The United States of Adderall

Last week, the Centers for Disease Control (CDC) released analysis of data revealing a major increase in the incidence of attention deficit hyperactivity disorder (ADHD) among children in the United States. The number of children between the ages of five and 17 reported by their parents to "have" ADHD or the non-hyperactive form of the disorder (ADD) had risen from 7 to 9 percent over a decade ending in 2009. Nine percent translates to 4,858,210 children according to 2010 U.S. Census data.

In actuality, the researchers do not know for certain whether these children actually meet criteria for ADHD/ADD. The data is culled from a national telephone survey which asks parents the question, "whether or not a doctor or other health-care provider had ever told them that their child had attention deficit disorder or attention deficit hyperactive disorder, that is, ADD or ADHD.'"

Since there is no biological or psychometric test for ADHD/ADD no one can be certain these children have a definitive neurological condition. In its extreme form the hyperactivity and impulsivity of ADHD are easy to recognize. But most children are commonly diagnosed with the mild variety which blends seamlessly into the behavior of normal but active or lively children. It is with this mild form where opinions vary widely between professionals. This survey then only measured what parents had been told.

Still the continued rise in the diagnosis and treatment of ADHD/ADD in children is unmistakable. As a long time observer and participant (I prescribe drugs like Ritalin, Adderall and Concerta every day) of this trend, I have watched the 20-year growth of this condition with curiosity and some consternation. I have also been involved in what has been colloquially called "The Ritalin Wars" -- an often polemical debate conducted in the media as to whether the widespread use of prescription stimulant drugs (essentially amphetamine) is good or bad for the children of this country.

The upward trend continues. Given the current CDC data, one can safely estimate (based on previously detailed distribution curves) that one of six 11-year-old white boys with medical insurance currently take a stimulant drug at least during the school week. Is this over medication or simply good medical care for children with a previously undiagnosed and untreated condition? What I do know is that we are the only society currently managing our under performing/misbehaving children with drugs to this degree.

While the diagnosis of ADHD/ADD can seem ephemeral, the production of prescription stimulants, whose use is closely tied to the diagnosis, is monitored by the Drug Enforcement Administration (DEA). Since 1966 the annual amount of Ritalin-type drugs approved for production by the DEA quadrupled to 50,000 kilograms, and for Adderall increased ten-fold to 26,000 kilograms. In more common terms nearly 84 tons of legal speed were approved for production in 2010.

The U.S. is a signatory to a 1972 United Nations treaty monitoring the production and sale of potentially addicting substances. The U.N.'s International Narcotics Control Board (INCB) based in Vienna, monitors the production of legal stimulants worldwide. INCB data shows that in 2009 the U.S., representing 4 percent of the world's population, produced 88 percent of the world's legal Ritalin type drugs. Canada uses a third per capita of prescription stimulants compared to the U.S. -- Germany, one eighth, the U.K. one twelfth, Japan, one fiftieth.

These drug production amounts do not separate child from adult use and clearly there has been a surge in adult ADHD/ADD and their use of stimulants in America in the last decade as well. Still the CDC study marks a continued increase in the diagnosis and use of these drugs in children. Is this a good thing or a bad thing?

I suppose it comes down to values. Amphetamine when used (in low doses) immediately improves focus and attention in anyone (including ADHD/ADD children) who takes them. Specific behavioral interventions (especially by parents) and educational interventions (by schools and teachers) also improve the performance and behavior of ADHD/ADD children.

Pills, however, place value on efficiency -- they work quickly and are relatively less costly. The non-drug interventions value engagement with the child; they require more time, more involvement by adults and initially cost more money. Medical and educational systems value efficiency. Parents generally value engagement but if the treating systems only offer pills, parents will surely take them over no treatment.

Ritalin type drugs have been around for 80 years, used in children for 70. They are reasonably safe and effective in children -- not so for older teens and adults, where the specter of over-use, tolerance and addiction has a long historical precedent. The trends that have fostered the United States of Adderall continue.

I see no countervailing influences in the immediate future that may slow the use of prescription stimulants in children (and adults) in our country. As with most things in America, money factors rule. But a society that chooses to cope by using drugs, in the long term, does so at its own peril.

CORRECTION: An earlier version of this post stated that since 1996 the annual amount of Ritalin type drugs approved for production by the DEA multiplied 4,000 times to 50 million kilograms, for Adderall 10,000 times to 26 million kilograms, and that 83,776 tons of legal speed [Adderall] were approved for production in 2010.

