Are Doctors Over-Diagnosing Stimulant Medication To Children Essay, Research Paper

A new epidemic has hit our society and it seems to be effecting nearly all of our children. Many adults seem to also be suffering from the same disorder . Doctors are giving out prescriptions to try and control those suffering from this elusive and confusing condition. Arguments are abundant in the medical field over the cause. What is the cause behind the disorder ? That is yet another point to argue. No one knows the answers for sure, but everyone has an opinion. The primary point of concern is whether or not doctors are over-prescribing and over-medicating the children that they are responsible for treating.

The new epidemic that is flooding the medical profession, is known as Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, also known as ADD/ADHD. According to the medical professionals three to five percent, some say eight to twelve percent, of all U.S. school aged children could easily be diagnosed as ADD or ADHD. There are two different types of ADD, the first type is ADD with hyperactivity and impulsivity as the main characteristics (ADD/H), and the second type is ADD with inattention as the primary characteristic (ADD). The two types can combine together and form one final type known as ADHD, with this type inattention, hyperactivity, and impulsivity all occur within the individual. People all have different ideas on how to deal with this condition. Unfortunately no one can agree on which way is the correct way. Doctors are handling this epidemic with their prescription pads. Prescriptions for Ritalin, Adderall, and Dexedrine are being written at an alarming rate. It is estimated that at this time ten percent of boys in our schools now are taking Ritalin.

Doctors are prescribing stimulant medication at an all time high now to control what they, parents, or teachers perceive as an unruly child. Statistics are mind-boggling. In 1990, 750,000 children were diagnosed with Attention Deficit Hyperactive Disorder. Today, there are more than 4 million. Ciba-Geigy, the company that manufactures Ritalin, attributes the surge in ADD/ADHD to “heightened public awareness.” Yet some critics compare the increase to an epidemic and claim that parents, teachers, and doctors are over-diagnosing, misdiagnosing and therefore drugging spirited and creative young children. (Andrews) Where did this disorder come from?

This is not a new disorder; it was identified in medical literature more than 100 years ago. The characteristics of this disorder have also been recognized and described in educational literature and research for decades. A popular German tale from the early 1900 s (Hoffmann’s Struwwelpeter) written in rhyme for children, portrays a child with ADHD. This shows us that for at least the last 100 years there have probably been ADD/ADHD individuals. In the early 1900 s, when documentation of the disorder began, those who exhibited the signs we know today, were considered amoral. In the 1920 s and 1930 s the individuals were considered learning disabled. That was a label that lasted for many years. In the 1970 s the word Hyperactive emerged. Finally, in the 1980 s the term ADD became the official diagnoses. (Wykoff ) It is interesting to note that the behavior of the people didn t change, just the label that was applied to them. Even with the change in terms used to describe the condition , the rate of diagnoses increased only slightly. In the early 1990 s the explosion of ADD/ADHD individuals and the diagnoses of the condition hit at an extremely alarming rate. ADD cannot be fixed or cured, and sometimes it is not outgrown. So many times this leads to a lifelong struggle of self-control problems and often a prescription of medicine that will follow them through life.

The ADD child is the child who is constantly moving, shaking a foot, bouncing a leg, or drumming their fingers. Also these children tend to not be able to stay on task for any length of time or stay seated. Several terms are repeatedly used to describe ADDers these include: poor, diminished, low, impaired, difficult, interruptive, resistant, aggressive, & erratic. Still more are poor attention, boredom, low tolerance, judgment lags behind, intensity may lead to power struggles with authorities, high activity level, & questioning of rules. The interesting thing is that these are often the same rules used to describe giftedness. Dr. Ned Hallowell, an adult and child psychiatrist at Harvard Medical School, has written several books on ADD. He states “ADDers are highly imaginative and intuitive. They have a feel for things, a way of seeing right to the

heart of matters, while others have to reason their way along methodically. This is the child who, having been reprimanded for blurting out something, is then praised for having blurted out something brilliant.” He goes on to say that These people can feel a lot. In places where most of us are blind, they can, if not see the light, at least feel the light, and can produce answers apparently out of the dark.” It has been said that ADDers have a sixth, seventh, or even an eighth sense that sets them apart from others. Boys seem to outnumber girls on being diagnosed with this disorder. One sign a boy may exhibit is aggression, the tendency to fight, and repeatedly get angry. A propensity for violence seems to accompany many boys. Girls, on the other hand, are more social, the center of attention, the talkers. These are not traits that someone would seek medical treatment for. Perhaps behavior modification could be attempted, before prescribing a medicine, which, as stated earlier, for some children, will have to accompany them through life.

