ADHD and Drug Abuse

Source: Connect with Kids

“In a way that athletes have used steroids and other medications in the past to enhance their athletic performance, Adderall is actually being used to kind of pseudo-enhance their academic performance.”

– Heather Hayes, M.Ed., Counselor.

Nineteen-year-old Marisa McCorkle has been using Adderall for two years.

“I use it for various reasons,” she says, “like tests, it helps me on tests. [And it] helps me stay awake, and [with] studying.”

It sounds like a wonder drug. Adderall – an amphetamine commonly used to treat ADHD. But, studies show it’s being abused more and more.

“In a way that athletes have used steroids and other medications in the past to enhance their athletic performance, Adderall is actually being used to kind of pseudo-enhance their academic performance,” states Heather Hayes, a licensed professional counselor.

One of the biggest problems with using the drug recreationally is that most teens are unaware of its dangers.

Twenty-year-old “Dave,” a college student, says, “I think it’s pretty safe unless you’re taking five at a time.”

But experts say even in small doses, the dangers of taking Adderall can range from headaches, increased heart rate and insomnia to things far worse.

“Any amphetamine has the potential to give someone an amphetamine psychosis,” warns Hayes. “So when you take a lot of amphetamines and you’re not sleeping, then you will literally hallucinate. … [You] will absolutely leave reality and become delusional and paranoid.”

Hayes says parents need to make the dangers of taking Adderall clear to teens. Otherwise, they may continue to believe it’s a cheap and easily available drug that helps them study. Marisa and Dave are examples of students with this belief.

“I get it for free, but I know people who will give … maybe two to five dollars [per pill],” says Marisa.

“Actually, I’m gonna go to my doctor and, uh, try to get a prescription next semester,” says Dave, “’cause I think it’s a really effective way to get good grades. I wouldn’t think it was that hard to, uh, fake having ADD.”

But others say Adderall fools you – that it only seems like it’s helping kids study. Amanda Mattison, 17, has seen first-hand what can happen.

“[Students taking Adderall] can focus when they’re taking it, and they study and they cram for five or six hours and they’re good-to-go for the exam,” she says, “but by the time the exam rolls around, they’re either too worn out or … it’s lost it’s effect.”

“Bottom line,” says Hayes, “Adderall is as dangerous of a drug when unsupervised as any other medication. It’s addictive and it is dangerous.”



Tips for Parents

Adderall, manufactured by Shire Pharmaceuticals Group of the United Kingdom, is a stimulant prescribed for attention-deficit hyperactivity disorder, or ADHD. Shire states, “Adderall isn't intended to enhance test scores and should only be used under medical supervision.”

Adderall is a fast-acting mixture of amphetamines. Amphetamines act on the brain by mimicking the neurotransmitter dopamine, which increases alertness and concentration. Studies conducted by the National Institutes of Health in the late 1970s found that low-dose stimulants increase concentration and alertness in everyone, not just people with attention disorders. Here are some things to know about ADHD:

ADHD is a medical condition linked to a chemical imbalance in the brain. Doctors believe it stems from biological, not environmental, conditions.
Generally, people with ADHD have trouble focusing on tasks or subjects, and they may act impulsively and often get in trouble.
Approximately 3 to 7 percent of school-age children and 4 percent of adults suffer from ADHD.
Adderall is one of a handful of stimulants prescribed for ADHD.
Side effects of Adderall can include loss of appetite, insomnia and weight loss.
During late-night study marathons, students from grade school to med school have long relied on stimulants– which include everything from caffeine to cocaine. But with Adderall, and other similar prescription drugs, some high school and college students are hoping to improve scores on standardized (and even classroom) tests. Other students are turning to alternative medicine, such as hypnosis or herbal supplements, for an extra edge.