This has been changed to reflect corrected information: Since 1966, the annual amount of Ritalin type drugs approved for production by the DEA quadrupled to 50,000 kilograms, and for Adderall increased ten-fold to 26,000 kilograms. Nearly 84 tons of legal speed [Adderall] were approved for production in 2010.

 

 

 

Comments

[Sunny Peace]

07:58 PM on 09/19/2011

I see a lot of people self-diagnosing and treating themselves with other family members' prescriptions! So when I hear about how much the prescriptions have risen, I get a funny feeling about who exactly is using this legal speed .... How convenient to get lil johnny or sally some medicine; boosts the medicine cabinet's stock.

[sensimilla]

05:25 PM on 09/16/2011

Big Phrma can kma, they are all about profits and very little about "cures" or "treatment". Psychiatrists are basically just drug pushers these days.

Kids are hyper, THATS NORMAL. Work on their activity level, their diet, their emotional balance FIRST.

[quartrol]

03:16 PM on 09/12/2011

Please look at all data,
unless essential none of the brand names are needed.
if we organize
the cost can be almost eliminated for many.
almost all these drugs are very cheap,
big Pharma did a great servive
by educating,
when the country failed these kids,
and they madea profit too.

for decades
all these drugs are generic
practicall­y no profits,
if we, the churches, and govt agencies organized
could have
bought the meds

for a couple of dollars,
a months supply for less than 1/2 a 6 pack
or 1/3rdOf aCigarette­Pack,
mush much less than streetDrug­s.

AndMillion­sWould haveWorked­,
contribute­dTrillions­To theTconomy
evenCreate­d betterOrga­nizedCongr­ssmen,
andNotDecl­atedUSAban­krupt.

1 of 4 to 1of 6Are toALesserO­rGreater extentAffe­cted by this and related disorders,
we can treat it
weCanGenet­icallyElim­inate[Sele­ctiveGenet­icoutBreed­ing
can partly[but do not hold your breath, as the latter ,shallWill­KillYou]

please do notIgnore thisVeryEm­inentlyTre­atable, curable
groupOfDis­orders,
that can MakeOurPop­ulation
function better,
beLessSelf destructiv­e.

IHad thePleasur­e and priviledge­ToTreatTho­usands[hel­p manyToCont­rol other patients],
inAreas,
neve coveredByS­pecilists,
fo200yrsLo­nger,

theResults areVery rewarding,
cashIsNot there,butN­othing canEver equal the nearly
50YrsOfTre­atment[rer­ely failres when we obtai compliance­,mostly with thehelpOfM­others and grandmothe­rs][Father­sTeachersH­ave aProblemUn­derstandin­g orAssiting compliance­]
I amHopingTo­ContinueAW­hileLonger­,
one must see theoutcome­, to see how rewarding it it
to be able to almostCure­[symptomsU­nrecogniza­ble]
lnThose affected.

I thank myPoor patients[m­ostOf them are,though manyVeryRi­ch live quite close to me]for being supportive
andAllowin­gToPerform­,
what wasConside­red impossible­,
whenIWas first draftedInT­heVietnamW­ar[AKAmass­acreOfInno­cents].

todyayAnd in thenext coupleOfDe­cdaes,we can almost fully,elim­inate the negative impact of these disorders[­andothers] on our society
then go and offer
this to others or mae it Freeley available.

[quartrol]

01:14 PM on 09/12/2011

ADD ADHD ODD and related,accompanig,
comobid disorders
were ignored,
part our own illiteracy[even when information was abundant.
we had treatment methods for nearly 50-60 yrs,
but the restrictions and poor coverage for those in dire need,
and seeking whipping, punishment
Banishment etc
was the rule.
society owes a lot to those affected and their offsprings,
for blatanyly ingnoring this destructive ,neurotansmittr based, tereatable/controllable disorder.

let us look at the figures of nearly 25% prevalnce of some or most disabling symptoms.
Also how many smoked cigarretes, and died[partial relief for adhd symptoms]
Alcohol, weed
crack cocaine and other addictive drugs[uncontrolled ,except by the dealers.

non beneficial treatment,
even seeking divine interference[when the divine should have eliminated the Genes so easily from the population.

if in some cases it is or appears to be overtreated,
or non disgnosed seek medications,
they can be weaned off via non stimulants,
until evaluation of
main symptoms re complete.
the treatment is started in the street
or by non specialized people,
a regular supervsion by psychiatrst
can almost elimiate this,

butdo not eny tretmnt.r cut benefits.

