Anderson 1 Trisha Anderson Professor Alicia Bolton English 101 10 April 2014

Medicinal Miracles or Over-Medicated Youth?

Raising children is a demanding job. As parents it is our responsibility to try our hardest to teach our children to grow, do their best, and thrive in life. If you are the parent or caregiver of a child with ADD (attention deficit disorder) or ADHD (attention deficit-hyperactivity disorder) this may take more work on your part but our children are the most important aspect of the future and they are worth the extra effort. In Attention Deficit Hyperactivity Disorder, a book by Russell A. Barkley, it is noted that the disorder was first referred to as Fidgety Phil in the poems of the German physician Heinrich Hoffman in 1865 (Barkley 3). Today, Attention-Deficit Hyperactivity Disorder (ADHD) is the number one childhood psychiatric disorder in the United States so this has become a concern for most of America. According to the Centers for Disease Control and Prevention 6.4 million U.S. children between the ages of 4 and 17, or about 11 percent of all school-aged children in the country, have received a diagnosis of ADHD (Perry). They go on to state that, 86 percent of children diagnosed with ADHD in the United States have only mild or moderate forms of the disorder and that less than 14 percent, of that 86 percent diagnosed, have severe ADHD (Perry). However, In the United States, about 87 percent of all children diagnosed with ADHD are prescribed a medication, mostly methylphenidates (such as Ritalin) and amphetamines (such as Adderall). Yet, as the authors of the BMJ (British Medical Journal) paper point out, these drugs were developed for the treatment of severe, not mild or moderate, symptoms.

Anderson 2 Children in America are being over diagnosed and over medicated for ADD and ADHD; while medicine is currently the primary treatment suggested for these disorders, it should be used as a last resort, only when all else fails. The Academy of Pediatrics (AAP) guidelines are discussed in an article from WebMD, stating that they recommend medicine be used in the treatment of American children to help control the main symptoms of ADHD, like hyperactivity, impulsivity, and inattention ("Attention Deficit Hyperactivity Disorder"). Most physicians, as recommended, do in fact prescribe medications to help control symptoms of ADD and ADHD in children. The number of American children diagnosed with these disorders has skyrocketed and along with it so have the number of drugs out their available to treat it. According to federal studies, the rate of Ritalin use in the United States is more than five times higher than it is in the rest of the world. Doctors have discovered that stimulants work somewhat like an antenna adjuster for children whose brains crackle with static interference, as if a dozen stations are coming in on one channel (Hancock 51). Children suffering from this disorder are usually very intelligent but they cannot easily focus on one idea to completion without many more ideas rushing around inside their head. Stimulants increase dopamine levels in the part of the brain where attention and impulsivity is regulated. It is discussed that in or around 1937 papers were written up on the treatment of hyperactive children marking the beginning of medication therapy for behaviorally disordered children that were hospitalized at the Emma Pendleton Bradley Home in Providence, Rhode Island. Positive drug responses came back in half or more hyperactive children that were hospitalized. As a result, by the 1970s stimulant medication had become the treatment of choice for the characteristics of ADHD and so they remain today (Barkley 7). In Hancocks article is a story about a day in the life of a man named Mark Wagener, a principal at Winnebago Elementary School in the middleclass Chicago suburb of Bloomingdale, who stated,

Anderson 3 For some students, Ritalin can make the crucial difference between failing a test or sitting still long enough to pass it. Dr. Laurence Greenhill of Columbia University medical school states Pharmaceutically speaking, Ritalin is one of the raving successes in psychiatry,a pill that allows children to focus their minds and rein in their rampaging attention spans (Hancock 50). Many agree that stimulants can be a blessing but only for those who really need it. Although the medications used to treat ADD and ADHD are effective in helping children focus in a majority of cases, they are often over prescribed and come with a variety of risks. Of the three distinctive signals of ADHD: inattention, impulsivity and hyperactivity, all can be part of normal child development. Many ordinary children get off track, lose focus, do impulsive things, and even bounce off the walls from time to time. So how can doctors tell enough about a child to diagnose them with this disorder after spending just a few minutes with them? "Parents need to make sure their child has a full evaluation before the first pill is put in their child's mouth," says Dr. Stanley Greenspan, psychiatrist and author of "The Challenging Child" (Hancock 52). The problem, according to Frank Barnhill, MD in his book, Mistaken for ADHD, is that many doctors will make the assessment for ADHD and prescribe medication often in one visit, sometimes without even seeing the child (Staikova). Sometimes children dont even get a proper evaluation; according to the author, many parents take their children to a doctor and the doctor will ask some routine questions and then prescribe the child medication. The authors of the BMJ paper note that teacher and parent expectations of academic achievements in children diagnosed are often significantly lower and that children diagnosed with ADHD are said to be at a greater risk of being stigmatized and socially excluded by their peers as well as many supervising adults. The widening of the definition of attention deficit hyperactivity disorder (ADHD) has led to an over diagnosis of the condition, causing many people, especially children, to receive needless and