The concern with Adderall is not from a single use. One pill won’t kill you. But one pill is likely to lead to a second pill, then a third and a subsequent snowball effect where physical damage can occur. Also, Adderall is relatively easy to obtain. Overall, prescriptions for stimulants have risen from 1.6 million in 2000 to 2.6 million a month in 2004. Adderall XR, a once-a-day, extended-release form of the drug, is the leader in its class, capturing about a third of the market. Consider the following:

Prescription drug use was once rare, but it has now crossed into the mainstream.
Prescriptive amphetamines have figured prominently in calls to emergency departments and poison control centers.
Kids, and even their parents, are desperate for any available academic edge and willing to go to the extreme to obtain it.
Some students feel extra pressure because they feel they are not just failing themselves, but also failing their parents and other family members.
The College Board, the nonprofit administrator of the SAT, has no rules explicitly prohibiting drug use. Spokeswoman Chiara Coletti says, "We certainly do not recommend that students take any drugs or stimulants in hopes of affecting their scores."
Some kids taking Adderall have valid prescriptions, but not all. Under federal law, it's illegal to knowingly possess a "schedule II" drug (like Adderall) without a prescription. But prosecutions for possession are rare.
Many schools would suspend or expel a student caught using marijuana or other street drugs but might not punish students taking prescription drugs to help with test taking.

References
ADHD Support and Resources from Eli Lily
National Institutes of Health
Nature Magazine
Shire Pharmaceuticals Group
TeensHealth
The Wall Street Journal

ADHD Over-Diagnosed

Source Connect with Kids

Looking at her sitting quietly, reading intently; no one would ever think that ten year old Samantha had attention problems. But last year was a different story. Her grades dropped suddenly. She got distracted in class and she struggled to keep up with all of her 4th grade assignments. Her teacher suggested she get tested for ADHD: Attention-Deficit/Hyperactivity Disorder. So her mom took her to a doctor for testing.

“She told me she was borderline ADHD and we were going to go ahead and treat her with 5 milligrams of Adderall,” says Connie Hodges, Samantha’s mother.

Both Samantha and her mom were unhappy with the results. “It was upsetting me because it was like she was drunk. She was moving really slow and just lethargic – just not Samantha,” says Hodges. And Samantha herself agrees. She wasn’t her normal energetic, active self. “It made me just want to sit down in one place,” she says.

So her mom took her to see a specialist for more tests. Dr. Thomas Burns, Director of Neuropsychology at Children’s Healthcare of Atlanta did the testing himself. “We did full cognitive battery of tests to rule out some of those other areas like learning disabilities or behavior problems. She did very well in testing – performed within the expected range – no evidence of any cognitive impairment. And from what I saw, at least in a one-on-one setting, she was certainly able to hold her attention and perform really well,” he says.

Burns says Samantha doesn’t have ADHD and that often, kids are diagnosed with the disorder when, in fact, their attention problems are symptoms of something else.

“It’s important to rule out the learning problems, the emotional, behavioral issues, adjustment concerns – whether it’s a change to a new school, or there might be changes in the family - divorces, deaths – things like that,” he says.

Samantha was easily distracted and had trouble keeping up with multiple assignments. Dr. Burns and her teachers have taught her how to get organized, focus, and complete tasks one at a time.

Samantha says, “They help me learn how to take the right notes and learn how to study right.”

Her mother adds, “I worked with her teacher and her counselor at school. She has taught Samantha how to organize her – not only her book bag, her desk, but her thoughts.”

And it’s working … without medication.

“I’m me again,” says Samantha.

“She’s not struggling like she was last year. She doesn’t hate school anymore. She’s not even the same child she was last year,” says her mother.

Tips for Parents

According to the American Academy of Child and Adolescent Psychiatry, ADHD occurs in 3 to 5 percent of school age children. The following are given as symptoms of ADHD:

Inattention
Distractibility
Impulsivity
Excessive talking
Impatience
A tendency to interrupt or intrude on others
In addition, researchers found that boys with ADHD move two to three times as much and cover four times as much area as normal boys. Girls with ADHD move as frequently but their movements cover a smaller area.

What Parents Need to Know

Since judging the symptoms of ADHD can be very subjective, some children may be diagnosed with ADHD without actually having the disorder. A recent study suggests that parents’ and physicians’ preconceived notions about children’s behavior may interfere with the identification and diagnosis of ADHD and other disorders.

Because this possibility exists, it is very important to find a good pediatrician who will properly diagnose your child and around whom you and your child will feel very comfortable. Experts at BJC HealthCare and Children’s Healthcare of Atlanta suggest keeping the following points in mind when choosing a pediatrician:

Are you more comfortable with a doctor who is no-nonsense and businesslike, or do you need more handholding?

Would you prefer a doctor who sets aside a particular time each day to take phone calls or would you rather contact the office when questions arise and have the doctor return your call between patient visits?

Do you prefer a male or a female pediatrician?

Is age a factor for you? Are you more comfortable dealing with an older or younger doctor?

