Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds

http://www.nytimes.com/2014/05/17/us/among-experts-scrutiny-of-attention-disorder-diagnoses-in-2-and-3-year-olds.html

by zackmorris • 12 years ago

66 57 12 years ago

What could a 3 year old possibly have to focus on that they need to take amphetamines?

I'm imagining either a really intense game of peekaboo or the kid is Doogie Howser and having trouble with his MCATs at age 3.

mikevm4• 12 years ago

ADHD is a grossly mislabled condition. It should be more appropriately called "Executive function disorder"[1].

Kids who have the hyperactive "subtype" of ADHD tend to move non-stop to the point where they injure themselves, and they also don't seem to listen to their parents. I'm not sure how much of this behavior shows for 3 year olds though...

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

ctdonath• 12 years ago

tend to move non-stop to the point where they injure themselves, and they also don't seem to listen to their parents.

Sounds like a quintessential 3 year old.

chimeracoder4• 12 years ago

I agree with your statement that ADHD is a completely mislabled condition.

HOWEVER, "executive function disorder" is too general. Medically, it refers to a class of disorders that includes not just ADHD, but also Asperger's syndrome, Parkinson's disease, schizophrenia, and more[0].

I agree with your general sentiment; I just want to point out that we cannot use the term interchangeably, as many people who have executive function disorders do not have ADHD.

[0] https://en.wikipedia.org/wiki/Executive_dysfunction#Executiv...

jforman• 12 years ago

My one year old moves constantly and injures herself unless we hover non-stop. I hear I was the same as an infant/toddler, and I'm sure I could get an ADHD diagnosis now as an adult. I would never consider medicating her even if this kept up for years, though — despite my hyperactivity I'm happy and operate just fine in society. When I got bored in chemistry and math classes as a kid and had trouble paying attention, they put me in advanced classes (or even let me do experiments in the back of the classroom during lecture), where I continued to learn effectively.

Sometimes when a human being and society are misaligned, the society should adapt rather than the human being.

ollysb2• 12 years ago

People did not evolve to politely sit still all day, the thought of medicating children to comply with our current sedentary habits (which are doing a good job of damaging our health) seems perverse to say the least...

pirateking• 12 years ago

"Look at little Johnny concentrate on his iPad. You know those great new user interfaces... easy enough for a baby! He has been so well behaved lately, maybe we can buy him some Candy Quest Coins as a treat? Oh, and don't forget his pills at noon."

D.A.R.E. - To keep kids OFF the streets (where they could engage in dangerous activities such as "play"), and to keep them ON drugs (where they are easy money).

aidenn03• 12 years ago

All issues with the article aside, it does seem like a poor idea to prescribe stimulants to a 3 year old for a disorder that is still hard to diagnose in early elementary school.

tthomas48• 12 years ago

This is one of the frightening thing about ADHD prescriptions. With children with ADHD the amphetamines are supposed to work as a depressant. If your kid is getting focus from the drugs they don't have ADHD. You have a kid on speed.

GHFigs• 12 years ago

Getting into Harvard.

bayesianhorse3• 12 years ago

There are certain children who even at this age are extremely uncontrollable. From the outside, this is mostly ascribed to bad parenting, like "What else could it be?"

Well, it turns out, these children often can't be helped by "good parenting" or non-pharmaceutical therapy. They are still destroying their homes, terrorizing their parents and peers. And even though they are the aggressors, they suffer immensely, let alone their parents.

Also, even in much milder cases it has been shown that beating or otherwise severely punishing children (emotionally might count, too), actually increases the behavioral problems in the long term. If ADHD medications helps these children to actually choose peacefulness, I'm not entirely against it.

RankingMember2• 12 years ago

There's a difference between methamphetamine and Adderall (mixed amphetamine salts). I say this because the host indicated that kids are primarily on methamphetamine. Meth can be prescribed legally, but I don't know anyone who's ever been prescribed it.

adamgravitis• 12 years ago

Methyl, not metham. Rather substantial difference.

mikevm4• 12 years ago

You're confusing methylphenidate (active ingredient in Ritalin/Concerta) and amphetamine salts which are used in the other family of stimulants such as Adderall, Vyvanse, etc...

awda• 12 years ago

Desoxyn is literally brand-name prescription methamphetamine.

skywhopper• 12 years ago

Please, don't take this very seriously, the guy oversimplifies and misrepresents ADHD symptoms, our environment, and treatments.

