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Understanding Attention Deficit Disorder (ADD/ADHD): To Medicate or not to Medicate?
By ILSE D. CARRIZALES
2010, VOL. 2 NO. 09 | PAGE 1 OF 6 | »
Keywords: ADHD Attention Deficit Hyperactivity Disorder Attention Deficit Disorder ADD ADD Medication FDA ADD ADHA Medicate
Introduction to Attention Deficit Disorder (ADD/ADHD)
Attention Deficit Hyperactivity Disorder (ADHD), also known as Attention Deficit Disorder (ADD), has become increasingly prevalent in children and adolescents as the years have passed. Reports show that more than two million school-aged children are diagnosed with this neurobehavioral disorder that may transition with them into their adult lives (“ADHD-A Public”). ADHD is an important public health concern because it causes impairment in school performance as well as in socialization habits (Lesesne, Perou, and Brann). While there are many different ways to treat ADHD, such as counseling, therapy, and prescription medication, which is seemingly effective in helping children improve concentration, the question remains: should very young children, known to be naturally "hyper," be medicated for this condition? Currently, the effects of many drugs have not been studied in young children, which also leads to the question of whether the Food and Drug Administration (FDA) should more stringently regulate the use of stimulant drugs given to children.
Although ADHD does not have an exact definition, a large number of scientists agree that ADHD is a biologically based disorder of the nervous system. People with ADHD show “symptoms of impulsiveness, inattentiveness, and hyperactivity” yet different problems are seen in children than in adults (“Preschool Attention” 1). According to a diagnostic manual that the American Psychiatric Association composed, there are three types of ADHD: inattentive, hyper-impulsive, and combined. A person that is diagnosed with ADHD “has trouble focusing on activities, organizing finishing tasks, and following instructions” (Bren). A child that is diagnosed with ADHD is said to be constantly running around and constantly active. He or she shows excessive emotions and usually speaks out of turn as well as says inappropriate things. Adults tend to multitask, are always restless and always act on impulse (Bren).
People with ADHD tend to have behavioral problems that sometimes lead to serious consequences. Children diagnosed with ADHD tend to visit the emergency room more often than those who do not have ADHD. Adolescents with ADHD are said to engage in risky behavior more often than those without ADHD and are also more likely to drop out of school. Adults with ADHD suffer from depression and anxiety more often than those adults without ADHD (Bren). According to Russell Barkley, director of psychology at the University of Massachusetts Medical Center, “90 percent of ADD children are academic underachievers, 25 percent are held back at least one grade, 36 percent don’t finish high school (compared with 9 percent of the general population) and more than half have no friends during childhood” (qtd. in Koch). Statistics illustrate that 72 percent of boys and 68 percent of girls in juvenile detention centers suffer from ADD or ADHD. Those affected by ADHD are said to have higher auto accident rates and speeding tickets than those without ADHD (Koch).
ADHD and its Challenges: Diagnoses and Misdiagnoses
ADHD is a social problem that leads to many health and safety concerns. There are an estimated 2.5 million children and 1.5 million adults currently taking stimulant drugs to treat ADHD (Ginsberg). According the National Institute of Mental Health (NIMH), it is estimated that 3 to 5 percent of children residing the United States have ADHD. In other words, it is as if 1 out of 25 or 30 children have ADHD. Nora Galil, M.D., a psychiatrist in private practice in Washington, D.C., claims boys are also more commonly diagnosed than girls but this is rapidly changing. The reason boys are three times more likely to be diagnosed than girls is because symptoms are more easily recognized in boys. Boys are more active whereas girls tend to daydream and therefore go unnoticed (Bren).
The over diagnoses of ADHD as well as the over use of stimulant drugs to treat ADHD is a social problem affecting society today. Critics argue that the over diagnosis of ADHD causes the over prescription of stimulants, which pose serious health risks in the long term. On the other hand, ADHD experts and scientists say that while over diagnosing may occur in isolated cases, a greater number actually go undiagnosed and, therefore, go untreated (Koch). Over diagnosing ADHD is a common problem because currently no one test is able to determine if someone has ADHD but rather a specialist has to make the diagnosis. Paul Andreason, M.D., a drug reviewer in the FDA’s Division of Neuropharmacological Drug Products states that since many health professionals believe that ADHD is being over-diagnosed, the history of patients should be considered by doctors before diagnosing them. Diagnosis is usually based on a comparison of “a person’s pattern of behavior against a set of criteria established by the American Psychiatric Association” (qtd. in Bren 3). A specialist can be a number of professionals such as a psychologist, psychiatrist, or even a developmental or behavioral pediatrician. ADHD is the most common diagnosis for children 3-5 years old, but not much is known about effects of medication on this age group (“Preschool Attention” 1).
The overdiagnosis and misdiagnosis of ADHD can cause harm to the child that is being diagnosed. While it is said that some stimulants help children with ADHD function better, the same stimulant might cause a child without ADHD to have negative results. According to Raymond Woosley, M.D., Ph. D., a clinical pharmacologist and vice president for Health Sciences at the University of Arizona, a child that is misdiagnosed may have a negative increase in blood pressure since a regular increase is seen normally in ADHD children that are taking stimulants. Woosley recommends that a child’s blood pressure and heart rate should be monitored closely for safety reasons (Bren 6).
Though there is speculation of overdiagnosis, the American Medical Association’s (AMA) Council on Scientific Affairs noted that there is an insufficient amount of evidence that points to overdiagnosis or misdiagnosis. A reason given for the rise of diagnosis was because the diagnostic criteria have been broadened and therefore more people are being diagnosed (Koch). A great number of times, children are diagnosed with ADHD when in reality they might just have dyslexia or something as simple as vision problems (Koch).
