are being medicated. (Check out my video; for more on this: where I share my personal experiences as a Pediatrician).
What affect can artificially increasing important neurotransmitters of the brain, have on long term self-regulation/pleasure attainment/fulfillment/desires/chemical dependency and self-control abilities, among many other potential effects?
As a pediatrician, and first and foremost a mother myself, the staggering numbers of children on these medications is concerning. The prescription rate has recently for example become so high that Adderall has been found to be in short supply. This should not be the case.
What can we do to safeguard our children? The solution is not necessarily singular, but a concerted effort is needed by parents, health care providers, and teachers.
Another consideration, that some may not have ventured into or thought about, is homeschooling our children. In this way, we can really streamline the time, and efforts that our students need, as we know them best.
In addition, monitoring and controlling what our children are being exposed to: ie. foods, social exposures, influences is also very key, among others.
The considerations are vast, and wide, but necessary.
Check out my Part 2 video on "ADHD Medications: What We Need to Know from a Pediatrician", where I will go into further detail of the potential side effects to consider, as well as some potential solutions.
Medications are not benign, and they must be better managed. It comes down now to a decision of lifelong effects, and even in some cases fatality. What are we doing, as parents to protect our children, and what can be done as health care providers for medication management?