[Mom in NY]

08:41 AM on 09/12/2011

As I agree ADD/ADHD is a highly over diagnosed issue in America, please take in consideration some children truly are suffering. My 16 year daughter has been in counselling since she was in 6th grade. Her impulse control was scary, her grades we were close to failing yet my child continued to try to do better. We did all the right things, preferential seating, tutors, agendas, lists, quiet study places... everything. Finally with a conversation with her counseler we took her to a psychologist who specialized in learning disorders to begin a battery of tests. I never considered her ADHD. I thought the media and music and peer influence were her issues. I am not an advocate of drugs and never have been. Nor do I believe that drugs are the easy answer. It took us 4 years to understand that my daughter could not controll what was happening any more than a person with Autism can. She is still in counselling and has been on Concerta since the beginning of summer. This is the first achool year using a drug to help her. I am still very skeptical. My point... not all of us parents look for the easy way. Wish my girl luck. And when you hear of another child that has been diagnosed; really try and understand.

[rainnn24]

07:42 AM on 09/12/2011

..."As a long time observer and participant (I prescribe drugs like Ritalin, Adderall and Concerta every day) of this trend, I have watched the 20-year growth of this condition with curiosity and some consternation."...

So what's changed within the last 20 years to cause this 'curious' increase? The average kids' exposure to microwave radiation. Cell phone towers began to pop up within our neighborhoods, and wifi popped up in our schools. Please do some research on this and examine the research that's already been done on this subject.

[quartrol]

01:22 PM on 09/12/2011

itsis nt icease in dignoss,
tose wochoosetormai blin, decided to open their es.
still we har ny cases re people teachers, famiy edicl persne,
opted to alow the lives of these people
to rot,
while refusing to support diagnosis
or treatment.

t f ancer,Hypertension,cardiac bockage,Early cerebral hemorrage
is ignored,someone dies or isseverely damage,due to negligentce
and one or more generations suffer?

there is one case, where negligent LawSuit
is being evaluated against Several people for refusing to allow teatment or even disgnosis,
and ruinedTheLives of more than one person.

[ADDASDDoc]

03:33 AM on 09/12/2011

Since 1999 a test called QEEG (Monsatra, Lubar, Linden, 1999) has been available to determine if a child-adult has ADD/ADHD & what type. This can be used to determine if they actually need treatment & more specifically what treatments would be most successful while limiting potential side effects.

[quartrol]

03:24 PM on 09/12/2011

no tests exist with any reliability
that trumps good clinical evaluation
by an experienced psychiatrist.
tests can indicate possilbe presence of critera
or those leading to further evaluation
and a final diagnosis.

no 2 patiets are ever the same,
and also their clinical/social manifeatations, change from day to day.
check with experts who have followed them closely every 1-2 weeks until most symptoms were relatively stable,
In mnay centers,
the clinicians hardly see them
except once in 3-6 months,
and then errors are more likely to occur.

[momof2kulkids]

01:18 AM on 09/12/2011

Doesn't anyone look at our difference in activity at schools these days compared to years ago as part of the reason for the rise in the diagnosis of ADD/ADHD (and for the rise in childhood obesity in the US as well)? My understanding, having a child diagnosed with ADD, is that physical activity lessons the symptoms of ADD and ADHD. At our schools in California, our children are only given a physical education class 2 to 3 days a week in elementary and middle school, as compared to all 5 days when I was in school. And my 8 year old is coming home with 6 pages of homework each night. Our elementary kids, who used to go out and play when they came home from school, are now stuck inside doing loads of homework until dinner time. People tend to blame computer time and hand held electronic games for less physical activity in our children, but I think the school systems need to take a look at themselves and see how they might be contributing to not only the rise in ADD and ADHD, but in the obesity rate, too. There are studies that show higher test scores in schools that have PE everyday and do not give elementary school children any homework. I wonder how many of their students are diagnosed with ADD and ADHD, or taking meds. I don't medicate my child. We use metronome brain training and have had wonderful results!

