Medication: The smart-pill oversell

Unlock-Your-PotentialGiven the simultaneous explosion in ADHD diagnosis, prescribed use of stimulants and non-medical use of stimulants, maybe it’s time to look at the cost/benefit ratio. We’ll it’s clear that the benefits aren’t all that. What to make of it?

Researchers are beginning to address this paradox. How can medication that makes children sit still and pay attention not lead to better grades?

One possibility is that children develop tolerance to the drug. Dosage could also play a part: as children grow and put on weight, medication has to be adjusted to keep up, which does not always happen. And many children simply stop taking the drugs, especially in adolescence, when they may begin to feel that it affects their personalities. Children may also stop treatment because of side effects, which can include difficulty sleeping, loss of appetite and mood swings, as well as elevated heart rate.

Or it could be that stimulant medications mainly improve behaviour, not intellectual functioning. In the 1970s, two researchers, Russell Barkley and Charles Cunningham, noted that when children with ADHD took stimulants, parents and teachers rated their academic performance as vastly improved9. But objective measurements showed that the quality of their work hadn’t changed. What looked like achievement was actually manageability in the classroom. If medication made struggling children appear to be doing fine, they might be passed over for needed help, the authors suggested. Janet Currie, an economist at Princeton University in New Jersey, says that she might have been observing just such a phenomenon in the Quebec study that found lower achievement among medicated students1.

And it may simply be that drugs are not enough. Stimulant medications have two core effects: they help people to sustain mental effort, and they make boring, repetitive tasks seem more interesting. Those properties help with many school assignments, but not all of them. Children treated with stimulants would be able to complete a worksheet of simple maths problems faster and more accurately than usual, explains Nora Volkow. But where flexibility of thought is required — for example, if each problem on a worksheet demands a different kind of solution — stimulants do not help.

What about those non-medical users? Don’t they get a boost?

In people without ADHD, such as students who take the drugs without a prescription to help with school work, the intellectual impact of stimulants also remains unimpressive. In a 2012 study of the effects of the amphetamine Adderall on people without ADHD, psychologists at the University of Pennsylvania in Philadelphia found no consistent improvement on numerous measures of cognition, even though people taking the medication believed that their performance had been enhanced10.

via Medication: The smart-pill oversell : Nature News & Comment.

Could ADHD Meds Promote Future Cocaine Use?

 

State-based Prevalence Data of all Children Receiving ADHD Medication Treatment (2011 - 2012)
State-based Prevalence Data of all Children Receiving ADHD Medication Treatment (2011 – 2012)

Boston University recently posted a series on their own addiction research. One examined whether there is a relationship between taking ADHD meds and future cocaine use.

 

The results of Kantak’s research could present a dual cautionary tale for adolescents diagnosed with ADHD. “If they’re an adolescent getting a stimulant medication, and they’re properly diagnosed, the medication may put them at increased risk” for cocaine use as an adult, Kantak says. “If they’re misdiagnosed, and get Strattera, this may also be putting them at greater risk…of acquiring an addiction to cocaine.”

Kantak’s bottom line? She thinks adolescents properly diagnosed with ADHD should take either Strattera or another nonstimulant medication, while those whose diagnosis is doubtful would be wise to stay away from Strattera. She also believes pediatricians need to be especially careful when arriving at diagnoses. At the same time, she cautions parents who may see certain symptoms and “convince themselves that their child has ADHD, while what they really want is to give them a better competitive edge.” That edge could have dire circumstances down the line.

 

This is especially concerning, given the high rates of ADHD diagnosis. From the CDC:

 

  • Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011.
  • The percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011.
  • Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
  • Prevalence of ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.

 

via The Addiction Puzzle, Part 2: Could ADHD Meds Promote Future Cocaine Use? | BU Today | Boston University.

 

 

 

Diagnosing ADHD in detox?

fear_false_evidence_appearing_realUnreal. Someone’s got an awful lot of faith in their diagnostic skills. Diagnosing ADHD with addicts in a detox unit? Really?

And, now that it’s published, it’s “evidence”.

Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units

Background

ADHD is a common childhood onset mental health disorder that persists into adulthood in two-thirds of cases. One of the most prevalent and impairing comorbidities of ADHD in adults are substance use disorders. We estimate rates of ADHD in patients with substance abuse disorders and delineate impairment in the co-morbid group.

Method

Screening for ADHD followed by a research diagnostic interview in people attending in-patient drug and alcohol detoxification units.

Results

We estimated prevalence of undiagnosed ADHD within substance use disorder in-patients in South London around 12%. Those individuals with substance use disorders and ADHD had significantly higher self-rated impairments across several domains of daily life; and higher rates of substance abuse and alcohol consumption, suicide attempts, and depression recorded in their case records.

Conclusions

This study demonstrates the high rates of untreated ADHD within substance use disorder populations and the association of ADHD in such patients with greater levels of impairment. These are likely to be a source of additional impairment to patients and represent an increased burden on clinical services.

ADHD overdiagnosed

Symptoms of ADHD described by the literature
Symptoms of ADHD described by the literature (Photo credit: Wikipedia)

A recent study look at diagnostic reliability of ADHD:

RESULTS: Many mental health practitioners seem to proceed heuristically and base their decisions on unclear rules of thumb. The respondents more readily diagnosed ADHD when the case involved a male patient and presented prototypical symptoms, such as impulsiveness, motoric restlessness, and lack of concentration. They were, for instance, twice more likely to conclude ADHD with the boy version of the vignettes than with the girl vignettes. Interestingly, even the therapist’s gender played a role in the diagnostic as male doctors diagnosed ADHD more frequently than their female counterparts.

CONCLUSION: ADHD is over-diagnosed because doctors rely too much on their intuition and not on defined, established diagnostic criteria.