Beware Adult ADHD Self-Tests
In one ad from a drug company that makes ADHD medications, there was a series of photographs of an attractive, dark-haired woman sitting in her office, adopting various poses of distractedness and worry. Over her picture appear words like DISTRACTED? FRUSTRATED? DISORGANIZED? Below that, there’s a black box, over which is written: “Modern Life or Adult ADD?” Then there’s text with a heading, “Take the Attached Test and Talk With Your Doctor.”
The test was adapted from the Adult Self-Report Scale from the World Health Organization (WHO) Composite International Diagnostic Interview, which in its entirety contains 18 questions. Here, there are 6 questions (perhaps the drug company figured that a person with adult ADHD wouldn’t be able to manage all 18 questions), along these lines:
“How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?”
“How often do you have problems remembering appointments or obligations?”
“How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?”
The reader evaluates him- or herself on each question in one of five categories: Never, Rarely, Sometimes, Often, or Very Often. Four or more checkmarks in the range of Sometimes to Very Often, says the ad, “indicate that your symptoms may be consistent with adult ADD,” and it recommends that you “give the completed questionnaire to your health care professional during your next appointment to discuss the results.”
This is clearly an example of a disease being created out of thin air to create a market for a drug. Putting this kind of “diagnostic quiz” in a magazine is a great tactic for selling prescriptions directly to consumers. We love to attribute our problems in life to a disease and then get a drug to fix it all. But as many people are beginning to recognize, this is only a short-term solution, and it doesn’t—in the end—improve anyone’s situation other than to increase pharmaceutical company profit margins.
CAUTION!
Don’t Give This Drug to Your Child If . . .
• He or she has a seizure disorder.
• He or she has hypertension.
• He or she is severely depressed.
• He or she seems chronically tired.
• He or she shows signs of psychosis or bipolar disorder (these drugs can make these conditions worse).
• He or she is less than 6 years of age.
• His or her symptoms are due to acute stress. The drug can make symptoms worse if this is the case.
• His or her symptoms include agitation or aggression. These symptoms can also be made worse with Ritalin and other stimulants.
• He or she is vulnerable to addiction or drug abuse.
The drug should be discontinued in children who do not appear to be growing normally.
Tourette’s Syndrome
Many people think that Tourette’s is a disorder that leads to uncontrollable shouting and cursing, but this is only one aspect of the disorder, and a rare one at that. People with Tourette’s may suffer from mild tics, including repetitive humming or growling in the throat, sniffing, head jerking, grimacing, or blinking. It can also involve seemingly odd behaviors, such as needing to touch things with both hands to “even things out,” or other habits that bear some similarity to obsessive-compulsive disorder. Sufferers can temporarily suppress tics, but they eventually have to be released, and many people with Tourette’s try to hold back and then find private places where they can release tics.
Tourette’s can range in severity from almost unnoticeable to almost debilitating. There is no reliable treatment; some doctors will prescribe SSRIs, but risking further damage to a child’s neurotransmitter system is not a good solution. In about a third of children who develop Tourette’s, symptoms fade on their own by adulthood.
Giving children methylphenidate, dexmethylphenidate, or amphetamines can cause Tourette’s syndrome. Risk is especially high in children with relatives who have Tourette’s. If you are considering giving these drugs to your child, consider how you will feel if the result is an incurable, socially disabling tic disorder that may never go away.
What Are the Interactions with Other Drugs? Methylphenidate can increase the effects or prolong the action of the following drugs:
Anticonvulsants (phenytoin, phenobarbitol, primidone)
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants
Methylphenidate can decrease the effects of the following drugs:
Guanethidine and other drugs used to lower blood pressure
Antiseizure medications (phenobarbital, phenytoin, primidone)
Monoamine oxidase inhibitors (MAOIs) can increase the effects or prolong the action of methylphenidate.
Clonidine, a drug sometimes given to help children sleep when coming off of stimulant drugs for ADHD, can interact negatively with stimulants.
What Are the Interactions with Food? It is recommended that methylphenidate be taken 30 to 45 minutes before meals, with the last dose of the day taken before 6 P.M. to avoid insomnia. Extended-release versions are taken less often and early in the day.
With this class of medications—the stimulant drugs—the worst side effect may turn out to be the drug’s actual “therapeutic” effects on the brain. According to a 1999 article in the International Journal of Risk and Safety in Medicine by psychiatrist Peter Breggin, M.D., arguably the world’s foremost expert on the dangers of psychiatric drugs, the millions of North American children who are diagnosed with ADHD and treated with stimulant drugs (including Ritalin, Adderall, and Cylert) are subjected to “a continuum of central nervous system toxicity that begins with increased energy, hyper-alertness, and over-focusing on rote activities” and that may progress
. . . toward obsessive-compulsive or perseverance activities, insomnia, agitation, hypomania, mania, and sometimes seizures . . . They also commonly result in apathy, social withdrawal, emotional depression, and docility. Psychostimulants also cause physical withdrawal, including rebounding and dependence. They inhibit growth, and produce various cerebral dysfunctions, some of which can become irreversible.