Are the office hours convenient for you? Do you need evening or weekend hours?

Is the office conveniently located?

How are after-hours calls and emergencies handled?

Do you want a doctor who is board certified or board eligible in pediatrics? (Board eligibility means the doctor has completed training at an accredited medical school and residency program. Board certification in pediatrics means the doctor has completed not only the accredited training but also specialized examinations in pediatric medicine every seven years.)

When you have narrowed down your list of potential pediatricians, you may wish to interview each candidate. This will give you a chance to learn as much as possible about the pediatrician and to evaluate your level of comfort with him/her. Children’s Healthcare of Atlanta suggests asking the following questions during your interview:

How many doctors are in your group?
Has the size of your group changed recently?
What are the special interests of the doctors in your group?
Do you use nurse practitioners? If so, what are their roles?
If your office is very busy and my child needs to be seen today, what is your policy? Will I have a primary doctor, or do I see whoever is handling sick patients that day?
How are calls for advice handled during office hours? What about during evening and weekend hours? What is your philosophy of providing care via the telephone?
What are your average waiting times for scheduling a routine visit? What about after arrival at the scheduled time?
What is your philosophy about discipline? Medication use? Antibiotic use?
How do you handle payment for services?
Will you assist me in evaluating doctors recommended by my health plan?
Until what age will you continue to see my child?
Do you refer only to pediatric specialists?
Do all of the doctors in your group participate in my insurance company or managed care plan’s provider network?
Are you still accepting new patients for my managed care plan?
Once you make your decision, you can take several steps to get the most out of your relationship with your new pediatrician. BJC HealthCare suggests following these rules to make your parent-pediatrician relationship a success:

Know your child’s medications and administer them as prescribed.
Come back for a return visit when you are asked to come back.
Make sure your child is up-to-date on all immunizations.
If you have questions, it might be helpful to write them down and take them with you to the next office visit.
Listen to your pediatrician and take notes if necessary.

Ask questions.

References
American Academy of Child and Adolescent Psychiatry
Children’s Healthcare of Atlanta
BJC Healthcare
Centers for Disease Control and Prevention

ADHD and Heart Problems by Connect with Kids

“The concern is that there is the possibility of sudden cardiac death, although it’s not well-established whether it’s related to the medication or not. But certainly those children who have a history of structural cardiac abnormalities should not be taking this medication.”

– Dr. Richard Winer, M.D., psychiatrist

Approximately 2.5 million American children are on stimulant medication for Attention Deficit Disorder (ADD/ADHD) -- medication that, according to the Food and Drug Administration (FDA), could potentially trigger heart problems. That’s why the American Heart Association has a new recommendation.

Devon, 17, takes the prescription medicine Adderall because she has ADHD -- Attention Deficit Hyperactivity Disorder.

Devon also has a defective valve in her heart.

“I don’t know if my heart condition is going to change or get more serious,” says Devon.

Her mother has the same fear.

“I’ve lived with this all the time, wondering secretly what this medicine was really doing to my child,” says Colleen Baird, Devon’s mother.

Is there a link between ADHD medications and heart problems?

Recent studies show that children on stimulant medication are 20 percent more likely to visit the ER for heart-related problems than kids not on these medications. That’s why the American Heart Association is recommending that every child have an EKG (electrocardiogram) prior to taking stimulants.

“The concern is that there is the possibility of sudden cardiac death, although it’s not well-established whether it’s related to the medication or not. But certainly those children who have a history of structural cardiac abnormalities should not be taking this medication,” says Dr. Richard Winer, M.D., psychiatrist.

Experts agree that any child on medication should be closely monitored by a physician. Experts also say that not all ADHD kids should be taking medication and that there are other treatments. According to Winer, however, medication increases the odds of success.

“There’s always the possibility that a child might be able to function at a decent level using non-pharmacological approaches … but the odds are certainly much greater in favor of a child who actually does utilize medication as long as they’re physically able to do so,” says Winer.

Devon’s mom says it’s a painful dilemma: the medicine helps Devon’s functionality and grades in school, but it may also be damaging her heart.

On the other hand, says her mother, “If she wasn’t on her medication, I’d also live with the other fears, the impulsivity – driving in a car, getting in an accident … doing something that is just as dangerous for her.”

Tips for Parents

Although medication is not the only way to treat Attention Deficit Hyperactivity Disorder (ADHD), the American Academy of Child and Adolescent Psychiatry (AACAP) says research clearly demonstrates that it can be helpful. Stimulant medication can “improve attention, focus, goal directed behavior and organizational skills.”

