Attention Disorder or Not, Pills to Help in School

http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?ref=ushttp://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html

by 001sky • 14 years ago

46 56 14 years ago

nytimes.com

carterschonwald• 14 years ago

This article conflates a lot of mental health topics via the lens/story of single family that unfortunately has a wide range of behavior difficulties.

Risperdal is mentioned in the same breath as the standard ADHD precriptions. This is an anti psychotic which is meant to be prescribed to help manage recurrent aggressive / violent behavior and has a huge slew of side effects.

In contrast, most prescription stimulants used to treat (actual) ADHD have no side effects that persist after the cessation of taking the medication.

Likewise, it is well established fact that ADHD medications such as Adderall and Concerta are only effective when coupled with behavior therapy of some sort.

The larger picture behind this is that these adhd medications when taken at their recommended dosages help to make it easier to enter a focused state (as in the metaphorical sense of reducing the activation energy for a chemical reaction), and so direct efforts to develop the habits/ behaviors that are difficult with unmanaged ADHD are needed to attain any long term value out of ADHD medication.

point being: nothing new in this article, just lots of anecdote and a story built out of a single families mental health issues. Like wise the statistic that relevant diagnoses are increasing + a handy quote from a single doctor does not establish a systematic trend that should call to question the validity of a health condition.

this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today

calydon• 14 years ago

I think you nailed it in your last sentence. Where are the articles that point out how industrial 'batch' education is no longer serving kids of the present (the future)?

Ygg2• 14 years ago

Well, as the article says, it's cheaper to medicate children than to change the environment. That includes the educational system.

digitalengineer• 14 years ago

"this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today" Agreed! Non-single parent (and the not so poor) family's can compensate with attention, added education and more possibilities to explore and learn.

paulsutter• 14 years ago

ADHD as a binary diagnosis seems odd to me. It seems within a normal range of spectrum that we're all on. Modern schooling and white collar work are so radically different from the environment where we evolved that it's surprising how well we've adapted.

Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?

Why is psychiatry so dead set on binary yes/no diagnoses, and labeling everything as a disorder? Is that the consequence of having to code records for insurance? Something related to prescription laws? Or is it an underlying mistake in psychiatry to think there is one right way to be, and other states are wrong?

jiggy2011• 14 years ago

Indeed, I find a lot of people self diagnosing themselves as ADHD because they find it difficult to sit still and stare at a screen for 10 hours at a time.

sliverstorm2• 14 years ago

why do we need to label people with a "disorder" in order to give them the meds?

My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them.

It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems:

- We have no way of identifying this!

- Prescriptions are in units of pills, not nanograms of active substance

- What is the ideal level of focused vs. unfocused, anyway?

cynest• 14 years ago

>- Prescriptions are in units of pills, not nanograms of active substance

While that level of precision would be nice, pills are delineated by dosage so you can simply give 100mg of substance to one patient, and 200mg to another.

fpgeek• 14 years ago

> Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?

Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".

scotty79• 14 years ago

But in practice that's exactly that happens. Barely known kid is given this drug by the doctor because of bad grades.

Make people aware of possible side effects and what to be vigilant about and that's all. Doctor as a hoop you have to jump through to get your poison doesn't help much. You'll end up in the doctors office if side effects show up anyways.

WildUtah2• 14 years ago

Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?

The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal.

Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available.

It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent.

As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to.

Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.

grimboy• 14 years ago

I think one of the differences with Methamphetamine is that it can and generally is smoked which gives a much quicker onset and rush which makes it more addictive.

hristov2• 14 years ago

Because they are dangerous and bad for you. Maybe if you have the disorder, curing your illness outweighs the danger of the pills. But otherwise there is no reason to take them.

lucvh• 14 years ago

What attention is being paid to the potential long term effect of these stimulants on the serotonergic & dopaminergic systems of these young people's brains? Prescribing such powerful neurotoxins to young people who's brains are still very much in a developmental stage seems risky to say the least.

Synaesthesia• 14 years ago

http://www.erowid.org/experiences/exp.php?ID=67797 http://www.erowid.org/experiences/exp.php?ID=22166 http://www.erowid.org/experiences/exp.php?ID=47529

bemmu• 14 years ago

Just checked what the attitude on Adderall is here in Japan. From ministry of health site (http://kouseikyoku.mhlw.go.jp/kantoshinetsu/gyomu/bu_ka/shid...):

"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan. If you are found with any medicine containing Methamphetamine or Amphetamine illegally in Japan, you can be arrested as a criminal on the spot, immediately, without a warrant in principle."

anigbrowl2• 14 years ago

Japan had an amphetamine epidemic in the 1950s, and has had a major down on them ever since. Asian countries in general seem to treat drug problems as something foisted on them by western imperialists, a belief for which there is some historical basis; but it has also become a convenient narrative that's preferable to the loss of face involved in admitting that any of one's citizens might have a tendency towards abusing drugs or be disenchanted with the status quo.

dschiptsov5• 14 years ago

Drug problem is not a political, but social one. It is connected with lower-class unemployment and general despair. Take a look at modern Russia - it is a disaster.

pdog3• 14 years ago

When you say "some historical basis" do you mean the Opium Wars[1] and the Century of Humiliation[2]? They were pretty bad, so perhaps there is more than just a "convenient narrative" (as you acknowledge).