[jeromettaylor]

11:53 PM on 09/11/2011

When I was 4 years old my Dad removed his leather belt and calmly explained to me,
"Son, If you don't sit still, I'm going to beat you to within one inch of your life."

My Dad never beat me. There was never a need to repeat our conversation.
Behavior modification was permanently accomplished. No drugs were required.
I have always loved my Dad. He has always loved me.

[quartrol]

03:29 PM on 09/12/2011

great example,
events like this,prevented many from reaching proper diagnosis, treatment,
some believe in this archaic,discarded, often illegal paddling,
beat the kid for symptoms of an illness,
wil he paddle,
if the kid had a toothache,
abdominal pain[matbe pre Appendicitis]
or broken bone, pain before x ray or clinical confirmation??

If one posts a guard at the door of every ER, Clinic etc,
to shoot anyone who dares to complain
or force them to pay $300 up front,
most cases will not be evaluated.

[fish59]

08:46 PM on 09/11/2011

My kids knew that when I said "listen up" or "do xyz" I was not going to repeat myself more than once or twice. After that I rang their little bells. This made them focus. There was never a need to drug them; they learned that they could focus. Parents today repeat and repeat themselves, while the kid ignores them. Pitiful. Oh, and of course Mom has to go to work in order to pay for all the clothes and the car she has to have----to go to work! Meanwhile, the day care center is raising the kids, with daycare center values.

[GinaPera]

10:12 PM on 09/11/2011

You "rang their little bells." You mean, you beat them?

Even kids with ADHD will learn to avoid consequences like that. But is that really the way to raise a child? How much better would it be for the child with ADHD to be able to regulate his or her own actions without swift and certain punishment from an angry parent?

[quartrol]

03:31 PM on 09/12/2011

that type of punishment led to abuse,
and is still prevalent[if one takes care to take a detailed history]
but it does not cure ADD,ADHD or reted disorders
better and chaper t select one of the100,00 gods e ave reated, and mostl discarded,
pata ime
and pray for relief,
Placebo effect would ure, alost 30%
wthout the belt. or the gun or the fist.

[fish59]

08:42 PM on 09/11/2011

SOLUTION: Mom stay home and TRAIN children. Dad some home from work and use the belt if there is a report of disobedience. Worked well for years. Drugs unnecessary.

[GinaPera]

10:13 PM on 09/11/2011

Oh really? Beating children with a belt "worked well for years"? Is that why we have so many college and high school dropouts, people who are alcoholics or other substance abusers, people who are incarcerated due to same as well as impulse-control issues?

[Fromageball]

08:38 AM on 09/12/2011

What if mom can't stay home and TRAIN the children? What does that even mean?

[quartrol]

01:25 PM on 09/12/2011

making mom stay at home and train was a stupid idea,when training was only a small part after the major symptoms were controlled,
often the child was able to make the changes,
without the trauma and the beatings.

[Susan Dean]

07:42 PM on 09/11/2011

I have been a teacher for a long time. I hated sitting almost all day in school. Most children do great if they get a good start, but now children very young(3-4) are given these drugs and it is very sad to me. I had a energetic smart little boy of 3 in one of my classes and then suddenly his personality changed, he lost that excitement, interest and energy that he had and became disinterested and passive. I didn't see that sparkle in his eyes anymore. I kept asking the director what was wrong with him and found out that a doctor had prescribed adderall for him and his sister. I think it is used too much just to control in a boring uninspiring environment whereas an active program and a good teacher can keep direct children and keep their attention and the child develops a joy in learning. I could tell you many stories like this.

[GinaPera]

10:14 PM on 09/11/2011

Actually, that story does not sound right to me. And maybe YOU were seeing "joy" in the child but the parents were seeing a child who was running out into the street or unable to shut down the "joy" at night and go to sleep.

[Nita Kieffer Sanders]

08:22 AM on 09/12/2011

Since these drugs started to become so popular, they have seemed to be an 'easy out' for parents who don't want to take the time and offer the love to raise their children in a logical manner. Many just don't want to deal with things that come about, so they take their children to be prescribed drugs to make them zombies. Now it has moved on up to adults. Some doctors and patients will actually admit they use these drugs to hyperfocus. I know a woman in her fifties who was using one of these drugs to concentrate more on administrative work. Now that she doesn't work anymore, they have decided she has cognitive memory loss. My opinion is totally different. Of course, it's a way to get on disability. Wow, the way the world works these days certainly can boggle the mind.