Although it is usually the negative aspects of ADD that are focused upon, there are positive traits that accompany the

disorder. These can include creativity, hardwork, high energy, resourceful, warm-hearted, loyal, sensitive, trusting, forgiving, fun, observant, down-to-earth, responsive to positive reinforcement, & a stand-up comic. There are several famous American historians who can be linked to ADD. Thomas Edison could easily be the ADD Poster Child. Thomas Alvin Edison is cited more often than any other historical figure for exhibiting classic hyperactive ADD behavior. ADD and divergent thinking styles have even been dubbed “The Edison Trait.” Ben Franklin the father of electricity is another historic figure who exhibited signs of ADD. Although these two men were not officially diagnosed, they did exhibit all the symptoms or traits of ADD. Current famous people who have been diagnosed are Robin William and Whoopi Goldberg. All of these well-known individuals have done extremely well in life. We all enjoy their inventions, comedy and humor.

Why must medicine be used to control these children? At times the medicine is beneficial for the aggressive child. If a child is unable to control threatening or dangerous behavior then they may require the medicine to give them the opportunity to stop and think before they act. However, if we compare the overactive child to other types of children is the treatment the same? If a child shows signs of a learning disability we don t look for a medicine to fix that. What if they are shy, or unsociable? We don t give medicine for those either. If a child is extremely violent or aggressive, then yes, if all other methods have been tried, then try medicine. This should be the last resort, not the first or second.

There are many things that can be tried before medication, such as a behavioral modification program. This includes counseling, structure of time and school, positive feedback, family negotiations, internal structure, easing the child into transitions, to assist the child in dealing with peers and peer conflicts, temper control and building self-esteem (this is the longest and most difficult part of treatment). A point system, used at school, with awards at the end of the day may be a possible modification also. Counseling should be offered to the child and their family. Having a child and their family talk out their problems with someone who can guide them through proper actions and reactions often proves to be one of the best treatments available. Many times teaching a child social skills, just the basics, how to resolve conflict and arrive at a solution that is non-violent can also help. Pre-intervention by both parents and school personnel can be beneficial, this is done in the classroom or at home, simply put this requires trying different methods of working with the child, and seeing if the response given is better or worse. Take the child s history to the team members of their school, maybe they will qualify for testing, which in turn qualifies them for an Individual Education Plan (IEP). After trying some, or all of these, if none seem to work, then see a doctor. If a medicine is prescribed, be sure that it is administered exactly as it is supposed to be.

Ritalin, Cylert, & Dexedrine are stimulants that are thought to stimulate the under stimulated brain chemicals, or neurotransmitters, which allow the individual to focus, learn, sit still and concentrate. When the medication is used effectively and the diagnosis is correct, these medications will work 80 percent of the time and not all children will need to take the medication for life. (Wykloff) Often times ADD/ADHD is outgrown in puberty. Until that time comes, if it does, the child will have to be treated as normally as possible. This means being held responsible for their actions.

Studies have shown that as many as 65 percent of children with ADHD will have one or more co-morbid (accompanying) conditions at some point in their life. Bipolar disorder, Tourette syndrome, and learning disorders are among the conditions that commonly co-occur with ADHD. The presence of ADHD at any age was found to increase the risk of behavioral and emotional problems. In fact, “one study suggested that 10 to 20 percent of children with ADHD developed mood disorders, and 20 percent developed conduct disorders. (Horan, 20) ADD is not the cause of the accompanying disorder but it may make the symptoms more noticeable, in a child that is already coping with so much.