Heart Hazards and Hallucinations with Stimulant Drugs
Manufacturers of stimulant ADHD drugs have been instructed to add patient warnings about increased risks of psychiatric symptoms (hallucinations, delusions, manic or aggressive behavior) and cardiovascular problems in people who previously had not experienced any of these kinds of problems.
Between 1992 and February 2005, 27 patients 18 and younger who were on stimulant drugs for ADHD (including methylphenidate and amphetamines) suffered sudden death related to heart problems. About half of these kids were found to have underlying cardiovascular defects or ailments. It has long been well-understood that these medications increase blood pressure.
This evidence of serious cardiovascular risk has led to a call for more intensive evaluation of any patient who is considering taking these drugs, and more focused, ongoing follow-up with a physician for those who are already using them. Like two other related stimulants—phenylpropanolamine (PPA) and ephedra—methylphenidate and amphetamines have been linked to cases of heart damage that are sometimes fatal. PPA and ephedra have been banned, however; so far, there’s no sign of this happening with ADHD drugs. At this writing, clinicians are considering giving heart function tests to any child who seems to merit a prescription for a stimulant medication.
An FDA advisory board recently heard from hundreds of parents about children on stimulant drugs who had terrifying visual and tactile hallucinations, often involving bugs and snakes. These hallucinations were both visual and tactile, meaning that the children both saw and felt these critters. Hallucinations stopped when the drug was stopped and began again when the meds were started again. Drugmakers fearing more requirements for labeling changes and warnings to the public suggested that their meds were not to blame for this rare but significant problem, but that the dru
g “brought out” underlying psychiatric problems that “emerged when their ADHD was brought under control.” The FDA panel nixed this idea and insisted that labeling inserts for stimulant ADHD drugs Adderall, Focalin, Concerta, Metadate, Methylin, Ritalin, and Dexedrine mention the potential for hallucinations and aggressive behaviors in users who have never had them before and who are on the standard dosage of the medication. The drugs’ makers have also added risk of heart attack, stroke, or sudden death in people with undiagnosed heart problems to their package inserts.
Breggin tells us that any
. . . “therapeutic” effects of stimulants are a direct expression of their toxicity. Animal and human research indicates that these drugs often suppress spontaneous and social behaviors while promoting obsessive-compulsive behaviors. These adverse drug effects make the psychostimulants seemingly useful for controlling the behavior of children, especially in highly structured environments that do not attend to their genuine needs.
Studies on rats strongly suggest that Ritalin and drugs like it could permanently alter the brain for the worse. One of the studies came from the lab of McLean Hospital in Belmont, Massachusetts, which is part of the medical school of Harvard University; the other came from the University of Texas–Southwestern. Both studies administered either Ritalin or a placebo to young rats, in doses equivalent to those that would be given to a child with ADHD. After stopping the treatment, the rats—now all grown up—were given a series of tests used to measure depression and despair. Rats exposed to Ritalin showed less interest in sugar water and sexual activity in comparison with rats who got the placebo. In a test where rats are dropped into a tank full of water to see how long they swim before giving up, the Ritalin rats gave up a full two minutes sooner than the placebo rats.
Here’s an interesting snag: the rats were also given the option of consuming cocaine. Normally, rats love the stuff, but the Ritalin rats were much less interested in it than their placebo-using counterparts. This suggests that studies showing decreased risk of cocaine abuse in kids who used Ritalin may be on the mark—not because the kids who used Ritalin were happier and better adjusted because of the use of the drug, as the drug’s makers might like you to believe, but because the brain pathways that are involved in pleasure (including the pleasure experienced with cocaine use) may have been permanently affected adversely by the stimulant drug.
Examples of Amphetamines
Amphetamine sulfate
Dextroamphetamine sulfate (Dexedrine, Dextrostat)
Methamphetamine HCl, also known generically as desoxyephedrine HCl (Desoxyn)
Dextroamphetamine plus amphetamine (Adder-all, Adderall XR)
Lisdexamfetamine dimesylate (Vyvanse)
What Do They Do in the Body? Stimulate the central nervous system by causing the release of the neurotransmitter norepinephrine. At higher doses, the neurotransmitter dopamine is also released.
What Are They Prescribed For? Treatment of ADHD, narcolepsy, and obesity.
What Are the Potential Side Effects? Palpitations, rapid heartbeat, high blood pressure, decrease in heart rate, heart rate irregularities, overstimulation, restlessness, dizziness, insomnia, irritability, inability to sit still, euphoria, dysphoria (mild depression), tremor, headache, changes in libido, psychotic episodes, Tourette’s syndrome, aggravation of pre-existing motor and vocal tics, dry mouth, unpleasant taste, diarrhea, constipation, anorexia, weight loss, elevations in serum thyroid hormone levels, itching, and impotence.
Children given stimulants have been found to have temporary slowing of growth rate—on average, they are 2 centimeters shorter and 6 pounds lighter than their same-age peers after three years of taking the drugs—but they catch up once they stop taking it.
Amphetamines can cause a significant increase in blood levels of corticosteroid hormones—“stress” hormones. For more on the hazards of this situation, refer to Chapter 19.