A few specific quibbles:

The article says it's not a "disorder", but a "disorder" in psychiatry-speak means "Any pattern of psychological or behavioral symptoms that causes an individual significant distress, impairs their ability to function in life, and/or significantly increases their risk of death, pain, disability, or loss of freedom." ADHD symptoms may not represent a disorder for every individual in every situation. It's fine to say "change the environment" but that's not always an option.

Not to mention the "hunter-gatherer vs farmer" dichotomy doesn't explain the rise of ADHD diagnoses in the last 20 years mostly in the US vs other western countries, which are just as rich and just as regimented.

The other issue I have is with Thom Hartmann's description of ADHD which focuses on distractability and hyperactivity, but those are just two of the most common of the many symptoms that make up ADHD.

Finally, the woman apparently is familiar with abusing Adderall herself. Speaking as someone who has ADHD and benefits from Adderall, I don't experience it as "crack". Nor have I found it remotely addictive. Certainly it's less addictive than caffeine.

The general points are fine (schools and workplaces in the US have issues of their own that encourage ADHD-like symptoms), but the details are wildly wrong.

wismer• 12 years ago

I second what you've said, as I've had the same experiences in dealing with it myself. Adderall is not crack, but other people may abuse it as such. People without the disorder.

mareofnight• 12 years ago

I'd imagine a lot of that increase has to do with fewer people going diagnosed, rather than more people having ADHD in the first place. People become more aware of the symptoms and realize they can get help, they're less scared of being called crazy, etc. Given how hard it is to tell mental conditions apart (I think I remember reading that somewhere around 40% of psychologists' diagnosis are later changed), there are probably some false diagnosis in there too, where the "true" diagnosis is something else that's less top-of-mind, or that hasn't been discovered yet, or is something other than mental disorder.

It's fine to say "change the environment" but that's not always an option. ^ good point.

hoggle3• 12 years ago

I've been suffering from ADHD all my life but only got diagnosed when I was 30. I still haven't taken any meds yet but a diagnosis alone in my childhood probably would have helped with preventing neurosis originating from a school-time worth of derogatory remarks by teachers like "you are a lazy, lazy boy" and "please be quiet, you are inferior anyways". Drugging kids (especially at the very low age of 2-3, no problems advancing in school yet etc) surely must be a function of the pharmaceutical industry trying to make money with overtly fearful parents ("Will my child be able to compete?").

It's all wrong.

On the general "over-diagnosis" of ADHD, my problematic social-darwinist opinion: I believe that especially in the US there might really be more people with ADHD brains (in the end leaving your continent to settle on a new one is still perceived as something bold to do in 2014 - think of how much more risky this must have felt over the first couple of centuries after the discovery of America).

I can also think of many reasons why people are willing to take medication these days - all of them probably boil down to being profoundly desperate. I remember my grandfather who died last year at age 90, he clearly had all the traits of severe ADHD but he also had a secretary (cue "Mad Men" generation) and so didn't need to manage all the minutiae himself and was very successful at his job at a big company fully capitalizing his creative/impulsive side. This is a luxury most people with ADHD don't have any more as we are expected to do a lot more different, often detail oriented little jobs in-between - so to be able to do a somewhat acceptable job with those kinds of tasks it drives people towards drugs like Adderall, Ritalin etc (I'm constantly abusing caffeine myself, it doesn't help much but again I'm desperate). I can't tell you how devastating it feels when people who don't understand our different wiring shout at you to "simply just fucking do it" when you are really, really trying hard to do just that. It's terrible and drives a lot of people towards alcohol and heavy drug addictions. I've read somewhere that a very high percentage of the jail population actually has ADHD.

dfc4• 12 years ago

To say that this social darwinist opinion is problematic is the under statement of the week on HN. How bold of a decision was immigration in light of the Irish Potato Famine or African Slave trade? Why was the decision to go to Australia less bold and less defining than deciding to go to America? It is also worth pointing out that America was discovered 10,000 years ago. Is that the discovery you were referring to?

