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Controlling ADHD with drugs is at the center of attention

Friday, April 2, 2004 | 12:00 a.m. CST; updated 10:06 p.m. CDT, Thursday, July 17, 2008

Of the approximately 6 million Americans diagnosed with attention-deficit hyperactivity disorder, three live in Geoff Lanham’s Columbia home.

Lanham’s son, Jordan, 15, was diagnosed with ADHD seven years ago, after his school suggested that Jordan be evaluated. As a second-grader, Jordan was having a hard time staying on task with an increase in self-regulated activities and desk work.

“We got a call from the school that said he was not staying on task, getting up, bouncing back and forth, assignments weren’t quite being completed like they should be, that kind of thing,” Lanham said.

Both Lanham and his son noticed a difference after Jordan started taking Concerta, a prescription drug for treating ADHD.

“I’m definitely concentrating better,” Jordan said.

Through the process of Jordan’s diagnosis, Lanham recognized that the troubles doctors identified in his son were the same difficulties he had endured during childhood. Four years ago, he was diagnosed with ADHD as well.

Later, another son, Grant, 7, was also diagnosed .

Multiple family members with ADHD are not uncommon, according to psychiatrist Jyotsna Nair.

“It is one of the few disorders which is highly clustered in families,” she said.

Often, parents don’t recognize the symptoms in themselves because they don’t know the disorder can affect adults.

[photo]

Pam Lanham carries Grant before giving him his daily dose of Concerta. (CHRIS DETRICK/Missourian)

The American Psychiatric Association defines ADHD as a disorder manifested in symptoms of inattentiveness and hyperactive or impulsive behavior. While the average child typically gets distracted or wound up, children diagnosed with ADHD exhibit such behavior all the time, and it interferes with their daily lives.

Until 1980, the disorder was also called attention-deficit disorder, but while the term ADD is still used, it is no longer the officially recognized name.

Ellen Horwitz, a child psychologist who works with Nair as co-director of the ADHD Clinic, uses the American Psychiatric Association’s standards to diagnose children with ADHD. If these guidelines are strictly followed, the chance of misdiagnosing a child should be limited, she said.

Delicate diagnoses

A major concern behind diagnosing children with disorder is that there is no physical or clinical test that can be done to aid the diagnosis. There are no blood tests or brain scans to detect ADHD.

“There have been no imaging studies that have been done in children,” Nair said. “But in adults, recently, there have been reports on imaging studies that were done. And adults with ADHD have lower dopamine.”

Some children with ADHD will continue to experience symptoms into adulthood, resulting in a belated diagnosis like Lanham’s.

Treatment for ADHD often involves medication with stimulants such as Ritalin, Concerta and Adderall. Ritalin and Concerta contain a drug called methylphenidate, while Adderall contains amphetamines. Both these substances increase dopamine transmission in the brain.

Dopamine is a chemical in the brain that gives people a sense of well-being and also affects motion. Drugs like methylphenidate, the active ingredient in Ritalin, are thought to work by increasing dopamine transmission in the brain. Substances that tinker with dopamine levels have the potential to be addictive because of the feelings of pleasure they can produce. The most notorious drug to influence dopamine is cocaine.

[photo]

Grant Lanham’s mother, Pam, attempts to fix his hair while he plays on their computer. Grant has been on medication for attention-deficit hyperactivity disorder since he was 4 years old. Grant’s brother and father have also been diagnosed with the disorder. (CHRIS DETRICK/Missourian)

Because of their ability to influence dopamine transmission, methylphenidate and amphetamines are listed by the Drug Enforcement Agency as Schedule 2 drugs, meaning they have accepted medical uses, but also have a high risk for abuse.

“People will always find ways and means of modifying everything that’s available,” Nair said. “If they want to be addicted to it or want to abuse it, that will always happen. Individuals are very imaginative.”

Opponents of medicating children with symptoms of ADHD often point out the similarities between how cocaine and Ritalin affect the brain.

The Citizens Commission for Human Rights, a watchdog group founded by the Church of Scientology, is one organization that claims the medications prescribed for children with ADHD are too strong and that doctors and psychiatrists are manipulating patients into taking drugs for the disorder.

“There’s no biological proof to substantiate the disorder,” CCHR Vice President Marla Filidei said.

“When you get to ADHD, we’re the most vocal opponent of the use of psychiatric drugs,” she said. “No one is arguing against a parent’s right to choose what they feel is best for their child. It’s not a situation of saying a parent doesn’t have a right to choose. But they can only make an educated choice if they’re given all the information.”Filidei listed several different reasons why children might exhibit symptoms that could be diagnosed or mis-diagnosed as ADHD. Poor education is a problem. Many children who are diagnosed with ADHD don’t have a mental problem—they just haven’t been taught basic skills such as how to read, she said.

In other situations, environmental problems such as lead poisoning from tainted water supplies could cause children to exhibit symptoms similar to learning disabilities. One of the commission’s greatest concerns is that parents are being pressured by schools or doctors to medicate their children.

Alternatives to medication?

There are theories and studies that diet can dramatically affect a child’s behavior. Parents can put their children on specialized diets to see if eliminating consumption of certain foods has an impact, but this can be a difficult tactic if the child is in school and suffering academically on a daily basis.

“If a parent really feels that that’s the way they want to go, then they can try the elimination diet and see if that changes things,” Horwitz said.

For children who are not yet in school, she recommends that parents try changes in parenting and behavioral intervention before medication.

Many organizations associated with ADHD, the most prominent being Children and Adults with Attention-Deficit/ Hyperactivity Disorder, and the National Information Center for Children and Youth with Disabilities advocate behavior management as an alternative or addition to medication.

Opponents of prescription medication for children who exhibit ADHD-like behavior often cite pressure from school teachers and counselors as one reason children are put on medication. Legally, school districts cannot require children to take medication for ADHD, but CCHR documents many claims from parents who say they were pressured to put their children on drugs.

Lanham admitted he didn’t know much about the medications for ADHD when his first son was diagnosed, and it made the decision to medicate all the more difficult.

“As a parent, when anyone says anything about your kids, it’s an automatic mechanism that comes up, a defensive mechanism, that there’s nothing wrong with my child,” he said. “I tried to do as much research as I could about the medications and the side effects.”

Now, he is confident that without the medication, his children would not be able to reach their full potential in school.

“The most important thing for my children is to have a positive experience in an educational setting,” he said. “I know there’s no miracle drug that’s going to wipe everything away and suddenly you’re going to be able to focus...but it does help. I don’t know what our worlds would be like without it, to be perfectly honest.”


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