Drugged ‘for being boys’

Most boys on Attention Deficit Hyperactivity Disorder meds are “being drugged for no good reason—simply for being boys,” charges Ryan D’Agostino in Esquire.

By the time they reach high school, nearly 20 percent of all American boys will be diagnosed with ADHD. Millions of those boys will be prescribed a powerful stimulant to “normalize” them. A great many of those boys will suffer serious side effects from those drugs. The shocking truth is that many of those diagnoses are wrong . . .

“We are pathologizing boyhood,” says Ned Hallowell, a psychiatrist who has been diagnosed with ADHD himself. The co-author of two books on ADHD,  Driven to Distraction and Delivered from Distraction, Hallowell “there’s been a general girlification of elementary school, where any kind of disruptive behavior is sinful.”

Most boys are naturally more restless than most girls, and I would say that’s good. But schools want these little goody-goodies who sit still and do what they’re told—these robots—and that’s just not who boys are.”

Boys aren’t given time to outgrow immature behavior, writes D’Agostino. A huge Canadian study found that “boys who were born in December”—typically the youngest students in their class—”were 30 percent more likely to receive a diagnosis of ADHD than boys born in January,” who were nearly a full year older. And “boys were 41 percent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.” 

“Sluggish cognitive tempo” — day dreaming — is the latest candidate for diagnosis and medication, reports the New York Times.

“We’re seeing a fad in evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances, an emeritus professor of psychiatry at Duke University. “This is a public health experiment on millions of kids.”

More pre-K, more ADHD

More pre-k could lead to more ADHD diagnoses warn Berkeley researchers Stephen P. Hinshaw and Richard M. Scheffler  in a New York Times op-ed. 

Introducing millions of 3- to 5-year-olds to classrooms and preacademic demands means that many more distracted kids will undoubtedly catch the attention of their teachers. Sure, many children this age are already in preschool, but making the movement universal and embedding transitional-K programs in public schools is bound to increase the pressure. We’re all for high standards, but danger lurks.

Early intervention helps kids who really have ADHD, the professors write. But millions of children with ADHD labels — and prescriptions — don’t truly have the disorder.

Our research has revealed a worrisome parallel between our nation’s increasing push for academic achievement and increased school accountability — and skyrocketing ADHD diagnoses, particularly for the nation’s poorest children.

“By age 17, nearly one in five American boys and one in 10 girls has been told that they have ADHD,” Hinshaw and Scheffler write. That’s a 40 percent increase from a decade ago.

ADHD diagnoses surge overseas

Attention Deficit Hyperactivity Disorder (ADHD) diagnoses are surging overseas, as well as in the U.S. Children may be taking powerful drugs needlessly, warn researchers in the British Medical Journal (BMJ).

In Australia, prescriptions for the stimulant Ritalin and other ADHD drugs rose by 72 percent between 2000 and 2011, while in Britain and the Netherlands prescriptions roughly doubled between 2003 and 2008, said the paper.

According to the US National Institute of Mental Health (NIMH), nearly one in 11 American children aged 13-18 and one in 25 adults are affected by ADHD.

Ritalin and other drugs are appropriate only for “severe” ADHD symptoms, which occur among about 14 percent of children with the condition, the study noted. Yet 87 percent of U.S. children diagnosed with ADHD in 2010 received medications.

ADHD drugs don’t raise kids’ grades

Attention Deficit Hyperactivity Disorder medications don’t improve academic achievement, according to new studies, reports the Wall Street Journal.

Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called “cognitive enhancers” because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term.

. . . However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren’t any different in kids with ADHD who take medication compared with those who don’t.

Boys who took ADHD drugs performed worse in school than those with similar symptoms who didn’t, according to the study, which tracked students in Quebec. Girls on ADHD drugs reported more emotional problems.

Teach to boys’ energy, curiosity, drive

Stop Penalizing Boys for Not Being Able to Sit Still at School, writes Jessica Lahey, who teaches middle school, in The Atlantic.

“Something is rotten in the state of boys’ education,” she starts. Boys are kept back at twice the rate of girls, according to Reaching Boys, Teaching Boys: Strategies That Work and Why Boys are “diagnosed with learning disorders and attention problems at nearly four times the rate of girls,” do less homework, earn lower grades and drop out of high school in higher numbers. Only 43 percent of college students  are male.

Many teachers and school administrators think “boys are too fidgety, too hyperactive, too disruptive, derailing the educational process for everyone while sabotaging their own intellectual development,” Lahey writes.

