Even as a first-time mom, the Silver Spring woman knew her infant son had difficulty paying attention. “His hearing was fine,” says Kathryn, who asked that her last name not be used, “but at times he was so distracted he didn’t even turn around to respond to my voice.”
When her son, Seth, began attending school, he’d shout comments out of turn and interrupt people, and he wouldn’t stay in his seat or complete his work. “I was called several times by the school because of Seth’s disruptive behavior, which was very upsetting and embarrassing for me,” Kathryn says. “But because he is bright, it was unclear whether he was bored or had Attention Deficit Hyperactivity Disorder [ADHD].”
Although her pediatrician recommended ADHD medication because of the classroom problems, “I was against using medication for my son,” she says. “I did not want to give him the message that he should turn to drugs to solve his problems. We were determined to use alternative treatments.”
Kathryn and her husband tried an allergy elimination diet, removing foods such as wheat products to assess whether Seth’s behavior would improve, and established rewards and consequences for his classroom behavior. But by fourth grade, Seth had hit a wall.
“Even with all of our efforts, he still couldn’t control his impulsivity,” Kathryn says. “We finally decided in 2006 to put him on the stimulant medication Adderall.”
The first day Seth took the drug, he told his mother, “School was different today. I used to be a bad boy. Now I’m a good boy, and I don’t even have to try.”
Stimulants have been used to treat ADHD since the late 1930s, just a few decades after the cluster of symptoms associated with the disorder were formally identified. It wasn’t until 1987, however, that the American Psychiatric Association deemed ADHD a medical, rather than purely psychological, disorder.
From 1997 to 2006, the diagnosis of ADHD in children increased an average of 3 percent per year. And with Ritalin, Concerta and Adderall widely prescribed to treat it since the late 1990s, there has been a growing perception that children are being overdiagnosed and unnecessarily medicated, in part to give them a leg up in an unrelenting culture of achievement. Some critics believe this has led to a “Ritalin Nation.” In 2007, the play Distracted dealt with just this theme, prompting columnist Arianna Huffington to write that “we are in the midst of a legal-drugging epidemic.”
Dr. Larry Silver is a Rockville-based child and adolescent psychiatrist, clinical professor of psychiatry at Georgetown University Medical Center and the author of 12 books, including The Misunderstood Child. He says that ADHD is caused by a deficiency of the neurotransmitter norepinephrine, which affects the parts of the brain that regulate attention and response. People don’t outgrow ADHD, Silver adds; they “just mature and adapt.”
“When you have ADHD, you have a Ferrari engine for a brain, but you only have bicycle brakes to focus it,” says Dr. Edward Hallowell, a nationally recognized child and adolescent psychiatrist based in Boston and author of several books about ADHD, including Delivered From Distraction (Ballantine Books, 2005). “ADHD is a weakening of the inhibitory circuits of the brain. Treatment such as medication focuses on strengthening the brakes.”
In a 2006 summary, the Centers for Disease Control and Prevention (CDC) reported that 3 percent to 7 percent of school-age children have been diagnosed with ADHD. An earlier CDC survey suggested that about 56 percent of those diagnosed take medication for the disorder. Many experts believe, however, that ADHD is significantly under-diagnosed, particularly among girls, whose symptoms are often “quieter” and less disruptive.
Diagnosing ADHD can be complicated—it involves cognitive testing and observation to rule out learning disabilities—and it can be missed altogether until adolescence or adulthood. Adding to the difficulty of diagnosis and the need for a comprehensive assessment is the fact that other disorders often exist alongside ADHD. “If you have ADHD, there is a 50 percent greater likelihood than someone without ADHD that you will also have a learning disability, anxiety, depression or obsessive-compulsive disorder,” Silver says.
He points to three major criteria for identifying and diagnosing the disorder: fidgetiness, inattention or distractibility, and impulsivity, all of which must be chronic and pervasive by age 7. (In cases where hyperactivity is not a significant symptom, children may be diagnosed with Attention Deficit Hyperactivity Disorder-Inattentive Type, commonly known as ADD.)
It took Silver Spring parent Andrea Kibbe years to get an accurate diagnosis for her 14-year-old son, Sawyer.
“When Sawyer was 3, he was diagnosed with sensory integration dysfunction. He got lots of treatment, such as speech therapy and occupational therapy,” she says. “By the time he was in third grade, while he was still struggling with sensory integration problems, a Montgomery County Public Schools psychologist suggested that he also had ADHD.”
Kibbe initially resisted the diagnosis. But once a psychiatrist confirmed it, she had to confront the issue of treatment.
“I never thought that we would use medication,” she says, “because I always thought we could teach him ways to manage rather than fixing it with a pill. But we saw how he was suffering, which included being bullied at school.”
Once Sawyer started taking Ritalin, he began participating more in class, she says, and his concentration, confidence and grades improved.
With success stories such as his, it’s little wonder that one Chevy Chase mother felt intense pressure to medicate her 13-year-old. “Our son was diagnosed with ADHD-Inattentive Type a number of years ago,” says the woman, who asked not to be identified. “We have been bombarded since then with recommendations from teachers, educational professionals, a psychiatrist and well-meaning neighbors that we put him on Adderall. My husband and I did not want to go that route. We tried neurofeedback for a few months, and it seems to have helped with his ability to focus.”
But “it is heartbreaking to see your child struggle,” she says. “I understand why so many people turn to medication. We still wonder if we should medicate our son from time to time—at least I do—but we’re committed to helping him forge his place in the world without turning to drugs. But when I hear other parents tell me that their child has thanked them for putting them on the medication, I question our decision.”
Judith Warner, the Washington, D.C., author of We’ve Got Issues: Children and Parents in the Age of Medication (Riverhead Books, 2010), thinks “many people, unless they are dealing with schizophrenia or very serious depression, feel that psychiatric drugs are optional.”
Karin Torrez of Silver Spring initially did. Her 13-year-old, Pablo, was diagnosed with ADHD at age 11. “I was one of those parents who always said that I would never give my children pills,” Torrez says. “But with medication, which includes Concerta and [the antidepressant] Prozac, my son’s life is so much better. Now he can control his behavior and has better relationships with his peers.”
Medications used to treat ADHD, such as Ritalin, are administered as a pill one to three times a day, depending on the type of stimulant and the child’s needs. The most common side effects include sleeplessness and loss of appetite. But another, more disturbing side effect has been observed, as well.