CAUTION!
Don’t Give Your Child These Drugs If . . .
• He or she is vulnerable to drug addiction or abuse.
• He or she has a family history of Tourette’s-like symptoms.
• He or she has symptoms of psychosis, mania, aggression, or bipolar illness.
• He or she is younger than 3 years of age.
• He or she is hypertensive.
• He or she is sensitive to tartrazine.
Adults with hypertension, heart disease, or glaucoma should not take stimulant drugs.
Atomoxetine (Strattera)
What Does It Do in the Body? It affects the action of the neurotransmitter dopamine in the brain.
What Is It Prescribed For? Treatment of ADHD.
What Are the Potential Side Effects? Abdominal pain, vomiting, nausea, fatigue, irritability, decreased weight, decreased appetite, anorexia, headache, sleepiness, dizziness, rash, mood swings, heart palpitations, dry mouth, constipation, insomnia. In adults, the following side effects have been found: urinary hesitation or retention, erectile dysfunction, priapism (an erection lasting four or more hours), irregular periods, sweating, and hot flashes.
CAUTION!
Don’t Give Your Child This Drug If . . .
• He or she takes MAOIs or has taken them within the last two weeks.
• He or she has symptoms of psychosis, mania, aggression, or bipolar illness.
Adults with narrow-angle glaucoma should not use atomoxetine.
Sudden cardiac death has occurred in children and adults taking atomoxetine; it increases heart rate and blood pressure significantly. It should not be taken by anyone with high blood pressure, a heart condition, or atherosclerosis.
This drug has rarely been linked to suicidal thinking and suicide attempts in children. Parents are warned to look for side effects like akathisia (restlessness), agitation, anxiety, panic, insomnia, irritability, hostility, aggressiveness, impulsivity, and mania, and to use these as cautionary signs that the child may become suicidal or violent.
This drug is also linked to liver injury that, rarely, has been fatal. Itching, jaundice (yellowing of eyes and skin), dark urine, upper right abdominal tenderness, and flulike symptoms all suggest that this drug is causing damage to the liver.
Natural Alternatives for ADHD
Having a child with symptoms of ADHD can be extremely trying. Such children can be impossible to handle at times, and they can disrupt classrooms and family life with equal zest. In more extreme cases, ADHD kids may have impulsively violent tendencies that cause them to hurt others. It’s understandable that teachers and parents grow desperate to control the wayward behaviors of such children in the hopes that they can weed out the bad and allow the good that they know is inside the child to come through. Please don’t imagine that we are minimizing the hardships that come with ADHD when we caution against the drugs used to treat it.
Natural alternatives to these drugs can be time-consuming and trying. They can involve a good amount of trial and effort on the part of parents. By pointing out the dangers of ADHD drugs, we hope to make the point that the effort is worth it.
Commonsense Approaches
If you’re a baby boomer, you likely recall kids who were “impulsive,” “hyperactive,” or “inattentive” from your own childhood. Perhaps you were one yourself. We remember how those kids were dealt with, and it certainly wasn’t with drugs. It was with discipline. Many of today’s schools are trapped in an environment of overwhelming political correctness, and educators and care-givers are unwilling to risk doing anything that could be even remotely construed as abusive to a child. Many schools of thought on teaching and parenting focus more on improving a child’s self-esteem than on building the internal framework that enables that child to be disciplined and well behaved. The disease’s classification information points out that ADHD disappears when a child is “under very strict control, is in a novel setting, is engaged in especially interesting activities, [or] is in a one-to-one situation.”
This is not a book on parenting or teachi
ng, and we are not claiming to be experts on either topic. This is a book about alternatives to prescription drugs. If stronger discipline is a viable alternative to the increase in the use of psycho-tropic drugs in children, it’s certainly worth mentioning.
When a child seems to have problems behaving, focusing, or sitting still, the first thing to look at is the child’s overall situation. Kids who are stressed by problems at home or with peers, difficulty sleeping, or health problems may exhibit symptoms consistent with an ADHD diagnosis. Peter Breggin, M.D., the expert mentioned earlier and author of several excellent books on the dangers of psychiatric drugs, has found that many children with ADHD symptoms would be more appropriately diagnosed with “DADD,” or “Dad Attention Deficit Disorder,” caused by lack of adequate attention from fathers or other male role models. Counseling for the child and parenting education for parents hold far better hope for an ADHD cure than any pharmaceutical.
If problems seem most pronounced in school, you may want to consider exploring other educational options where your child can have more one-on-one attention and can work in a way that interests him or her more. Most kids with ADHD are very bright and get bored easily in school (the tests used to diagnose ADHD and those used to gauge which children are gifted and talented are remarkably similar), and some do better with alternative approaches that allow them to be more physically active and have more engagement with teachers and other adults.
If all else fails and a child seems out of control, try exercise. Set up a specific space or course for him to go to when he feels he can’t sit still, focus, or control himself. You might try a punching bag, a mini-trampoline, or a course where he can run laps to release his extra energy.
Prescription Alternatives Page 58