Spotlight on ADHD: Failing to Focus

When stimulants seem to be the only solution

By Jeff Woodburn
 
In 1988, Casey Jesson of Derry, then 11, made national headlines when a federal court sided with his parents and ruled that the school district could not force him to take Ritalin to control his impulsive, out-of-control behavior.

It was a landmark case that perhaps first exposed the nation to the debate about medicating children with Attention Deficit Disorder or Attention Deficit Disorder with Hyperactivity, one of the most common childhood disorders that can continue through adolescence and adulthood.

Attention Deficit and Hyperactivity Disorder is described by the U.S. Center for Disease Prevention as a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity and resulting in significant functional impairment. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity (over-activity). ADHD has three subtypes: predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive, according to the National Institute on Mental Health.

It is a strongly genetic, developmental disorder that seems to manifest itself in middle-school age boys when organization becomes increasingly more important than intelligence. According to the Centers for Disease Control, in 2009, five million children age 3 to 17 had been diagnosed with ADHD; boys (12 percent) were more

than twice as likely as girls to be diagnosed with ADHD (5 percent).

Medicating children with a stimulant is quite common. Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD, according to NIMH.

And New Hampshire, more than any other state, medicates hyperactive children -- specifically with the drug, Ritalin.

A decade ago, the federal Drug Enforcement Agency reported that on a per capita basis, 5,525 grams of methylphenidate (better known as Ritalin) are prescribed for every 100,000 people.

There seem to be three reasons for this -- wealth, access to medical care and an anxious and competitive culture. Studies reveal that New Englanders are more troubled by anxiety than any other region.

New Hampshire, maybe not surprisingly, also has a problem with teens illegally using prescription pills. According to the 2009 Youth Risk Behavior Survey of NH students, one in five students admitted to at some point in their life using medicine that was not prescribed to them; 10 percent admitted to using one in the past 30 days.

Psychotic stimulants like Ritalin, Adderall and Concerta are among the most popular street drugs according to school officials -- and it’s easy to see why. They are readily available, easy to hide and, possibly, offer a false sense of safety as they are prescribed by a doctor. Students have been known to crush the pills and snort them to get a quicker high.

It is used not only recreationally, but also to give competitive students and upstart professionals an added edge with a jolt of drive and focus.

“There is a lot of pressure to perform,” said Dr. Rickey Silverman, a psychologist with a practice in Derry and Hampstead. He related a story of a college student, who came to see him looking for medication. “Doctor,” the young man said, “I can’t pass this exam without it.”

The National Institute on Drug Abuse reported in 2008 that 13.5 percent first-year college students at a mid-Atlantic university used prescription stimulants for non-medical reasons.
　
You could jump to the conclusion that New Hampshire’s penchant for pill-popping proves a conspiracy of complicity. Pharmaceutical companies, health professionals, educators, parents and, possibly even, youngsters themselves may all have a contradictory interest often draped with the hope of improved behavior — in the various, short-term benefits of psychotic drugs. But are we too quick to turn to drugs a solution? Who is the gatekeeper? And, with growing suspicion, are some very needy children missing out on some benefits of drugs? No doubt, quick assumptions and broad characterizations miss the mark.

This topic is as complex and evolving as the brain itself. Unlike most conditions, it’s not clinically conclusive. It can‘t be proved by a scan and some of the classic ADHD symptoms are shared with other conditions.

“We define it behaviorally,” said Dr. Silverman, so it’s hard to ignore preconceived biases.

“It is very easy for a primary care physician to write a prescription. The symptoms can be caused by other things -- (like) anxiety and depression.”

Most hands-on practitioners say the stigma of drugs lags behind the science, and it seems the entire debate has shifted toward acceptance of medication -- that is better medication, which is decidedly milder, not as many side effects and quite different from what was prescribed years ago.

Ritalin was the pioneering ADHD drug and it took many hits, some deservedly so. Kathryn Powers, a therapist in Derry, uses the word “harsh” to describe it, and Silverman calls it “peaky” for it powerful highs and crashing lows. There were all kinds of speculation about its long-term effects, but it is being replaced with advanced drugs that in some cases are not stimulants at all.

Powers, who stresses a holistic approach including exercise, diet and counseling, said Ritalin is passé and this has moved the debate. “It is not about medication,” she said, “it’s about performance.”

Stimulants are not the only way to reduce the symptoms of ADHD and improve functioning. Treatments also include various types of psychotherapy, education or training, or a combination of treatments, which may or may not include medication.

According to NIMH, current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn or improve their academic skills. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems.

An earnest and off-the-record school nurse moves her eyes slowly down a list of her dozen or so students who are on ADHD medication. With reluctance in her voice, she admits that she wouldn’t remove a single one of them.

"When these children don't have their medication,” she said, “it's very noticeable."

Much like the evaluation used in 1988 by then-Derry Schools Superintendent David Brown, to suspend Casey Jessom from the third grade. “He is,” Brown wrote, “almost never still.”

Jeff Woodburn of Dalton is a teacher and writer. He's taught in middle and high school settings. Previously, he owned an award-winning real estate firm and was prominent in state politics. He and his wife and four children live on a small hill farm, where they raise poultry.