Is ADHD and ADD a Real Thing?

~ Laura

The Times has yet another article on the ADHD and medication. This must be a big traffic topic for them, because they have a new article every month. Check out the comment section for the real world stories. It’s truly amazing that lack of consensus on this topic.

Published by Laura

9 thoughts on “Is ADHD and ADD a Real Thing?”

  1. The article had interesting information on the marketing by the pharmaceutical industry (and the correlation of the marketing with increased diagnosis).

    For me, the bottom line about the lack of consensus is that I think that the ADHD drugs can have “useful” effects (for concentration and focus and productivity) for many individuals (only some of whom are functioning atypically without those medications). The drugs also have side effects, for some individuals, serious ones (addiction and, I think, even, psychosis), which makes balancing the benefits with the drawbacks difficult. And, advertising could end up playing a significant biasing role.

    I didn’t think the article provided much information on the “overdiagnosis” problem, though, because it didn’t grapple with the issues of what “overdiagnosis” means (and the articles never seem to, instead using short-hands like the number of people diagnosed). It could be that some day many aging adults will be diagnosed with a number of diseases of aging which can be treated with medications, and the fact that, say, 50% of 60 year olds are prescribed medication for heart disease or blood pressure means that they are over diagnosed. If the medicine works, and makes people’s lives better, the mere fact of incidence doesn’t mean that it’s over-diagnosed.

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  3. I might have said most of this before, but here’s my two cents. Our daughter was diagnosed with ADD. I was very reluctant to put her on any medication, but it was looking doubtful that she could stay at her current school, so I gave in. Her grades improved significantly (like from B- to B+), although I also thought at times that her personality flattened somewhat. So most of the commenters on the NYT article expressed sentiments that I share, or have shared, at least in part. I’m still very ambivalent about both the diagnosis and the drug treatment.

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  4. It’s clearly real, and is addressed by the drugs. At least, my number two had been sent to the principal three times in a month for fighting (in third grade! we were beside ourselves) and he got diagnosed and started taking Ritalin, was not in trouble again til once in fifth grade. His ability to pay attention in class was reported to us by his teachers as having gotten much better, and his grades went up. Overdiagnosed? very possibly it is often used as a mechanism to get boys not to be boys. But, for us, a godsend, both the diagnosis and the drugs.

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  5. Are ADHD and ADD real things? In my opinion, yes, in that there are people who do suffer from them.

    On the other hand, there is no physical test to confirm diagnosis. Thus, yes, it exists, but many kids without the condition are being prescribed pills by doctors. There’s no ADHD swab to test in a lab. Questionnaires are used for diagnosis, but the parents (or older students) filling out the forms know the answers to give, if they want the medication and/or extended time on tests.

    Before everyone flies off the handle–of course, many parents report only what they observe. On the other hand, I know parents who want their children to try the drugs to see if it helps their kids. Teens are also dealing these drugs in high schools. As far as I know, no student has ever been charged with a felony for selling a classmate Adderall.

    There are also a range of behaviors, and one end of the range is normal. Many of the symptoms coincide with normal boy behavior.

    I began reading up about it when a child was diagnosed with inattentive add, after a full neuropsych asssessment. The diagnosis explains some really strange things he does; dealing with the add has really helped him.

    However, most parents who are handed medication cannot arrange for a full neuropsych assessment. There are doctors who hand out the pills really quickly, seemingly on the feeling that it can’t hurt, and might help. I have heard hair-raising stories from friends; one friend’s child turned out to be bipolar. The first diagnosis was ADHD. It’s not a good idea to give Ritalin to someone who’s bipolar. Another friend’s child has a heart condition, which they only discovered after he was taking Ritalin.

    So, yes, it exists, but not every child taking ADHD medication has ADHD. There are also kids who have ADHD who don’t know it, because they do well enough.

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  6. (second comment)

    This may seem obvious, but medication is not the only treatment for ADHD. It may not help more than other treatments, in the long term. The MTA study has shown the difference between treatment groups in the study disappeared over time. http://columbiachildpsychologist.blogspot.com/2009/04/adhd-mta-study.html

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063150/#!po=10.6061

    http://online.wsj.com/news/articles/SB10001424127887323368704578593660384362292

    Unfortunately, the pharmaceutical companies aren’t selling other treatments. They’re selling drugs. As a mother trying to decide the best course to follow, I’ve been researching the issue. There’s a lot of information available about ADHD, but much of it has been directly or indirectly financed by the drug companies.

    All studies seem to show that family background really matters to outcomes. There’s a lot of effort put into scaring parents about outcomes such as eventual illegal drug use or, shall we say, immoral behavior.

    I would suggest the following changes to current practice: first, no doctor may prescribe ADHD meds unless the child has had a neuropsych exam by a qualified psychologist or psychiatrist. End the practice of doctors who are not specialists handing out stimulant drugs on the basis of a questionnaire and a short conversation with a parent.

    Second, end direct-to-consumer advertising.

    Third, do not allow high schools to make course placement decisions on the basis of elementary and middle school performance. Some of the parents deciding to medicate their children do so because they know how the academic funnel works. Research does show that the brain matures during childhood. A certain number of ADHD kids stop taking their medication because they don’t need it anymore.

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  7. Interesting how we’re all switching to calling the stimulants “drugs” (rather than medicine).

    I agree about direct consumer advertising. It skews the balancing of costs and benefits, and that is its purpose. We should stop allowing it, except in the most

    I worry about doctor-directed advertising as well, but am less clear about where to draw the line between information (take, for example, the information that is being released about the new methods of deliver of HIV drugs — a single pill rather than the much more complicated liquid medication regimen, and the benefits the simpler delivery system can have on compliance and outcomes) and manipulation.

    I think limiting the prescription of the drugs on the basis of more extensive (and expensive testing) might be good in theory, and seems like a good practice to follow when we ourselves makes decisions about the drugs, and have resources to follow up on care. But, I think the effect for under-served population would be to deny them the medication — and I don’t think that is a positive result. Maybe a requirement + a right to the neuropsych evaluation would be good, but, then, would we just end up with a boondoggle of bad neuropsych evaluations?

    We also need to address the issues of secondary markets for the stimulant medications. They are becoming drugs of abuse and they are addictive. The wink/nod about the sharing the medications (and, their sale) and the lack of control of supply needs to be addressed.

    Oh, and I don’t really know what to say about the use of medications to access the “advanced” classes. I’m sure it happens. But, I don’t think we’re going to get rid of the funneling. If public schools were to, people will just look harder for private placements.

    I remember being casually (and mildly) annoyed at the use of tutoring/medications (by others) when I was a newish school parent, because I saw those interventions as ways of “cheating” into the placements my children found themselves in (my kids are good at school-based skills). But, then, I realized that we all try to support our children in their weaker skills in an effort to let them shine in their strongest skills. I think the decision to medicate is one that should be personally made by the family, in the context of the situations their child needs to navigate, and I think they need to have the best information they can to make that choice.

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