[Vision2020] Ritalin Gone Wrong

Sun Jan 29 12:57:19 PST 2012

This is fascinating, Wayne.  I've often wondered if ADHD and ADD are over-diagnosed and/or improperly treated.  This suggests that's the case.  

I do remember my son's Co-op preschool teacher asking me if we could "have a conversation about his behavior," which puzzled me, as I was watching him interact well with the other kids and adults, and was, if anything, wondering if he was perhaps a little too compliant and mellow.  But she had a son with ADHD whose behavior she often used as a cautionary tale for all of us moms, and so she "knew"  what his problem was.

Which, it turns out, was that she had called our house a few days before and spoken to our son, and he forgot to tell me.  He was four.

Yeah, we had our conversation about his behavior.  It didn't go very well from my end, and Miss Holly probably still remembers Anthony's mommy going more than a little batshit angry on her . . . 

But, of course, that's just me.  And it turns out the kid never once had a behavior problem in school or out, and tomorrow begins his first teaching job in the Issaquah (WA) School District.

Keely
www.keely-prevailingwinds.com

Date: Sun, 29 Jan 2012 11:16:15 -0800
From: art.deco.studios at gmail.com
To: vision2020 at moscow.com
Subject: [Vision2020] Ritalin Gone Wrong

January 28, 2012

Ritalin Gone Wrong
    By L. ALAN SROUFE

THREE million children in this country take drugs for problems in 
focusing. Toward the end of last year, many of their parents were deeply
 alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning.        

But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?        

In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.        

As a psychologist who has been studying the development of troubled 
children for more than 40 years, I believe we should be asking why we 
rely so heavily on these drugs.        

Attention-deficit drugs increase concentration in the short term, which 
is why they work so well for college students cramming for exams. But 
when given to children over long periods of time, they neither improve 
school achievement nor reduce behavior problems. The drugs can also have
 serious side effects, including stunting growth.        

Sadly, few physicians and parents seem to be aware of what we have been 
learning about the lack of effectiveness of these drugs.        

What gets publicized are short-term results and studies on brain 
differences among children. Indeed, there are a number of 
incontrovertible facts that seem at first glance to support medication. 
It is because of this partial foundation in reality that the problem 
with the current approach to treating children has been so difficult to 
see.        

Back in the 1960s I, like most psychologists,
 believed that children with difficulty concentrating were suffering 
from a brain problem of genetic or otherwise inborn origin. Just as Type
 I diabetics need insulin to correct problems with their inborn 
biochemistry, these children were believed to require attention-deficit 
drugs to correct theirs. It turns out, however, that there is little to 
no evidence to support this theory.        

In 1973, I reviewed the literature on drug treatment of children for The
 New England Journal of Medicine. Dozens of well-controlled studies 
showed that these drugs immediately improved children’s performance on 
repetitive tasks requiring concentration and diligence. I had conducted 
one of these studies myself. Teachers and parents also reported improved
 behavior in almost every short-term study. This spurred an increase in 
drug treatment and led many to conclude that the “brain deficit” 
hypothesis had been confirmed.        

But questions continued to be raised, especially concerning the drugs’ 
mechanism of action and the durability of effects. Ritalin and Adderall,
 a combination of dextroamphetamine and amphetamine,
 are stimulants. So why do they appear to calm children down? Some 
experts argued that because the brains of children with attention 
problems were different, the drugs had a mysterious paradoxical effect 
on them.        

However, there really was no paradox. Versions of these drugs had been 
given to World War II radar operators to help them stay awake and focus 
on boring, repetitive tasks. And when we reviewed the literature on 
attention-deficit drugs again in 1990 we found that all children, 
whether they had attention problems or not, responded to stimulant drugs
 the same way. Moreover, while the drugs helped children settle down in 
class, they actually increased activity in the playground. Stimulants 
generally have the same effects for all children and adults. They 
enhance the ability to concentrate, especially on tasks that are not 
inherently interesting or when one is fatigued or bored, but they don’t 
improve broader learning abilities.        

And just as in the many dieters who have used and abandoned similar 
drugs to lose weight, the effects of stimulants on children with 
attention problems fade after prolonged use. Some experts have argued 
that children with A.D.D. wouldn’t develop such tolerance because their brains were somehow different. But in fact, the loss of appetite and sleeplessness
 in children first prescribed attention-deficit drugs do fade, and, as 
we now know, so do the effects on behavior. They apparently develop a 
tolerance to the drug, and thus its efficacy disappears. Many parents 
who take their children off the drugs find that behavior worsens, which 
most likely confirms their belief that the drugs work. But the behavior 
worsens because the children’s bodies have become adapted to the drug. 
Adults may have similar reactions if they suddenly cut back on coffee, 
or stop smoking.        

TO date, no study has found any long-term benefit of attention-deficit 
medication on academic performance, peer relationships or behavior 
problems, the very things we would most want to improve. Until recently,
 most studies of these drugs had not been properly randomized, and some 
of them had other methodological flaws.        

But in 2009, findings were published from a well-controlled study that 
had been going on for more than a decade, and the results were very 
clear. The study randomly assigned almost 600 children with attention 
problems to four treatment conditions. Some received medication alone, 
some cognitive-behavior therapy alone, some medication plus therapy, and
 some were in a community-care control group that received no systematic
 treatment. At first this study suggested that medication, or medication
 plus therapy, produced the best results. However, after three years, 
these effects had faded, and by eight years there was no evidence that 
medication produced any academic or behavioral benefits.        

