How does the epidemic of misdiagnosing and overprescribing medication to children with emotional and behavioral problems, such as ADHD, affect our modern society?

Some may argue that doctors and psychologists are not overprescribing or misdiagnosing children with ADHD, and that going right to drug therapies (Adderall and Ritalin) is the best option. Others, however, argue that the fact that 75% of all children diagnosed with ADHD are taking medication rather than going to therapy or trying alternative means of treatment (Eunjung Cha), is a percentage that is much too high. I support the idea that physicians should be trying therapy and alternative treatments before prescribing medication. While medications do work for many patients, some of those patients weren’t given a chance to experiment with other alternative treatments, and some might be in search of something other than a stimulant drug to correct their behavior. Nowadays, the “easy” and most efficient option is the answer we often turn to, but sometimes it is not necessarily the best option. There is not enough focus being put into alternative, more natural treatments for these children. Therefore, I strongly believe that our nation is facing an epidemic that will take serious time, awareness, and support in order to be able to begin solving the resulting problems. 

Attention Deficit Hyperactive Disorder, commonly known as ADHD, is defined as a “chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsivity” (Bhandari). Inability to focus and having difficulty completing daily tasks can pose a serious challenge, especially for young kids that are expected to sit still through a long day of school. When it comes to the diagnosis, “Diagnosing attention deficit disorder (ADHD) is an inexact science, not because it’s unsupported, but because of who is doing the diagnosing” (ADDitude Editors). It is not uncommon for a child to be diagnosed by a pediatrician, but never actually see a psychiatrist that has expert knowledge on the disorder. In an effort to fix this problem, the American Academy of Pediatrics has updated their clinical practice guidelines for both the diagnosis and the treatment of ADHD in children. When assessing kids age four to eighteen that show symptoms of Attention Deficit Hyperactive Disorder, the primary care clinician initiates an evaluation. They are expected to follow the guidelines established by the American Psychiatric Association. This requires the child’s symptoms to be present in two or more environments, and the child’s ability to function academically and socially must be impaired for at least six months (ADDitude Editors). Since there are so many factors that play into this complex disorder, the physicians must go through an equally complex process to diagnose it. 

The most common treatment method that these doctors turn to is medication, in particular Adderall. Designed to treat some of the symptoms of ADHD, Adderall is a stimulant medication that works to improve inattention, hyperactivity, impulsivity, fidgeting, frequent interrupting narcolepsy, etc. This FDA-approved drug is prescribed to children, adolescents, and adults either in immediate-release (Adderall IR) or extended-release (Adderall ER) versions (Dodson). Adderall is a mixture of four different amphetamine salts – dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate (Dodson). However, doctors and researchers do not know exactly how amphetamines improve the impairments of ADHD.  “It was once thought that the mechanism of action involved neurotransmitters in the brain. While this is how Adderall produces its stimulating effects, it does not explain how and why the medication works for ADHD” (Dodson). Some common side effects experienced by people medicated by Adderall include suppressed appetite, dry mouth, irritability, sleeplessness, and more. While there are definite benefits of taking Adderall, these side effects shouldn’t have to be experienced by young children if it isn’t absolutely necessary.

Similar to Adderall, Ritalin is another brand name stimulant drug that is prescribed to people diagnosed with ADHD to relieve some of the symptoms and behavioral problems that often accompany the disorder. The major difference between these two drugs is that Adderall, as stated previously, is an amphetamine while Ritalin is a methylphenidate. Both stimulate the central nervous system and work by increasing the availability of the neurotransmitters norepinephrine and dopamine in CNS connections, ultimately speeding up brain activity (Morris).  Ritalin works more quickly than Adderall does, however, Adderall stays active in the body longer than Ritalin (Adderall works for four to six hours while Ritalin is only active for two to three hours). “This doesn’t necessarily mean that Adderall is a better choice, though. Some people prefer the shorter-acting Ritalin because they can better control the timing of side effects, such as loss of appetite and trouble sleeping” (Morris). These minor differences between Adderall and Ritalin are taken into account by the prescribing doctor, for each child reacts to the medications in drastically different ways.