Other treatment may include cognitive-behavioral therapy, social skills training, parent education and modifications to the child’s educational program. The AACAP says a child who is diagnosed with ADHD and treated appropriately “can have a productive and successful life.”

ADHD occurs in an estimated 3-5 percent of school-age children, beginning before age 7 and sometimes continuing into adulthood. ADHD runs in families with about 25 percent of biological parents also having the disorder. According to the AACAP, a child with ADHD often shows some of the following symptoms:

Trouble paying attention

Inattention to details and makes careless mistakes
Easily distracted
Loses school supplies, forgets to turn in homework
Trouble finishing class work and homework
Trouble listening
Trouble following multiple adult commands
Blurts out answers
Impatience
Fidgets or squirms
Leaves seat and runs about or climbs excessively
Seems "on the go"
Talks too much and has difficulty playing quietly
Interrupts or intrudes on others
The FDA recommends that parents ask the following questions before selecting medication as the best treatment for their child's ADHD:

Will this drug cause a problem with other drugs my child is taking?
Will t his drug affect any other conditions my child has?
How often does my child need to take this medicine?
How many days or weeks does my child need to take this medicine?
What if I miss giving my child a dose of the medication?
How soon will the drug start working?
What side effects does the medicine have?
What should I do if my child begins experiencing any of these side effects?
Should I stop giving my child the medication when my child's behavior starts to improve?

References
American Academy of Child and Adolescent Psychiatry
National Parent Information Network

ADHD is Real by Connect with Kids

“Kindergarten is when we started with the diagnosis. His kindergarten teacher noticed it, said he just couldn’t focus, couldn’t stay on task.”

– Katherine, mother

Hundreds of thousands of kids have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and many are taking stimulant medicine to help them succeed in school. Will these kids have to take pills for the rest of their lives? New research says maybe not.

Nine-year-old Mitchell has ADHD.

“Kindergarten is when we started with the diagnosis. His kindergarten teacher noticed it, said he just couldn’t focus, couldn’t stay on task. So we took him to his pediatrician and he noticed it right in his office and said, ‘Let’s try to get him on some medicine,’” says Katherine, Mitchell’s mother.

Since then, Mitchell has been on a stimulant ADHD medicine. But will he need the medication forever? Not necessarily, according to new research. Researchers at the National Institute of Mental Health performed brain scans of more than 400 children. They found that children with ADHD had a three-year delay in development of the frontal lobe -- the area of the brain responsible for attention and planning.

“This study is important because now it links the behavioral disorder with a more medical or organic finding on brain development. I think it should also help parents to feel that it is a true disorder and is something that we’re trying to treat and to help the children get on task,” says Thomas Burns, Psy.D., Children’s Healthcare of Atlanta.

What’s more, says Burns, that three-year delay means some children with ADHD may outgrow their disorder.

“There’s a subset of kids that appear to catch up over time and for those children, it would fit with a small subset of the kids diagnosed with ADHD that appear to grow out of it in their teens,” says Burns.

Mitchell hopes he’s one of those kids.

“I think I might outgrow it,” says Mitchell.

”Yes, I’m thinking with our help we can overcome it and eventually get him off the medicine,” says Katherine.

Tips for Parents

Children with ADHD have impaired functioning in multiple settings, including home, school and relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood. (National Institute of Mental Health, NIMH)

NIMH reports that symptoms of ADHD will appear over the course of many months, and include:

Impulsiveness: a child who acts quickly without thinking first.

Hyperactivity: a child who can't sit still; walks, runs or climbs around when others are seated; talks when others are talking.

Inattention: a child who daydreams or seems to be in another world, is sidetracked by what is going on around him or her.

If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists, and clinical social workers. (NIMH)

For children with ADHD, no single treatment is the answer for every child. A child may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. And if a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best. Each child’s needs and personal history must be carefully considered. (NIMH)

Some people get better results from one medication, some from another. It is important to work with the prescribing physician to find the right medication and the right dosage for your child. For many people, the stimulants dramatically reduce hyperactivity and impulsivity and improve their ability to focus, work and learn. The medications may also improve physical coordination, such as that needed in handwriting and in sports. (NIMH)

References

National Institute of Mental Health (NIMH)
Children’s Healthcare of Atlanta