Childhood Challenges

Okay, test quiz: What do Tom Cruise, Michael Jordan, Vince Lombardi, Pablo Picasso, Ernest Hemingway, Bill Gates, Henry Ford, Elvis Presley, Winston Churchill, Albert Einstein, and General George Patton all have in common? Supposedly, they all have/had attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD).⁹ Amazing! Think about the accomplishments of this distinguished group: the entertainers, entrepreneurs, scientists, artists, and leaders. If kids and adolescents with ADHD/ADD are such a formidable problem, how do we nurture the next generation with these diagnoses so that the world will continue to benefit from these talented people? Children affected with these disorders are often exuberant, inventive, creative, and original, which can lead to outstanding productivity in many professions.

We’ve heard about the chronic problems children with ADHD/ADD pose with their inattention, overactivity, and impulsivity at home, and most commonly, at school.² With ADHD, there are 3 subtypes: (1) the primarily inattentive, (2) the primarily hyperactive, and (3) the combined. I’m not sure, but I think that several of my grade school classmates were affected by these disorders. Several were constantly inattentive, and others, hyperactive. They made teaching a little challenging for the Felician Sisters at the grade school I attended, but I don’t think any of my classmates were medicated with stimulants or antidepressants to control their disruptive behavior. The good Sisters had a way of making sure we conformed to classroom rules one way or another—corporal punishment was definitely a treatment option! Interestingly, I don’t think any of the parents complained when that was utilized. In fact, I’m sure my dad thought that I was deserving of much more than I received most of the time. The point here is that back in the 1950s, these were not common diagnoses. Some kids were disruptive and difficult to handle, but they were mainstreamed and were not medicated. Nowadays, between 3% and 6% of the general population carries the diagnosis of ADHD alone.² According to a most recent report in this edition of Sports Health, ADHD affects up to 10% of children today.⁸ In fact, according to one study, 7.3% of 870 interscholastic athletes carry these diagnoses, of which 94% are medicated²—interestingly, 4.4% of track athletes and a whopping 17.5% of football players. I don’t intend to belittle the chore that a school teacher faces. In fact, I deeply sympathize with them. Keeping kids with ADHD/ADD on task and not disrupting the progress of the rest of the class is a real challenge. However, is it really necessary or beneficial to medicate these children with stimulants and antidepressants? Are there other therapies that might suffice?

Unfortunately, many of these children are treated with Ritalin, a schedule 2 narcotic in the same class as amphetamines. While a stimulant may control ADHD/ADD symptoms, it may also stunt growth and cause insomnia.⁵ The Drug Enforcement Agency found a 500% increase in the prescription use of Ritalin from 1990 to 1996 and a 400% increase in the use of amphetamines for the same purpose.⁵ It’s established that 7% to 10% of male Americans are on these drugs at some point during their early years.⁵ I can’t help but believe that these medications are overprescribed for behavior problems at school and at home. Many of these children may have learning disabilities or other disorders that may lead to the incorrect diagnosis and difficulties at school. I wonder how many are correctly diagnosed. Worse yet is the establishment of the attitude early in life that the answer to social and behavior challenges at home or school is a pill.

The good news is that some children appear to grow out of these disorders naturally. However, 60% to 85% of kids with ADHD continue to meet criteria for this diagnosis as teenagers and young adults,⁸ and 30% will continue with these issues as mature adults.⁸ Knowing that ADHD is self-limited in some kids makes it a seemingly critical decision to prescribe stimulants like Ritalin and Adderall early in life. Consider how Ritalin works on those with these disorders and those without. Described as structurally close to cocaine, it appears to solely effect concentration in some while stimulating the nervous system in others, “creating feelings of alertness that fall somewhere between those produced by caffeine and cocaine.”⁷ No surprise then that the abuse potential of these medications is enormous!

Sales of stimulants for ADHD more than doubled between 2007 and 2012, reaching $9 billion.⁴ Survey results show that 1 in 4 teens has misused a prescription drug at least once in their lifetime, while 1 in 8 (14%) has admitted taking stimulants (Ritalin or Adderall) not prescribed for them. Twenty-seven percent of teens believe that abusing prescription drugs is safer than illicit drugs.¹ This may be because of the fact that their parents hold similar views. According to the same survey, 29% of parents believe that ADHD medications can improve their child’s academic performance even if they don’t have ADHD, while 1 in 6 parents believe that getting high on prescription drugs is safer than street drugs.¹

The result of the increasing use of stimulants to treat ADHD and what appears to be a general acceptance by society is the ready access to these drugs by those without the diagnosis and the subsequent rampant abuse. Kids with ADHD grow up far more likely to develop serious substance abuse problems as adolescents and adults.³ Interestingly, kids with ADHD who are treated with Ritalin and Adderall appear to not be at greater risk of alcohol, marijuana, or cocaine use than the kids with ADHD that didn’t take these medications.³

In 2005, 17% of men and 11% of women at a Midwestern university admitted to the illicit use of stimulant medication.A recent report suggests that it may be as high as 35% now with college students.⁶ In response to this growing dilemma, colleges from Fresno State to Alabama and Vanderbilt are requiring students to sign contracts promising not to misuse or share pills with classmates.⁶ Some schools, such as the University of Vermont, will not perform diagnostic evaluations for ADHD in their attempt to stem the problem by limiting access to these prescriptions. Unfortunately, they are also complicating the lives of those who do carry the legitimate diagnosis and require the medication to function. The problem doesn’t seem to be going away. As recently as last semester, my daughter, who attends a Midwestern university, said that at least 20 students were arrested at the library at the start of finals for selling these medications.

What’s the answer to this growing problem? No doubt, education, but it must start at home at an early age. Once the attitude is established that the answer to life pains, challenges, and difficulties is a pill, we’re on the downslope with a difficult climb ahead.

—Edward M. Wojtys, MD
Editor-in-Chief