Furthermore, a continuing problem seen throughout society is the abuse of Adderall, particularly among college-aged students. If crushed and snorted, Adderall creates a high from the dopamine released. Students may take Adderall (when they are not prescribed the medication) in order to stay up for an extended period of time and have a heightened sense of attention and focus. Others might abuse Adderall for the appetite-suppressing effects to aid in weight loss; doing so may result in serious health risks, including heart problems. Another risk of overdose associated with Adderall is when the drug is mixed with another substance, like alcohol. “Adderall has the ability to mask certain indicators of intoxication that people would otherwise use to slow or stop their consumption. If these signs go unnoticed, the user is at risk of continued drinking—potentially leading to alcohol poisoning, coma, or death” (Patterson). Research indicates that the potential for negative side effects from either drug (alcohol or Adderall) are enhanced when the two are combined. Long-term abuse of Adderall and alcohol can lead to serious cognitive issues that reflect damage to the central nervous system (Healthcentral). Therefore, regardless of the initial reason that may cause one to start abusing Adderall, the abuse almost always leads to unwanted symptoms, and tends to do more harm than good. 

When it comes to children, many from the ages of 2 to 5 are being overmedicated with prescriptions like these when there are safer options, such as therapy, 8 week “boot-camps”, and/or parenting classes to help deal with difficult behavior. As many as 75% of kids diagnosed with ADHD are on drug treatments, and many parents and doctors go straight to this option before trying the previously mentioned, more time consuming, ones (Eunjung Cha). The CDC argues that despite the fact that behavior therapies are costly, time consuming and require trial and error, they are often longer lasting that drug treatments. One article, “CDC Warns That Americans May Be Overmedicating Youngest Children With ADHD” describes how society can make a difference in bringing awareness to parents and communities as a whole, as well as to the insurance companies to make therapies a more viable option. The author, Ariana Eunjung Cha, advocates for insurance companies to cover more psychological therapies, which are often costly and takes more time and resources than medication. There are a significantly higher percentage of insured children receiving care for claims for ADHD medication than with claims for psychological services (Eunjung Cha). This ultimately means that prescription medications are not only less time-consuming, but are more likely to be covered by insurance than, say, a child who wants to see a psychiatrist to receive therapy. Therefore, people are choosing the “easier” and cheaper option, which may not always be in the best interest of the child. Another article, “Attention Deficit/Hyperactivity Disorder Is a Serious Problem for Many Children” provides two case studies of children diagnosed with ADHD, and how it plays a role in their daily lives and activities. The author claims, “The ADD/ADHD label should have the sole purpose of helping the child, not to disparage him or her. Labeling should not be stigmatizing and, last but not least, certainly should not decrease either parents' or teachers' expectations—only make them realistic” (Gupta). I feel as if this quote exemplifies the purpose of diagnosing one with ADHD; it is meant to help individuals, not hurt them. 

In my opinion, awareness is a huge step towards improving any epidemic that our nation comes into contact with. If more people are informed about ADHD, and understand the stereotypes and stigmas that often accompany the disorder, then the more accepting and helpful they can become. One mother, for example, is spreading awareness about ADHD through a blog about her six-year-old daughter. On the blog “My Little Villagers”, there is an interview that demonstrates some of the differences between children with ADHD and other kids without neurological or behavioral disorders. The two children were both in the first grade, six years old, and they were asked the same questions, and it was easy to differentiate between the two kids (meaning which one had ADHD). The girl with ADHD was knowledgeable of her differences to other kids in and out of the classroom, and it was clear to see that she didn’t have the easiest time completing ‘simple’ daily tasks (My Little Villagers). This shows viewers that it is important for children with ADHD to receive treatment, and that medications like Ritalin or Adderall do improve the lives of many ADHD patients, however it should be seen as a sort of last resort, if the patient doesn’t respond to any of the other alternative treatments. 

While there are many factors that play a role in the overmedication of adolescents, some theories suggest that psychiatrists are too busy to provide accurate treatment to patients, schools don’t allow enough time for fidgety kids to play, or that the pharmaceutical companies market drugs for the wrong reasons (Insel). It’s been shown that not only medications, but therapies, sports or even brain games could potentially correct some of the behavioral and psychological problems associated with ADHD. 