JohnBooty3• 12 years ago

  I believe that especially in the US there might really be
  more people with ADHD brains (in the end leaving your 
  continent to settle on a new one is still perceived as 
  something bold to do in 2014 - think of how much more 
  risky this must have felt over the first couple of 
  centuries after the discovery of America)

I'd never thought of that before. Another possible reason for increased prevalence in the US is that we work more hours and have less vacation time than a lot of European countries, increasing the demands on our focus.

Also, just for solidarity's sake: I was also diagnosed in my 30s, and was called "lazy" (etc.) a lot when young. Bet we went through a lot of the same things.

drzaiusapelord• 12 years ago

It's fine to say "change the environment" but that's not always an option.

I think that's more up to the individual than the institution. My own story is a typical "I didn't know I had ADHD until it was too late," and I do wonder if I would have a better life if I just went straight into the workforce instead of spending a couple extra years trying to finish college and not realizing why its so hard for me. I even had a decent IT job in college, but thought it so shameful not to have a college degree that I quit to continue my studies and, of course, get deeper into debt. Maybe some personality types just don't work well in those environments. Insert typical "higher education isn't for everyone" debate here.

Not to mention the "hunter-gatherer vs farmer" dichotomy doesn't explain the rise of ADHD diagnoses in the last 20 years

Maybe because society has reached a point where we can discuss these things without the idea of punishment and without applying morality to it? ADHD kids in the past were beaten, called losers, call sinful, called stupid, etc. Society hit them as hard as it could, yet it didn't fix anything. We've moved away from that mode of thinking and realized that some kids just aren't going to grow out of it and its not their fault. The same way that Alzheimers has been part of the human condition for god knows how long yet we only "discovered" it 1906. Before that, we just thought it was part of getting old and didn't realize its actually separate from aging the same way ADHD is separate from being an energetic child.

Certainly it's less addictive than caffeine.

Getting off caffeine is trivial. Adderal withdrawal can be very serious for many people. I consider most ADHD meds to be pretty serious drugs. I don't think that's very controversial.

hoggle3• 12 years ago

I've got the exact same history in terms of my academic career and being a "job-out" but I keep wondering about all the cool research work people like us could be doing if they would actually be able to study with discipline? I can't study, never been able to without out-of-proportion-huge investments in time and energy - I can't even finish books I really like anymore without brutally "hacking" my ADHD induced distractability and mind-wandering.

chimeracoder4• 12 years ago

Getting off caffeine is trivial. Adderal withdrawal can be very serious for many people. I consider most ADHD meds to be pretty serious drugs. I don't think that's very controversial.

Caffeine withdrawal is no joke either. Getting off caffeine is not trivial, and "can be very serious for many people" as well.

Whether or not your statement is controversial, your implication is not pharmacologically correct, in the sense that caffeine and amphetamines are both comparably serious drugs. It is not very meaningful to compare the addictive potential of two substances, but to the extent that we can, the two are roughly the same[0].

Contrary to public perception, it is not correct to say that amphetamines are inherently "more serious" than caffeine; the means of ingestion, dosage, and (most importantly) the individual's personal biochemistry vary enough that you cannot compare those two drugs directly.

[0] The reason it is not a meaningful comparison is that the actual chemical compound is only one small factor that influence substance abuse and/or dependence. The means of ingestion alone is far more significant than the actual compound being ingested, which often surprises people to learn.

JohnBooty3• 12 years ago

  Getting off caffeine is trivial. Adderal withdrawal can
  be very serious for many people.

This is obviously anecdotal, but I've discontinued Adderall (by tapering my dosage to zero over the course of 3-4 days) on numerous occasions with zero withdrawal or side effects.

Quitting caffeine by the same method is quite a bit more difficult for me.

