Attention Deficit Hyperactivity Disorder, or ADHD, gets a lot of undeserved flack. Stories abound about college students getting a quick ADHD diagnosis from a pill mill doctor, then hoarding Ritalin to sell or to snort for all-nighter study sessions.
Until medical marijuana came along in California and took the top spot as a joke medical regimen, professing to have ADHD got winks, chuckles and nods from some. It got disbelieving eye rolling and resistance from others, wary of stories about zombie-like kids in schools all across the country.
But for people who legitimately deal with ADHD symptoms daily, it is a very real thing that can wreck their lives, their finances, their education, and their families. Many children and adults work hard to get a handle on the facts of their condition. They educate themselves, they gather tools and techniques to help them cope and thrive, and, yes, they take Ritalin and Adderall, the two most prescribed drugs for the condition.
Contrary to popular belief and much-circulated tales, both Ritalin (methylphenidate) and Adderall (amphetamine/dextroamphetamine) are not depressants that calm hyperactivity. They are stimulants, specifically psychostimulants. Both are used to compensate for a deficiency of dopamine, and to a lesser degree, norepinephrine, in the brain.
Persons properly diagnosed with ADHD can choose to use medicines to aid their adjustment, but it is always recommended that they be part of an overall plan that includes other tools and techniques. These can include organizational methods, lists, calendars, clocks and watches, reminders, and many other aids.
But even with great effort in these areas, many choose to add medicines like Ritalin and Adderall to their regimen, often with pleasing results.
Stories about “Ritalin kids” who walk around in a daze are far too often really due to misdiagnosed or misdosed patients. Maladies such as fetal alcohol syndrome and others can be easily mistaken for ADHD. To medicate someone for ADHD who does not legitimately have it often causes undesirable results. Likewise, to not have a legitimate ADHD sufferer on the right medication, or the wrong dose size, often causes unfavorable results. Once dosages are properly adjusted, and proper hydration is observed, patients often do quite well.
Some states are concerned that more and more children on the state Medicaid rolls are diagnosed with ADHD. Children covered by Medicaid are 50% more likely to be diagnosed with ADHD than those on traditional insurances. Some see this as an epidemic of misdiagnosis. They believe that non-medicinal therapeutic treatments should be tried first, resorting to medicine only when those fall short.
But the reasons that children on Medicaid are diagnosed with ADHD more often are certainly not known to be misdiagnosis. There is a lot that is not known about ADHD. How much does diet affect it? What about food additives? Are there other environmental factors that come into play?
And how might the diets and environments of our nation’s poorest people fall into categories of risk more than those with money to eat better and live in better areas? This is already an acknowledged factor in the meteoric rise of obesity among the poor.
These things are unknowns. To presume that the atypical increase in ADHD diagnosis is in error — and to change public policy about Medicaid spending based on that presumption — is premature.
Medical professionals acknowledge the rise of ADHD diagnoses. They often will explain this by saying that diagnostic techniques are better now. People who used to be diagnosed with other maladies are now better understood to have ADHD.
But some suspect that pharmaceutical companies are behind the rise in ADHD diagnoses, that they are pushing their drugs to parents.
Dr. Jeffrey A. Lieberman wrote for Medscape.com:
“It is hard to know how much of the increase is attributable to [pharmaceutical] marketing, but other factors contributing to the increased rate in the United States must be considered. These reasons are more sociological than financial or clinical.”
Lieberman asserts that there is increasing pressure upon parents and schools to get to the bottom of why their child may be underperforming, and some may grasp for a diagnosis and medicinal aid to fix the problem. But, in the end, doctors are still the gatekeepers of such drugs, and must exercise discretion in prescribing.
"Psychostimulant drugs are effective for people who genuinely need them, but at the same time they can be dangerous and are associated with a high risk for abuse when they are used inappropriately. It is up to doctors to be extremely rigorous in their evaluation and establishment of the diagnosis and in their use of these treatments.”