Peek into most American classrooms and you will see desks in rows, teachers pleading with students to stay in their seats and refrain from talking to their neighbors. Marks for good behavior are rewarded to the students who are proficient at sitting still for long periods of time. Many boys do not have this skill.

What works for boys?  Teaching Boys: A Global Study of Effective Practices recommends lessons:  that result in an end product (a booklet, a catapult, a poem, a comic strip), that are structured as competitive games, that require movement, that require boys to assume responsibility for the learning of others, that address open questions or unsolved problems, that combine competition and teamwork, that focus on independent, personal discovery and realization and that introduce drama in the form of novelty or surprise.

In short, ‘the most effective way to teach boys is to take advantage of that high energy, curiosity, and thirst for competition,” Lahey concludes. And it’s not as if girls can’t learn from these sort of lessons.

Attention deficit or sleep deficit?

Some cases of Attention Deficit Hyperactivity Disorder may be a sleep disorder in disguise, writes Vatsal G. Thakkar, a psychiatry professor, in the New York Times.

Eleven percent of schoolchildren have been diagnosed with ADHD, he writes. Adult diagnoses are up too.

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused.

Adults and children are sleeping less, Thakkar writes.

The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.

Children with an A.D.H.D. diagnosis are likely to also have “sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted,” he writes.

In a 2004 study, 34 children with A.D.H.D.  all showed a deficit of delta sleep, compared with only a few of the 32 control subjects.

Sleep disorders can be treated, writes Thakkar, who has a rare form of narcolepsy.

Early high school start times don’t fit adolescents’ sleep patterns, research shows. “Tor a teenager, a 7 a.m. alarm call is the equivalent of a 5 a.m. start for people in their 50s,” writes Russell Foster in New Scientist. It’s the hormones.

Pushing drugs in school

Diagnosed as hyperactive in first grade, Ted Gup’s son was prescribed Ritalin and Adderall, Gup writes in the New York Times.

In another age, David might have been called “rambunctious.” His battery was a little too large for his body. And so he would leap over the couch, spring to reach the ceiling and show an exuberance for life that came in brilliant microbursts.

When he was older, he sold his Adderall to classmates, who saw it as a performance-enhancing drug.

As a 21-year-old college senior, he was found on the floor of his room, dead from a fatal mix of alcohol and drugs.

“I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable,” writes the grieving father.

Now psychiatrists have defined grief as depression, which “runs the very real risk of delegitimizing that which is most human — the bonds of our love and attachment to one another.”  Gup does not plan to take a pill to dull his grief for his son.

Huck Finn, 2013


– Signe Wilkinson

School is tough? Take a pill

Some doctors are prescribing medication for Attention Deficit Disorder to low-performing children, even if they don’t fit the diagnosis, reports the New York Times. Well, at least one doctor is.

CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

“It is not yet clear whether Dr. Anderson is representative of a widening trend,” reports the Times. That means they could find only one doctor willing to admit he’s handing out ADHD pills as a performance enhancer. However, there’s some evidence that affluent students “abuse stimulants to raise already-good grades in colleges and high schools.”

Are there side effects to these medications? Yes, there are.

Raising the Ritalin generation

We’re way too quick to label active boys as hyperactive, writes Bronwen Hruska in Raising the Ritalin Generation.

Will did not bounce off walls. He wasn’t particularly antsy. He didn’t exhibit any behaviors I’d associated with attention deficit or hyperactivity. He was an 8-year-old boy with normal 8-year-old boy energy — at least that’s what I’d deduced from scrutinizing his friends.

But the third-grade teacher suggested an evaluation.

. . .  once you start looking for a problem, someone’s going to find one, and attention deficit has become the go-to diagnosis, increasing by an average of 5.5 percent a year between 2003 and 2007, according to the Centers for Disease Control and Prevention. As of 2010, according to the National Health Interview Survey, 8.4 percent, or 5.2 million children, between the ages of 3 and 17 had been given diagnoses of attention deficit hyperactivity disorder.

There’s no test for ADHD, she writes. Teachers’ impressions —  they’re asked to rate “squirminess” on a scale of one to five — make a big difference.

Will was diagnosed as being inattentive in distracting situations, such as school, and prescribed Ritalin. “It was not to be taken at home, or on weekends, or vacations. He didn’t need to be medicated for regular life.”

He took the drug in fourth grade and had a great year, but quit in fifth grade. He’s done fine without it. “For him, it was a matter of growing up, settling down and learning how to get organized,” writes Hruska. “Kids learn to speak, lose baby teeth and hit puberty at a variety of ages. We might remind ourselves that the ability to settle into being a focused student is simply a developmental milestone; there’s no magical age at which this happens.”