There is frequent attention in the media regarding Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). Most recently, the New York Times published an article on March 31st titled “A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise “. The article cites a study from the Federal Center for Disease Control and Prevention that noted that ADHD diagnoses have increased by 41% overall in the last decade. There was a negative feel to the article regarding providers who diagnose and treat ADD/ADHD.
The numbers are disturbing, no question. Much of what the media reports about ADD/ADHD and treatment is negative (see “Ritalin Gone Wrong”, Jan 29th 2012 NY Times). It is unfortunate that psychiatric problems, including ADD/ADHD continue to have such a stigma in this country. Many people feel that stimulants, the primary medictations used to treat ADHD and ADD, are being prescribed by providers merely for behavior control or for “easy solutions” to problems.
Over the last few years, ADD/ ADHD diagnosis and treatment has sky-rocketed for many reasons. Common explanations of this include direct-to-consumer advertising from pharmaceutical companies motivating parents to ask for medications. Also, schools tend to be more crowded, resulting in more stressed students, teachers and parents. As a result, the need to do something quickly in conjunction with less time and resources for children to be evaluated leads to careless diagnosis. Additionally, more primary care providers have been forced to make diagnoses and start treatment plans due to lack of child psychiatrists. The over diagnosis tends to trivialize ADD/ADHD; to make it appear to simply be a “label” given to difficult kids.
As an expert who sees kids and adults with ADD/ADHD almost every day, I believe that ADD/ADHD is a very real thing and that people who truly have it potentially suffer in many ways; socially, at home and at work or school. Depending on the severity, sometimes the whole family suffers from the child’s problems. This being said, I am convinced that ADD/ ADHD is often misdiagnosed and over-treated. While I do appreciate these articles for bringing attention to the problem, I wish they contained more complete and balanced information regarding ADD/ ADHD and how it is treated by psychiatrists.
Psychiatrists are trained that medications are a critical tool in treatment, but also that work on behavioral and environmental supports is just as important. The lowest effective dose of medication is encouraged and very careful monitoring for side effects and response is ingrained during training. People who take stimulants as part of their treatment are encouraged to stop them periodically to assess how they function without them.
Overall, a holistic approach to treating ADD/ADHD is best. This means attention to the whole body, including medications, guidance on what a person eats, limits on screen time, and encouraging regular exercise are advised. Parenting strategies should be implemented and available resources should be mobilized. If you happen to have time in your busy day, please refer to another article I have published on my website titled “Attention!” in May of 2012. This covers non-medication ways to improve attention.
Meanwhile, stimulants are considered the gold standard in the treatment of ADD/ADHD. They work better than any other treatments. When used properly, they tend to be safe and well-tolerated and very effective. There is evidence that untreated ADD/ADHD can lead to long-term problems with interpersonal relationships, careers, and substance use. Adults who have ADD or ADHD tend to be extremely stressed and prone to anxiety disorders and depressive symptoms.
We really shouldn’t be too horrified by the idea of treating ADD or ADHD with stimulants. The vast majority of people in the United States and around the world are on stimulants any way. Caffeine is a stimulant and almost everybody uses caffeine. As reported by “Brain Research Reviews” in 1992, “Caffeine increases energy metabolism throughout the brain but decreases at the same time cerebral blood flow, inducing a relative brain hypoperfusion. Caffeine activates noradrenaline neurons and seems to affect the local release of dopamine. Many of the alerting effects of caffeine may be related to the action of the methylxanthine on serotonin neurons.” The main mechanism of action of stimulants is to increase Dopamine availability in the brain. I wonder if the authors of the ADHD articles mentioned were slurping down a hot mug of coffee as they wrote them.
So let’s all get focused here. Let’s stop throwing providers and stimulant medications under the bus. Yes, we have to be mindful about how we are diagnosing and treating ADD/ADHD. Yes, there are mistakes being made and it is important to bring attention to this; our overloaded systems of care need help. For now, it is crucial to be attentive and mindful about what you or your child are diagnosed with and are taking for it. It is just as important that you are working on ways to improve how you manage your life, and getting coaching on that if needed.
Some medical based articles in mainstream media do not report the whole story about the issue and potentially can be harmful. For example, if a child truly has ADHD that causes impairments academically or socially, he or she may not receive evaluation and treatment because the parents were concerned about information obtained from a news article. Making medical decisions solely on data from a New York Times article is like expecting to be able to pilot a space ship because you watched all six Star Wars movies.
Proper diagnosis and treatment of ADD/ADHD will change the course of a child’s life. I suppose we would call that a case of “Ritalin Gone Right”.