[1] http://en.wikipedia.org/wiki/Opium_Wars

[2] http://en.wikipedia.org/wiki/Century_of_humiliation

WildUtah2• 14 years ago

"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan."

It's the same in the USA without special permits. Methamphetamine and adderall are both classified under the same Schedule 2 criminal rubric. The investigation and prosecution of doctors who prescribe adderall, knowingly or not, to patients who then resell it to people without insurance or access to health care employs thousands -- probably tens of thousands -- of DEA and local police.

veb• 14 years ago

What annoys me with this, is are we going to get kids going through school, graduating from University, while taking amphetamines and then coming into the software industry and working 18 hour days without breaking a sweat?

If so, where's my option to get these meds? Oh wait, I can't because I'm not ADHD, and because I wasn't "diagnosed" as a kid, it won't happen now.

I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?

bluedanieru• 14 years ago

Aren't racetams a superior alternative anyway, and more easily available?

masterzora• 14 years ago

Superior how? Last I checked there was 0 solid research linking them to pretty much any effect whatsoever.

signified• 14 years ago

Different, not necessarily superior. The *racetams impact acetylcholine levels, and this neurochem plays a part in memory formation and retention. Additionally racetams are associated with increased oxygen flow in the brain. Anecdotal evidence suggests they can cause headaches if you aren't taking choline, but also is strongly positive towards sharper memory. They're easily obtainable as supplements, and unlike classic amphetamine-based stimulants, aren't demonstrably neurotoxic or addictive. In my opinion, however, there is no comparing/substituting them to traditional stimulants that allow for hours of immediate focus. Take both. Or better yet titrate the addictive amphetamine down with adrafinil or modafinil. Adrafinil is an effective way to avoid a lack of sleep's associated cognitive deficits. It seems to be correlated in people with subjectively low IQs though http://www.ncbi.nlm.nih.gov/pubmed/16140369 Nootropics are a fascinating topic, and many are inexpensive and uncontrolled enough to make a personal trial potentially pay dividends. Or cause an aneurysm. I am not a doctor.

guard-of-terra4• 14 years ago

I genuinely wonder why is it about competing in the workspace; instead cooperating in the workspace? The demand for programmers is not constant; it grows with the number of talented programmers, as many new projects now become feasible.

vl• 14 years ago

>I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?

Of course we'll have to compete, and of course we'll use medicine, brain implants, gene therapy, you name it, because it's either that or irrelevancy. Lets be grateful for our profession, because it has a chance to become irrelevant last.

hristov2• 14 years ago

If someone goes through school and university on these pills that would be what 8-12 years on speed? They are not to be envied.

And 18 hour work days take a toll on you regardless of whether you are taking pills or not. It is more dangerous if you are taking pills because then you do not notice the effect on your body.

charliepark• 14 years ago

Although I'm not sure what the air-quotes around "diagnosed" are intended to mean, I suspect it's because you doubt it's a legitimate dysfunction?

Regardless, on your point about being diagnosed as an adult: I was diagnosed as having ADHD as an adult. It's not unheard of. The only reason I wasn't diagnosed as a teenager was that I wasn't hyperactive — just incredibly distractible — and I was smart enough that I performed "acceptably" in school. I've wondered, though, what I could have leveled-up to if I hadn't been fighting my distractibility.

Anyway, I was diagnosed at around age 30, was on meds (Wellbutrin) for about two years, and developed good skills and organizational techniques, so that I don't need the medication any longer. Ultimately, it wasn't the medication that taught me the skills; they just cleared my head and allowed me to develop them on the side.

If you genuinely think that you might have ADHD (specifically, ADHD-inattentive-type, like me), you'd do well to talk to a psychiatrist.

rsaarelm• 14 years ago

It can be a legit dysfunction that starts getting a lot of false diagnoses once parents start thinking that the medication boosts academic performance whether or not the kid actually has the problem.

justinlink• 14 years ago

I second this. I was diagnosed as an adult (two years after college). I'm now thirty.

If you are not hyperactive as a child, I feel it's very rare that you will get diagnosed. People forgot these days there is just the attention-deficit-disorder without the hyper-activity.

Call your general physician.

EliRivers• 14 years ago

I would be very secure in my job if everyone I competed with for it had been an amphetamine addict since the age of ten.

On the downside, I dread to think of the code speed-freaks would churn out after 18 hours jazzed up, ten years into their addiction.

dschiptsov5• 14 years ago

Pills are for the symptoms, not for the causes. The same holds for depressions and anxiety disorders.

Cognitive-behavior therapy is the way to re-train, re-program, unlearn a wrong habit.

