ADD/ADHD in Four Parts: Part III: What You Need To Know About Medication

Florida Jewish News, November 11, 2005, p. 13

If we take a position that some aspects of ADD/ADHD are desirable, then the question of whether or not to use Medication becomes a question of whether, or when, to blot out those beneficial aspects.

Furthermore, there is a health and safety question to consider. In April, 2000, a Michigan medical examiner ruled Ritalin to be the cause of death for a 14 year old boy, Matthew Smith, who had been taking it for ADHD for 10 years. The child died of a heart attack although he had no prior known heart condition. His parents subsequently sued the creator of Ritalin, Novartis.

Ritalin is a stimulant and it works by constricting blood flow.

As a result, the medical examiner in the above case ruled that there was shrinkage of blood vessels going to Matthew’s heart. Other studies (Archives of General Psychiatry, July 1996) found that children with ADHD taking stimulants like Ritalin and Adderall had a smaller brain volume than normal, either due to the same arterial shrinkage implicated in the Smith case or due to the ADHD itself. Although the findings were not clear, one fact is: Ritalin and Adderall are amphetamines, their chemistry similar to cocaine. As such, they are controlled, Schedule II drugs as classified by the Drug Enforcement Agency.

According to the Smith website, http://www.ritalindeath.com, between 1990 and 2000, 186 children have died from taking Ritalin as prescribed.

According to the Duke University website, http://www.dukemednews.org/news/controversy.php?id=1732, the alarming part of the Medication picture is that while the number of children diagnosed with ADHD is fairly high, the number on Medication is even higher. The site states:

“ADHD is over-diagnosed because of failure to use normative standards, failure to consider comorbid psychiatric conditions which might explain the symptoms, and failure to use pre-referral interventions that might prevent the condition being labeled as a medical problem.”

My own guess is that learning the fine art of disciplining the child is harder for parents than medicating the child. What’s more, according to Fred Baughman, M.D. and a number of parents who have weighed in on this debate, the schools frequently demand that parents medicate. This, of course, makes their jobs easier.

There is yet another facet to the Medication argument. In 2002, I did some personal research on the subject and spoke to a Harvey Spigler of the Military Entrance Processing Station Public Affairs Office. He told me point blank, “Ritalin is one of the Medication they will not let people into the armed services for.” One needs to be off Medication for one year in order to qualify to apply; however, with a past diagnosis, they will look more closely at grades and present functioning, not to mention the doctor’s report.

The previous year, the Kaiser Family Foundation and Harvard School of Public Health National Survey on Consumer Experiences With and Attitudes Toward Health Plans, canvassing a random sample of over 1200 adults with over 700 on private plans, reported that 48% of Americans had problems with their health insurance. Of these, 13% of privately insured adults under 65 experienced delays or denials of coverage or care. This is not surprising. According to Georgetown University’s Karen Pollitz, a co-author of the Kaiser research, and reported on the website www.insure.com, you can be denied coverage if your medical history includes the use of psychotropic Medication to treat anxiety, depression, or a physical condition. Pollitz remarks, “People who’ve always had group health insurance are completely unprepared when they’re forced to seek [individual] coverage.” ADHD is considered a mental disorder.

When I first began seeing clients with ADHD, the web wasn’t the great resource for information and sounding off that it is today. One person that was given Ritalin thirteen years ago, lost his appetite, suffered insomnia, and had a come-down effect. This latter experience is the increase in unwanted behavior, above the usual for that person, following the drug’s wearing off for the day. Nevertheless, there was some improvement in his concentration in school and his parents continued the drug.

Eventually, he was switched to Concerta because it had a longer-lasting effect, and later was switched to Strattera to, presumably, avoid some of the side effects. When his liver-function study came back with slightly abnormal results last year, his parents said “Forget it” and pulled him off Medication completely. Indeed, the FDA requested the manufacturer, Eli Lily to place a warning on the label that the drug could cause liver damage. Other symptoms include itchy skin, jaundice, abdominal tenderness and flu-like symptoms.

Frequently, Medication does help, but a decision to medicate or not must be balanced between relief of symptoms and safety, and between reducing symptoms and capitalizing on them.

Next issue: Part IV: Capitalizing, Coping, and Making Meaning out of ADD