Over the years many theories have circulated as to what causes ADD. At one time it was assumed that poor parenting caused children to exhibit the signs associated with the disorder. Parents stricken with guilt blamed themselves for everything that their child did that was perceived as wrong, or any problems that their child had. Today, scientists believe that ADD is inherited and passed through families. Another theory is that it is a neurotransmitter deficiency. (Dendy, 10) Researchers also believe that chemicals in the brain, which are not working properly, cause ADD. Still more theories say that there may be a thyroid dysfunction, the brain may not metabolize glucose properly (at a rate less than normal), or toxins may have affected the fetus. Some say trauma after birth to the brain, or infections, premature birth or low birth rate appear to be a common link in most of those diagnosed.

Some skeptics still claim however, that the rise is due to both parents working outside the home and ignoring the children, or parents are not properly disciplining the children. One expert, such as Dr. Phelan, has a different explanation. “The increase is primarily due to public awareness. There is no more ADHD than there used to be,” he said, “the ADHD number hasn’t increased. It’s always been there. It’s just more public awareness. (Andrews) Dr. Lawrence Diller states that in 1975 he might have had a dozen cases of ADD a year. However, from the early 1990 s to the present day he has had hundreds of cases every year. (Diller, 6) Being diagnosed with ADD use to have a negative connotation, and be a point that the parents’ would argue and not admit. Now parents seem to hope that if their child is experiencing problems, an ADD/ADHD diagnosis will be arrived upon. Parents use to not want to give their sons and daughters a stimulant medicine to control behavior, the fears of the side effects scared them, now it is easily prescribed and accepted with little to no argument at all.

Why do parents seem to be more accepting of the diagnosis today? Some parents are aware that having ADD can qualify as a disability, suggests Diller, allowing a child to have unlimited time to take the SAT, for instance. That “has changed ADD from a stigma to a potentially ‘desired’ diagnosis.” Professionals report that it has become fashionable, especially among teenagers or their parents, to blame ADD for what may simply be negligent performance. (Dendy, 25) Behavioral pediatrician Lawrence H. Diller expresses concern about the phenomenon, even as he continues to prescribe it. Ritalin is given to children with a variety of symptoms — from aggressiveness on the playground to day dreaming in class. Primary care providers like it, because it is cheaper to prescribe than other treatment alternatives, such as counseling. The United States uses 90 percent of the world’s supply of Ritalin, and use and production is up by 700 percent since 1991. About 75 percent of the drugs are used on children. Nearly five million children and adults are diagnosed with ADD, and some experts say 10 percent of children have it. If all of those children took Ritalin, 1 in 6 boy s ages 5 to 12 would use the drug. Whether kids meet the criteria for a diagnosis of ADD, treatment with Ritalin doesn’t address the larger issues families face, says Diller, such as the high pressure put on children, even in kindergarten, and households with two working parents, which requires more preschoolers to be put in day care. (Diller 15)

Ritalin, Cylert, Dexedrine, and Adderall are the most common drugs used for treatment of ADD. Our children take them daily in school and at home to help cure, or fix their behavior difficulties. Our society is in for the quick fix, an easy answer; the ability to solve a problem and move on, that is what we look for. What does not seem to be understood is, do we want this at the expense of our children s health and mental well being? There have been studies conducted that state the effects of long term stimulant use can be harmful. Of course, to refute these studies, others have said that there are no long-term effects. Perhaps in the beginning of treatment, growth will slow down, but eventually after a period of three to six months; the child will again begin to grow at a normal rate. It should also be noted that untreated ADD/ADHD children tend to grow and develop at a slower rate anyway. Usually they will be smaller as children, and then grow more quickly and catch up to their peers, during later adolescence. ADHD is not found just in children. We have learned from a number of excellent follow-up studies conducted over the past few decades that ADHD often lasts a lifetime. Over 70% of children diagnosed as having ADHD will continue to manifest the full clinical syndrome in adolescence, and 15-50% will continue to manifest the full clinical syndrome in adulthood. If untreated, individuals with ADHD may develop a variety of secondary problems as they move through life, including depression, anxiety, substance abuse, academic failure, vocational problems, marital discord, and emotional distress. If properly treated, most individuals with ADHD live productive lives and cope reasonably well with their symptoms. (Phelan, 1998)

For an individual to get diagnosed with ADD/ADHD there are several steps that need to be taken, the first is visiting a doctor. There is an evaluation, review of past and present history, prenatal record, birth information, allergy testing (for some), school teacher evaluations and class history, test for teaming disabilities, family history, physical and in most cases, blood work. (Chadd) Testing for an adult is different than the testing of a child. Psychiatrists, Psychologists, Pediatricians, Doctors, & Neurologists can all diagnose ADD/ADHD however, not all these doctors are able to prescribe medicine, counsel, and follow the individual throughout their treatment. Primary Care Physicians, will write a referral for a patient, so they can get the medical help needed from the doctor that is best able to help them.