[quartrol]

01:28 PM on 09/12/2011

if anyone sees, clearly,
not making judgments based on illiteracy,
then discuss this with the doctor,Psychiatrist
and try adding more controls.
mothers often do not have the time or capability,
more so it she or the husband are also afffected.
fathers often deny this, and claim it is normal,
the Baby or KIDis LIKE the Father"

[acmes]

07:41 PM on 09/11/2011

Terrible how we let these kids get away with special advantages! It's like letting kids use special "magnifying lenses" just because they can't see the board clearly! SO UNFAIR to my kid with 20/20 vision. Kids should be allowed to sink or swim. After all, we lost entire generations to self-medicating when the society wouldn't acknowledge that mainstream schools couldn't serve every child. Shouldn't we just let some kids flounder, just so other kids can be comfy at the top?

I'm so glad "DR" Rankin isn't treating my child, who for the first time today, sat down and studied for several hours (because of her new Rx). Trust me, I tried lots and lots of therapy, natural treatments and just plain discipline. Most parents have. Parents aren't just dumping this on their kids (not at a $50 co-pay). It's not the easy way out. Rankin & Diller paint with too broad a brush.

[Fromageball]

08:40 AM on 09/12/2011

Special "magnifying lenses" and amphetamine prescriptions are different balls of wax. We do not know the long-term consequences of medicating these kids.

[quartrol]

01:33 PM on 09/12/2011

humans are not born with equal sight, intelligence, etc

please understand,
evolution tries to correct this
with a superior product,
then some of these who are not superior,
are still normal,
they are not stupid,
maybe more gifted in some areas,

but they do not progress at the same level.

that is our prblem,
we want, feel, all kids can be equal,

they advance at different levels,
there are spurts in growth,
some develop talents, that leaves other behind,

some are good parents long before they are parents,
others never learn the basic concepts,
we take away their kids, and sell them or spend money to give these kids
to those who make money out of fostering or adopting these unfortunate kids.

And wecall this progress.

[Anarchy4hire]

07:07 PM on 09/11/2011

Big pharma pays doctors to hand it out, and now we have legions of chemically altered, numb people

[GinaPera]

10:15 PM on 09/11/2011

Where's your proof of that? Many people have trouble getting the doctors to prescribe the medications for legitimate cases.

[DrHRankin]

04:14 PM on 09/11/2011

As a psychologist with 30+ years experience, there's no question that some children and adults suffer from what used to be called 'Minimal Brain Dysfunction." The issue is whether the rapid rise in diagnosis reflects a real brain condition or a convenient management issue.

The drug industry successfully created a change in name from from Minimal Brain Dysfunction to Attention Deficit Disorder. The term 'ADD' suggests that if you cant pay attention that you have this condition. WRONG! There are many reasons why someone might not be able to pay attention -- and only a few of those imply a brain dysfunction that stimulants are designed to "treat."

Moreover, I am a practitioner who uses the qEEG brain-map, a technology that is highly accurate in showing whether someone actually has a brain dysfunction that correlates with AD(H)D. Measuring brain wave activity reliably tells you whether someone has an attention and/or impulsive/executive function issue. But AD(H)D is currently diagnosed with highly subjective measures when cognitive and brain mapping measures are now available and, to my mind, much more reliable. If you're going to prescribe drugs that alter the brain and presume a brain dysfunction, why not look at the brain rather subjective responses to a questionnaire?

And, as others have pointed out, there are non-drug alternatives to treatment, including behavioral training, cognitive approaches and neurofeedback.

[GinaPera]

10:18 PM on 09/11/2011

It would be nice to think that we could always get objective findings from technology. But the fact is that evidence is slim for any kind of qEEG brain-mapping and many people waste precious time with this. The evidence-based strategies for ADHD are based on thorough interviews that include a complete history as well as corroborated information from third-parties.

[DrHRankin]

11:13 AM on 09/12/2011

I completely disagree that the evidence is slim for qEEG diagnosis of AD(H)D. In fact, work with my clients suggests to me that the qEEG is accurate in measuring not only presence of the disorder but also severity. I do agree, however, and practice, using ALL data sources -- clinical interview, third party information, cognitive testing and qEEG, for the most comprehensive assessment. In my view, if you're not using the latter two you are missing out on important data.