Anderson 4 potentially harmful medical treatment, according to a research analysis published in the journal BMJ (British Medical Journal) (Perry). The drugs prescribed are powerful, and Ritalin is one that the U.S. Drug Enforcement Administration has listed as a Schedule II controlled substance. It is in the same category as methadone, methamphetamine and cocaine. "Despite extensive research into factors contributing to ADHD etiology, we are no closer to understanding the cause or causes of this disorder," conclude the BMJ authors (Perry). ADHD is a disorder that is most commonly diagnosed in early childhood. Side effects of the medications vary in all children however preschoolers often have the strongest side effects. The most common of these symptoms are loss of appetite, insomnia, mood swings, irritability, headache, low self-confidence, and upper abdominal pain. However there are some side effects that are much more serious such as depression, suicidal thoughts/tendencies, anxiety disorders, and antisocial personality disorder which could dangerously affect them into adulthood. It is also feared that potential long-term effects, from stimulant drugs that may arise, on the heart and brain of developing children, as well as liver toxicity. While the medications being prescribed do help alleviate some of the symptoms a child experiences from these disorders, in most cases, many believe that the risks outweigh the benefits. Many experts believe that cognitive behavioral therapy (CBT) and social skills training are very effective in treating ADHD on a long-term basis when used alone or in combination with medication. It is a systematic approach designed for children, parents and teachers to promote change in behavioral problems that is especially effective with younger children. In this therapy, children learn a set of rules about their specific behavior and actions as well as a special learning strategy to self-improve from. They speak to councilors that specialize in the individual problems they are experiencing. At the same time, the patient's parents are taught certain skills necessary to fulfill the therapy at home. Researchers say that some parents, embarrassed by their difficulties in socializing their offspring, are relieved to be informed that the problem they face is a medical one. Within schools, there is also a noticeable demand for a medical diagnosis for the naughty child. Tackling unruly classroom behavior through popping a pill

Anderson 5 is an option that some institutions prefer to the exercise of authoritative teaching (Furedi 16). Every child is different but good parenting and teaching skills are the first step to raising happy, healthy, welladjusted children weather they have a disorder or not. Those who use praise and positive reinforcement for good behavior and have consistent consequences for bad behavior give children security and show them love while teaching them to manage any social or behavioral problems. Too often we look for a quick easy fix to problems which can be fine in some instances but not when it poses a risk to our children. ADHD experts now say, Most children need behavior-modification therapy and special help in school but most of the surveyed pediatricians said they rarely recommend anything more than pills. A lot of doctors," says Dr. F. Xavier Castellanos, an ADHD researcher at NIMH, "are lulled into complacency (Hancock 51). There have been many studies conducted in regards to behavior modification, one that got much attention, is The Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA). This psychosocial or behavioral treatment study was designed to examine treatment response of children randomly assigned to routinetreatments provided by the study, which included medication (methylphenidate [MPH]) management, psychosocial (behavioral) treatment, or the combination of the two Results of the MTA 6-year follow up reported that participants who received behavioral treatment had lower rates of depression and anxiety compared to those in the medication management, combined treatment, or community care groups. Altogether, preadolescent treatment resulted in what the investigators described as pro-depressant changes in behavior that persisted into adulthood (Staikova). Anxiety and depression are very common disorders for children with ADD and ADHD. Behavior treatment can teach self-control and give a boost in self-confidence. Furedi agrees when he writes,

Anderson 6 What kids need from adults is not a diagnosis but guidance, inspiration and understanding (Furedi 16). In this article, the author contends that "society has become increasingly drawn towards using medication as a substitute for authoritative teaching and child-rearing (Furedi 16). Too often children get attention when being bad although it is said to be more effective to ignore this behavior if possible. Focusing on good behavior helps children learn what behavior is and is not acceptable and eventually teaches them to develop awareness of their own actions without the assistance of others. Some experts believe that behavioral therapy for children, parents, and teachers should be used for all children but is especially effective for children diagnosed with ADD and ADHD. Additionally, physical activity is another alternate treatment to use rather than medication to lesson ADHD symptoms in children. Children need to run and play. If they are energetic or even a little hyper, why not put them into sports and/or extracurricular activities, or simply bring them outside to play every day, as often as possible, to help them to release some of these restless feelings. Scientists have found that being outdoors in a natural setting improves people's ability to concentrate and perform mental tasks. Using this knowledge, researchers at the University of Illinois at Urbana-Champaign conducted a study in 2007 to see whether spending time outdoors impacts ADHD symptoms. University researchers had the parents of 406 children with ADHD track their children's weekend and after-school activities and how these activities affected the children's behavior. When the children spent time indoors, their symptoms did not improve. When the children spent time in a natural setting, however, they were less restless and better able to focus their attention, complete tasks, and follow directions. In many cases, the children also slept better at night (Diseases and Disorders: ADHD 48).