Indeed, all of the treatment successes faded over time, although the 
study is continuing. Clearly, these children need a broader base of 
support than was offered in this medication study, support that begins 
earlier and lasts longer.        

Nevertheless, findings in neuroscience are being used to prop up the 
argument for drugs to treat the hypothesized “inborn defect.” These 
studies show that children who receive an A.D.D. diagnosis have 
different patterns of neurotransmitters in their brains and other 
anomalies. While the technological sophistication of these studies may 
impress parents and nonprofessionals, they can be misleading. Of course 
the brains of children with behavior problems will show anomalies on 
brain scans. It could not be otherwise. Behavior and the brain are 
intertwined. Depression also waxes and wanes in many people, and as it 
does so, parallel changes in brain functioning occur, regardless of 
medication.        

Many of the brain studies of children with A.D.D. involve examining 
participants while they are engaged in an attention task. If these 
children are not paying attention because of lack of motivation or an 
underdeveloped capacity to regulate their behavior, their brain scans 
are certain to be anomalous.        

However brain functioning is measured, these studies tell us nothing 
about whether the observed anomalies were present at birth or whether 
they resulted from trauma, chronic stress or other early-childhood 
experiences. One of the most profound findings in behavioral 
neuroscience in recent years has been the clear evidence that the 
developing brain is shaped by experience.        

It is certainly true that large numbers of children have problems with 
attention, self-regulation and behavior. But are these problems because 
of some aspect present at birth? Or are they caused by experiences in 
early childhood? These questions can be answered only by studying 
children and their surroundings from before birth through childhood and adolescence, as my colleagues at the University of Minnesota and I have been doing for decades.        

Since 1975, we have followed 200 children who were born into poverty and
 were therefore more vulnerable to behavior problems. We enrolled their 
mothers during pregnancy,
 and over the course of their lives, we studied their relationships with
 their caregivers, teachers and peers. We followed their progress 
through school and their experiences in early adulthood. At regular 
intervals we measured their health, behavior, performance on 
intelligence tests and other characteristics.        

By late adolescence, 50 percent of our sample qualified for some 
psychiatric diagnosis. Almost half displayed behavior problems at school
 on at least one occasion, and 24 percent dropped out by 12th grade; 14 
percent met criteria for A.D.D. in either first or sixth grade.        

Other large-scale epidemiological studies confirm such trends in the 
general population of disadvantaged children. Among all children, 
including all socioeconomic groups, the incidence of A.D.D. is estimated
 at 8 percent. What we found was that the environment of the child 
predicted development of A.D.D. problems. In stark contrast, measures of
 neurological anomalies at birth, I.Q. and infant temperament — 
including infant activity level — did not predict A.D.D.        

Plenty of affluent children are also diagnosed with A.D.D. Behavior 
problems in children have many possible sources. Among them are family 
stresses like domestic violence, lack of social support from friends or 
relatives, chaotic living situations, including frequent moves, and, 
especially, patterns of parental intrusiveness that involve stimulation 
for which the baby is not prepared. For example, a 6-month-old baby is 
playing, and the parent picks it up quickly from behind and plunges it 
in the bath. Or a 3-year-old is becoming frustrated in solving a 
problem, and a parent taunts or ridicules. Such practices excessively 
stimulate and also compromise the child’s developing capacity for 
self-regulation.        

Putting children on drugs does nothing to change the conditions that 
derail their development in the first place. Yet those conditions are 
receiving scant attention. Policy makers are so convinced that children 
with attention deficits have an organic disease that they have all but 
called off the search for a comprehensive understanding of the 
condition. The National Institute of Mental Health finances research 
aimed largely at physiological and brain components of A.D.D. While 
there is some research on other treatment approaches, very little is 
studied regarding the role of experience. Scientists, aware of this 
orientation, tend to submit only grants aimed at elucidating the 
biochemistry.        

Thus, only one question is asked: are there aspects of brain functioning
 associated with childhood attention problems? The answer is always yes.
 Overlooked is the very real possibility that both the brain anomalies 
and the A.D.D. result from experience.        

Our present course poses numerous risks. First, there will never be a 
single solution for all children with learning and behavior problems. 
While some smaller number may benefit from short-term drug treatment, 
large-scale, long-term treatment for millions of children is not the 
answer.        

Second, the large-scale medication of children feeds into a societal 
view that all of life’s problems can be solved with a pill and gives 
millions of children the impression that there is something inherently 
defective in them.        

Finally, the illusion that children’s behavior problems can be cured 
with drugs prevents us as a society from seeking the more complex 
solutions that will be necessary. Drugs get everyone — politicians, 
scientists, teachers and parents — off the hook. Everyone except the 
children, that is.        

If drugs, which studies show work for four to eight weeks, are not the 
answer, what is? Many of these children have anxiety or depression; 
others are showing family stresses. We need to treat them as 
individuals.        

As for shortages, they will continue to wax and wane. Because these 
drugs are habit forming, Congress decides how much can be produced. The 
number approved doesn’t keep pace with the tidal wave of prescriptions. 
By the end of this year, there will in all likelihood be another 
shortage, as we continue to rely on drugs that are not doing what so 
many well-meaning parents, therapists and teachers believe they are 
doing.        

L. Alan Sroufe is a professor emeritus of psychology at the University of Minnesota’s Institute of Child Development.	

-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com

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