There are sub-conscious habits, of course, which we cannot "see" without a training.

jamesbritt2• 14 years ago

How is a neurochemical imbalance a wrong habit?

dschiptsov5• 14 years ago

It is an effect, usually of flawed behavior. It is not hard-wired or even inherited.

One might have some genetic predisposition, say, a sensitive Amigdala or whatever it is, but even then it is possible to behave in such way that you will keep the level of arousal very low.

It doesn't mean you will not get aroused quickly, it means you will not stay in a permanent overload of stress hormones, but return to a calm and relaxed state very quickly.

Unless you have any organic damages or trauma or infection, your mental states and habitual emotional patterns could be successfully altered.

wavesounds• 14 years ago

"All the medicated geniuses"

lnanek2• 14 years ago

I wouldn't be surprised if he loses his license for saying this. I've seen other doctors lose theirs for prescribing it too much. The government is really strict on this one, even mandating production limits.

ernesth• 14 years ago

I have already seen this Simpson episode http://simpsons.wikia.com/wiki/Brothers_Little_Helper

Since 1999, the name of the drug was changed but the debate seems exactly the same.

guard-of-terra4• 14 years ago

I see the main problem of said pills in the following: Schools are boring, horrible and pointless experience. But if you're drugged enough you may just ignore that and happily buzz along like a zombie. Which in turn will lead you to not becoming angry with this crap, and not using yourself to change schools in the future.

Drugs for children seem to breed conformists. And conformism is bad because it ignores problems until they overhelm and crush the society.

susanhi• 14 years ago

Some of the more hazardous side effects of adderall: • Dangerous increase in blood pressure • Tachycardia or a high pulse rate • Irregular heart rate • Difficulty breathing • Chest pain • Allergic reaction that includes swelling and redness in the eyes or throat • Migraine headaches • Syncope or losing consciousness • Blurry or double vision • Seizure activity and excessive and uncontrollable shaking • Extreme nervousness and paranoid delusions • Mood swings that include hostility and severe aggression • Depression

tdfx• 14 years ago

Also note that during college I was a 6'2, 210lb guy who experienced these effects from adderall with as low as a 10mg dosage. Some kids are prescribed 2-3 times that amount. Luckily for me, I decided it wasn't worth the side effects and I'd rather deal with any attention problems on my own. I feel sorry for the kids who never had the choice.

throwaway9549• 14 years ago

I've lived my whole life with untreated ADHD, and experienced issues all across life because of it, not just work or school. It took many months to get the proper treatment for it (i.e. medications), and perhaps it's a good thing it's that difficult.

But if I encounter anyone who has the "everyone has trouble focusing" crab mentality that I've had told to me, even by psychiatrists themselves, I'll punch them square in the jaw.

sebastianmarr• 14 years ago

I find it interesting to what lengths parents go to improve their children's grades. The fact that grades indeed go up after taking those pills just make this worse: people believe to see "measurable" success.

“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid." - To me that is the gist of the article. We failed to provide an enjoyable learning experience for kids, so we have to make them enjoy it.

smegel• 14 years ago

Or we just switch off the bits inside them that yearn for enjoyment in the first place. Our kids are either academic robots or suffering from a disorder of being human, and thus imperfect.

spodek• 14 years ago

I know techy types who like technological solutions and probably felt they benefited from using such drugs are overrepresented on this site, but did no one else register the defeatist, victimhood justifications for using the drugs?

Trying to solve a social problem with technology misses the point. I highlight these two quotes:

From the article: “I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

We have to modify the kid???

Also from the article: “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

the only tool???

Modifying human beings because we have no alternative? If you ask me, the side effects of this approach are not just the potential side effects of the drug on the individual, but complacency in not addressing the problems' causes, creating dependency of a social class on a drug, teaching children to take drugs to solve problems, creating a belief we have no alternatives, perpetuating a system that bores children and punishing them for their boredom, and so on.

Does nobody else wonder what other unintended consequences such a policy might create, independent of the drugs' safety or not?

icegreentea• 14 years ago

This is kind of reflective of health care in general actually. The system in use (this isn't just the United States by the way, it's most of the Western world) is that we live in some state of 'healthiness' for most of our lives, where we do not interact regularly with health professionals (not just doctors) - except perhaps a pharmacist to fill some regular prescription.

Our interactions are clustered -after- we are deamed unhealthy. Only once the need is most urgent do try to become 'healthy' again. This predictably leads to a culture that favours drugs and surgery as solutions. This is so engrained that health care practically IS synonymous with drugs and surgery. This bias exists in everyone, from the health care professionals, to those who are sick, to those to who are healthy, to those who would lead us. We all have it.

The 'unintended consequences' of such a policy are the problems facing nearly all 1st world health care systems. Surging costs, potentially unsustainable growth, constant doubts of effectiveness (and actual questionable effectiveness in some areas), and in general, a culture that more or less treats staying healthy as a bang-bang control system.

Attention Disorder or Not, Pills to Help in School

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