"Sport-Based Group Therapy Program for Boys with ADHD or with Other Behavioral Disorders” was a study done to compare a group of children with ADHD to children with other behavior and emotional problems. After twenty weekly sport sessions over the course of one year, results showed that the children indicated improvement in two behavior domains while their parents indicated improvement in the children's behavior in five domains. Most importantly, there was a large improvement in reducing anxiety in the kids (Lufi). Sports can be a great way for children to release stress, anxiety, and get rid of extra energy that they have accumulated during a long day at school. Playing sports and other games allows children to work together and focus on a common goal, ultimately helping them one problem at a time. Furthermore, even having teachers break up the day’s activities and goals can prove beneficial for the kids, so everything doesn’t seem as overwhelming. Perhaps taking little breaks throughout the duration of class, or teaching them in ways that incorporates all children’s learning styles, in turn making learning more fun and realistic for the kids that are struggling. 

Another potential alternative treatment for ADHD is brain games. With 5.5 million children diagnosed between the ages of four and seventeen, roughly 70% are taking daily medication as primary means of treatment. However, almost 20% of these diagnosed children do not respond to stimulant medication, which has in turn lead for the search of different treatment options (Wegrzyn). In a recent study conducted by the Journal of Research on Technology in Education, participants were instructed to play brain games for at least 20 minutes before school each morning, for five weeks. Results (based on electroencephalogram, parent, teacher, and self-reports, and researcher observations) conclusively showed that the daily use of brain games could, in fact, help strengthen focusing ability and daily functioning within adolescents diagnosed with ADHD (Wegrzyn). These types of games could be played on the computer, or simply on pen and paper (such as a matching activity). It is all about trial and error, and which methods appear to work best for each individual child. It is studies and research such as this one that are benefitting society and children. There are countless opportunities and further studies that should and can be done, which hopefully lead to more widespread use as an alternative treatment. 

An additional interesting approach to solving the epidemic is behavioral parent training in order to try to change the environment the child is in before altering their body with medication (Power). Especially for children with borderline ADHD, therapy seems to be one of the best approaches to treatment, as opposed to simply medicating them. Thomas Power is director of the Center for Management of ADHD at Children’s Hospital of Philadelphia, and he has greatly increased awareness about the dangers of misdiagnosing and overprescribing medication to children with ADHD. He highlights the importance of therapies for not only the patients but for the families involved as well. Other simple steps can be taken to try and improve the environment in which the child is surrounded by. Steps can include things like setting clear rules and boundaries, not having expectations, and/or using a reward and consequence system for behavior. Another benefit would be communicating regularly with the child’s teachers and counselors at school to make sure there is consistency in the way that the child is being taught (ADDitude Editors). Starting with these more basic, environmental factors when treating a child with ADHD can prove to be very beneficial and effective, particularly the communication aspect. A parent shouldn’t expect all symptoms of ADHD in their child to simply go away with one or two changes. They must regularly talk to the kids and ask honestly what they think is working, and what is not. Parents should also regularly communicate with their child’s doctor and exhaust every resource in order to be able to find the best possible means of treatment. 

I chose to conduct research on the topic of overmedication of children and adolescents diagnosed with ADHD for a couple of reasons. First of all, I am majoring in Nursing and I’m particularly interested in children as well as pain management, so this type of research is something I could see myself pursuing further in the future. Second, and more importantly, I chose this topic because I believe that if more people became educated on the subject; more people (i.e. parents or people directly affected by ADD and ADHD) would feel inclined to search for better options and means of treatment. The audience that might care about this type of research includes parents, doctors and psychologists, along with the children and the adolescents themselves. There is not just one factor that plays into the problem, but rather it is a complicated combination. There are countless statistics and factual evidence that support the notion that something needs to be done about this epidemic, and if we come together as a community and continue to spread awareness, we will be that much closer to helping these children find the best, and healthiest possible treatment options. 