Anderson 7 Children with ADD and ADHD are at times unable to sit still for long periods of time so outdoor play and activities are very effective solutions in helping kids use up that energy. Most children are known to be full of energy so making sure they all receive proper exercise daily is a great ulterior to medication and it is healthy for everyone anyway. A childs diet can also affect the severity of symptoms experienced in patients with ADD or ADHD and sometimes a few simple changes can omit the need for medication. Omega-3 fatty acid for instance is a healthy fat that strengthens the immune system and appears to have a positive effect on ADHD symptoms. It increases blood flow to the brain. It is found in foods like fish, nuts, and dark leafy vegetables. A number of studies show that children with ADHD have lower-than-normal levels of omega-3 fatty acid in their bloodstreams. In a 2007 University of South Australia study, 103 children with ADHD were given either an omega-3 fatty acid supplement or a placebo every day for fifteen weeks. All the children were rated on the Connors' Ratings Scale at the start of the study and again after fifteen weeks. Researchers found that after fifteen weeks the scores of the omega-3 fatty acid group improved in impulsivity, inattention, hyperactivity, and social interaction. In comparison, there was no change in the control group's scores. Both groups were then given omega-3 fatty acid plus a multiple vitamin for an additional fifteen weeks. Once again, all the children were rated on the Connors' Rating Scale. This time every child's scores had improved to such a degree that the researchers concluded that treating ADHD with omega-3 fatty acid is just as effective as Ritalin (Diseases and Disorders: ADHD 50). Adding more iron rich foods to their diet also helps to regulate the flow of dopamine in the brain. Eating certain foods and cutting back on others appear to help control ADHD symptoms. Some foods break

Anderson 8 down quickly in the body and create quick bursts of energy, which can intensify hyperactivity. Many things we consume cause spikes in blood sugar followed by rapid drops. This lowers concentration and worsens inattention. Complex carbohydrates do not cause blood sugar to surge and are a better choice. Many people with ADHD say that eating a protein-rich diet increases their ability to concentrate and decreases restlessness. Meats, eggs, beans, and nuts, are all good protein sources. All described diet choices are again healthy for most people anyway and are much safer substitutes for medicating. In conclusion, parents, doctors, therapists and teachers need to explore as many options as possible before trying medicine. With medication being the first line of defense used to treat this ever growing problem something has to change. With behavioral training, proper exercise, and healthier diets we may not need to medicate our children. We need to work together to help our youth overcome these issues, choosing medications only after all other diagnostic possibilities and treatment options have been exhausted.

Anderson 9 Works Cited "Attention Deficit Hyperactivity Disorder (ADHD) - Medications." attention-deficit-hyperactivity-disorder-adhd-medications. WebMD, 2005. Web. 7 Apr. 2014. <http://www.webmd.com/add-adhd/tc/ attention-deficit-hyperactivity-disorder-adhd-medications>. Barkley, Russell A. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Second ed. New York: Guilford Press, n.d. Print. Diseases and Disorders: ADHD. Detroit: Lucent Books, 2010. Horry-GeorgetownTechnical College Library. Web. 7 Apr. 2014. Furedi, Frank. "Kids Don't Need Pills, They Need Parenting Source." The Independent [London] 14 Aug. 2013: 16. SIRS Issues Researcher. Web. 7 Apr. 2014. Halperin, Jeffrey M., et al. "Childhood stimulant treatment and teen depression: is there a relationship?" Journal of Child and Adolescent Psychopharmacology 20.5 (2010): 387+. Health Reference Center Academic. Web. 8 Apr. 2014. Hancock, LynNell. "Mother's Little Helper." Newsweek 18 Mar. 1996: 50-56. SIRS Issues Researcher. Web. 7 Apr. 2014. Perry, Susan. "ADHD Is Overdiagnosed, Leading to Needless and Harmful Treatment." SIRS Issues Researcher. MinnPost.com, 7 Nov. 2013. Web. 7 Apr. 2014.

Anderson 10 "Treating ADHD Without Drugs: Doctors Give Their Views." Internet Wire 5 Oct. 2007. Health Reference Center Academic. Web. 8 Apr. 2014.