Many times arriving at the decision to be tested or to have your child tested is not easy. There is such a stigma attached to being labeled ADD or ADHD that some people are scared of what will happen if they are diagnosed. Do employers have to know? What about telling my child s school? Why do I have to go see a psychologist, I m not crazy? I know, all to well, what all this confusion and fear feels like. In December 1999 I was given the diagnoses of ADHD.

I had fought with the process of getting diagnosed for quite sometime, but the stress level that my body was reaching, was causing other medical problems. I have told very few people about the diagnoses, only my immediate family knows. I am on a daily medication, and I can verify that the medicine does not change your personality, but it does allow you to focus on and finish whatever you start. If as a child, doctors would have medicated me, maybe my constant wiggling, talking, and activity levels would not have driven teachers and extended family up the wall. Then again, maybe I would not be the person I am today. My mother, father, and sister had no problems with my behavior, however when family kept implying that I was hyperactive my mother decided to have me tested. My pediatrician at the time informed her that I was mentally on, or above age level, small for my age but healthy, and that I had no problem at all. However, he did say that he would give my mom Valium. (She did not take him up on that.) I was one of the group, of ADDers that were brushed over in the 1970 s. I am a member of the adult group that is now flooding the medical community to get an explanation for something that we have lived with since birth.

Even though adults are now being diagnosed, the symptoms of the hyperactivity are not as vivid; they have evolved into other traits. Many times the hyperactivity will transform itself into high stress, anger, & depression. I use to believe that the reason for the surge in ADD diagnoses was due to lack of discipline in the homes and schools. At about the same time the surge began, corporal punishment ended in the schools. I was convinced that this played a major role. I still believe that it may play a part. I know as a child, no matter how hard it was for me to sit still and be quiet, (which I never have accomplished), I knew that I did not want to go to principal s office, or go home after getting into trouble at school. I was raised with a lot of love and southern discipline. I was expected to follow the school rules and those set by my parents. I was never in the principal s office, and I never had a discipline report in my file. Today I work in a school district, and I work with children in grades k-5, the kids I work with are ADD/ADHD, and behavior disordered. I find many of my past coping skills, from grade school, are useful to them. It is scary to see that there are still teachers out there that seem to feel that a child with this disorder is an annoyance. I remember two teachers that treated me that way, I knew from the first week in their class… they didn t like me. Kindergarten and second grade are very young ages to learn that your personality can set someone s nerves on edge instantly. These children are still treated by many like I was. We know when we bother someone, but many times it is not something that we can control. No matter how hard we try. This is the reason that I also feel that I am doing a job that I was made to do. That is why I chose to go for my special education degree, with emphasis on behavior disorder, and ADD/ADHD.

So are doctors over-diagnosing the condition of ADD? There is “little evidence of widespread over-diagnosis or misdiagnosis of over-prescription of methyl-phenidate by physicians.” (Baughman, 17-18). The reports have stated that although the diagnoses are at an all time high, so is awareness. Parents, schools, and physicians need to make sure that all other possible reasons for the concerning behaviors have been eliminated before they prescribe any medication. Make sure the child s ears and eyes are tested, many times if a child acts in a disruptive way it is because they cannot see or hear what is going on. Try some, or all, of the pre-intervention strategies mentioned before. The process may be long and tedious, however we are giving strong medications to our children, let s make sure that it is the correct medication for them, and not just a quick fix , to get them through the day.

Bibliography

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Running on Ritalin. New York: Bantam, 1998.

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“Report Concludes ADHD is Not Over-diagnosed.” Attention Magazine Summer 1998: 20. 15 Mar. 2000 .

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