JohnBooty3• 12 years ago

  Speaking as someone who has ADHD and benefits from 
  Adderall, I don't experience it as "crack". Nor have I
  found it remotely addictive. Certainly it's less 
  addictive than caffeine.

Similar experiences. Adderall is definitely not pleasurable in the sense that something like cocaine or meth (I don't have experiences with them) seems to be pleasurable.

I find Adderall addictive in the sense that I'm severely "lagged" and sleepy if I discontinue it cold turkey. But, if I taper the dose to zero over 3-4 days, there is no problem.

lelf• 12 years ago

http://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis

https://en.wikipedia.org/wiki/ADHD#Genetics

EGreg• 12 years ago

Yet another reason to reform schools so that kids can actually learn instead of exhibit ADD while being told to sit still at a time in their lives when they love to run.

http://magarshak.com/blog/?p=158

ADHD is the "Hysteria" of the 21st century

http://en.m.wikipedia.org/wiki/Hysteria

mpg33• 12 years ago

Dr. Russell Barkley is one the world's leading experts on ADHD.

https://www.youtube.com/watch?v=KQC-Nk5OOfE

tlogan• 12 years ago

There are definitely kids with ADHD for whom medications definitely help. However, from my personal experience, it seems like it is a little "over diagnosed". But I could be wrong - this is just my very limited experience.

Are there any material (video or similar) showing how an average ADHD kid behaves today vs. 20 years ago?

aidenn03• 12 years ago

It is both over and under diagnosed. Teachers are likely to refer any highly disruptive kids for screenings, while ignoring less disruptive kids.

However, being disruptive isn't a particularly good proxy for "has ADHD" and someone without ADHD that is referred has a higher chance of being diagnoesd with ADHD than someone with that is not referred. This results in a lot of kids who end up being treated who shouldn't and plenty of kids who go untreated who could benefit.

aidenn03• 12 years ago

TLDR: The ability to store fat is an evolutionary adaption, therefore obesity isn't a problem.

tokenadult• 12 years ago

It doesn't look to me like an original source is the basis of the kind submission here. The byline is "New York Times," but this submission is not from the New York Times website.

The submitted article mentions a study published by the United States Centers for Disease Control and Prevention (CDC), and I see that the CDC has a homepage on ADHD[1] with numerous subpages.

Searching Google News for more news on the recent statement discovers stories[2] leading back to the 16 May 2014 report in the New York Times[3] mentioning statements by a CDC official at a recent conference (that is, not yet an official report from the CDC nor a peer-reviewed journal article). The conference presentation, according to the New York Times report, is alarming to many doctors who work with young children.

The bit about ADHD as an evolutionary adaptation is tacked on in reference to ideas from "Journalist Thom Hartmann," who doesn't seem to have any particular expertise in health reporting. There are better sources for the same underlying idea, that some of the behavioral signs characteristic of ADHD may not be maladaptive in all life circumstances.

[1] http://www.cdc.gov/ncbddd/adhd/index.html

[2] http://www.indianagazette.com/news/home-lifestyle/rise-in-ad...

http://www.the-leader.com/article/20140520/NEWS/305209955

[3] http://www.nytimes.com/2014/05/17/us/among-experts-scrutiny-...

obiefernandez• 12 years ago

sloppy, at best. the reporter lost me about a minute in when she said that ADHD medications were "methamphetamanine-based"

dang• 12 years ago

We changed the url from http://www.mediaroots.org/10000-toddlers-on-drugs-for-non-di..., which links to this.

dfc4• 12 years ago

When I went to go back and see if I could find a link to the actual CDC paper the NYT layout did not seem familiar; and then it occurred to me "I bet dang changed the link and I bet he took the additional time to let us know he changed the link." As always thank you for your transparency.

Scienz2• 12 years ago

Personal anecdote, since there are some comments here by people claiming an early ADHD diagnosis might have changed their life: I was "diagnosed" with ADHD about five years ago, at around age 25, and it was a horrible experience. I'm not sure if I have ADHD, but at the very least was very depressed at the time, and they gave me some self-evaluation asking a bunch of questions like, "Do you have trouble concentrating? Does your mind wander?" Of course being very depressed I tended to be pretty hard on myself answering, they gave me the diagnosis, and at the first sign I gave of skepticism about it they basically ridiculed and humiliated me, telling me I was in denial and nothing in my life would ever change unless I started taking medication. They completely ignored any other problems I was having and other possible explanations once they pinned the ADHD label on me. In a conversation that lasted an hour, I didn't get a single word in after making the comment, "Well I'm not really sure if I have this..."

A few years later I did try taking some Adderall, unofficially acquired from a friend, and in three days it caused me to start having all kinds of mental health problems (OCD and Tourette's type symptoms, fyi) that I'm still not fully recovered from. Admittedly I think I took a bit too high of a dosage, but I'm scared to even try again if only three days of something could basically turn me halfway insane. Maybe if I'd started on only a half dose it wouldn't have happened, but I'm worried about the fact that such people were trying so hard to push a drug that ended up having those kinds of effects in only three days from only a slightly elevated dosage.

So I definitely think this whole thing is a huge pharma scam at this point. I'd be highly skeptical of any ADHD diagnoses, especially when they're all based on self-reporting (notoriously unreliable) and a bunch of therapists, teachers, etc. who are quick to jump to whatever explanation fits with their prejudices about a person. It scares me that they're pushing these drugs on people, especially at such young ages, not to mention how it prevents the real underlying problems from being solved.

pavel_lishin• 12 years ago

I have to take your story with a big ol' bucket of salt, because you ignored medical professionals, and then tried to self-medicate with un-prescribed drugs of unknown dosage.

Scienz2• 12 years ago

Point taken - I may have ADHD or I may not, as I implied I don't really know, and the bad reaction to adderall obviously isn't universal. Though I'll also say the dosage wasn't unknown, and the professionals gave me extensive reasons not to trust them. Drugs don't affect you differently depending on who prescribed them, and the main point of the story was that I didn't trust these people to accurately diagnose or prescribe anything. If they won't even let me question them about their diagnosis, I wouldn't trust them to listen to me about my reactions and side effects either.

This is a controversial subject though, so I'm going to step out now. Just wanted to share the story of my negative experience with it.

bayesianhorse3• 12 years ago

You are describing symptoms of depression and some mild or severe psychotic symptoms, combined with the very risky and assertive decision of self-medicating.

A bipolar disorder would explain these symptoms. Also bipolar is a very common comorbidity of ADHD, with overlapping symptoms. At the very least, the social problems that come with ADHD predispose for bouts of depression.

Taking destabilizing drugs like Ritalin or Amphetamines is also known to trigger manic episodes or other psychosis. Which is one of many reasons why medical professionals won't tell you to start at the final dose for the first few weeks...

dfc4• 12 years ago

Does anyone have a link to the actual CDC paper? I found some ADHD publications from Dr. Visser but they do not seem like they are related to the material presented at the conference.

gojomo• 12 years ago

Does the idea that thousands of toddlers have been prescribed ADHD-drugs become more or less concerning, once you consider some of those prescriptions may be schemes to acquire pills for diversion to other, unprescribed older users/buyers?

marak830• 12 years ago

Do these people not understand that they are children? I work with 4 and 5 year olds 8 hours a day, there is no way you could tell an adhd child from one without, their still developing. In 3 months i have seen every child in my 24 class change how they act, talk and play.

They shouldnt have children.

Edit: 550am fat thumbed typing.

Im_Talking• 12 years ago

And yet cannabis oil, which is non-psychoactive and an effective treatment for a myriad of issues including ADHD is still illegal at the federal level.

bayesianhorse3• 12 years ago

This kind of ridiculing ADHD is down right dangerous. Children with untreated ADHD, even at a very young age, are at riks to suffer depression, bipolar disorder and bad social skills later on.

ADHD is a very tough condition to understand. The repercussions of deciding not to treat a child are severe and unequivocal. A child with untreated ADHD will be much less happy, much less social, much less successful (in every sense of the term) and less healthy than need be. Which is sort of the point of treating it.

Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds

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