Seems like everyone is getting diagnosed with ADHD these days. The percentage of children in the USA aged 4-17 who’ve been diagnosed with ADHD was 11% in 2011, up from 7.8% in 2003. A little over half of them (6.1%) were receiving medication, according to the Centers for Disease Control and Prevention.
If you have a child or a relative who’s been diagnosed with ADHD, it seems you now have a terrible decision to make: Medicate the child with drugs that are chemically similar to cocaine, or withhold the medicine and raise the chances of the child becoming an academic and professional failure with increased chances of substance abuse and mental health issues later in life. What an awful dilemma for a loving parent or relative to have to make.
That’s what you may have been told. The truth is that this is a false dilemma. Here’s why.
Does Your Child Really Have ADHD?
There’s no lab test that determines whether your child has ADHD. Instead, a professional looks at behavior and judges whether it meets at least six of the criteria outlined in the “bible” of Psychiatry: the Diagnostic and Statistical Manual of Mental Disorders (DSM). Unfortunately, the criteria are awfully vague. They all use the words “Often” or “Easily” when describing symptoms. For example: “Often has difficulty sustaining attention in tasks or activities” and “Is often forgetful in daily activities.” Does “often” mean once a day or a hundred times a day? It’s up to everyone’s interpretation. Ten different professionals will have ten different opinions about where the cutoff is between normal behavior and ADHD behavior. And by the way, it’s a purely arbitrary decision to say that a child has to meet six of these criteria. It could just as easily have been seven or five. Or for that matter ten. So when a professional tells you your child has ADHD, take it with a grain of salt — they don’t know any better than you do.
There is no doubt that ADHD is wildly over-diagnosed. Reputations and profits are at stake, and that drives academics, doctors and drug companies to promote the diagnosis. Even the researcher widely considered the Father of ADHD says so, as does the Chairman of the DSM-IV Task Force.
Will Medications Really Help?
There is no question that the stimulants children take for ADHD in many cases reduce the symptoms (at least initially), and make the life of the teacher easier. But what do they do to the child? There’s a good deal of evidence that there are negative effects on a child’s social interactions, level of happiness and self esteem. Perhaps that would be worthwhile if academic achievement benefited. But a 2002 summary of 14 studies of the impact of Ritalin showed “little evidence for improved academic performance”. Even the American Psychiatric Association in 1994 admitted that “Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long term adjustment.” And there is evidence from the US based National Institute of Mental Health that the effect of the drug not only falls over time, but that symptoms actually worsen compared to peers who’ve not been medicated.
Is The Help Worth The Side Effects?
Consumer Reports in 2013 points out that decreased appetite, sleep problems, weight loss, upset stomach/stomachache, irritability/anger, headaches, and flat affect (among many others) impact between 18% and 57% of those taking stimulants.
Stimulants can also have much more serious side effects. Although rare, they’ve been linked to heart attacks, stroke and sudden death. There’s also evidence that depression, apathy, a general dullness, mood swings and a general sense of hostility toward the world can result.
Stimulants are also addictive. With ADHD drugs widely available, particularly in the United States, the opportunity for abuse is enormous. A drug that has mostly minor side effects when taken orally in small doses can be very dangerous when crushed and snorted, or taken in high doses.
Is The Decision NO?
It seems I’m building a case against using stimulants to treat ADHD. Surely, you might think, why would anyone give an addictive drug that is chemically similar to cocaine to a child when that drug has numerous negative side effects (which can very occasionally be fatal) and when the drug’s effectiveness is very much in doubt? Sometimes, you would indeed want to do that. But this should be a last resort, not a first.
What Should You Do Instead?
Everyone wants a quick fix — it’s only natural. The child takes a pill once a day, just like a vitamin, and everything is fine. But these aren’t vitamins: You’re putting chemicals into your child’s brain that don’t belong there.
The alternative is therapy. Sometimes that’s therapy for the child, sometimes for the family, and other times for the parents alone — or some combination of the above. That doesn’t mean there’s something wrong with the family or the marriage that is causing the child to be ADHD. It does, however, mean that talking about the child’s issue, devising strategies for dealing with it and eliminating triggers that worsen it can be extremely successful. And therapy has no negative side effects. It’s more expensive in the short term, but when you consider the cost of years of medication and doctor visits to monitor the drugs and manage side effects, it’s a bargain.
So the drugs/no-drugs dilemma is truly a false one. The first referral, in every case, should be for therapy. If the child still shows no improvement, and the parents are concerned the child’s symptoms will negatively impact the rest of their life, then it’s time to consider medication.
Bad Pharma: How Medicine is Broken, And How We Can Fix It by Ben Goldacre
The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch