Take a Pill

ADHD medsGrowing up, this was an expression people used in jest. It started with some variation of, “Dude, take a chill pill.” and eventually was reduced to simply, “Take a pill.” Unfortunately, someone, or perhaps many someones, seem to have taken this to heart.

I work as a pediatric speech-language pathologist. My caseload is comprised of children from one to five years old and I am alarmed by the number of children on my caseload who are taking prescription medication for A.D.H.D. I decided to do a bit of research this week and discovered that:

~ 11% of school-age children had a diagnosis of A.D.H.D. as of 2011 (that’s about 6.4 million children)
~ About 2/3 of the children with a current diagnosis were reportedly taking a prescription A.D.H.D. medication in the United States
~ 1 in 5 High School age boys had a diagnosis of A.D.H.D.
~ 1 in 10 High School age boys with a current diagnosis took A.D.H.D. medication

(These numbers may have changed since 2011, but these are the most recent statistics reported by the CDC)

A quote from this article in The New York Times states: “even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis.” (and therefore the treatment)

I can confirm that some changes to the definition did take place when the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders was released in May 2013. Here’s a quote from the American Psychiatric Association DSM-5 Development website:

Attention Deficit/Hyperactivity Disorder
The definition of attention-deficit/hyperactivity disorder (ADHD) has been updated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) to more accurately characterize the experience of affected adults. This revision is based on nearly two decades of research showing that ADHD, although a disorder that begins in childhood, can continue through adulthood for some people. Previous editions of DSM did not provide appropriate guidance to clinicians in diagnosing adults with the condition. By adapting criteria for adults, DSM-5 aims to ensure that children with ADHD can continue to get care throughout their lives if needed.

You can see the full fact sheet here here.

One thing that I find most interesting is that the DSM-5 fact sheet clearly states that the characteristics of A.D.H.D. must be present in a variety of settings, yet I am aware of cases in which children have been prescribed medication without input from the classroom teachers or other outside sources.

It takes a lot to really make my blood boil, but when I see children being given medication at FOUR YEARS OLD without families being required to try other alternatives first, it makes me angry. There are certainly cases in which medication is warranted however, I too often see medication a) being used in place of educating families on the effects of diet, exercise, and irregular sleep schedules b) purely out of convenience or c) prescribed and then not given according to the required schedule.

In most situations, I can empathize with parents. Parenting is hard and when families have multiple children as well as unstable financial or living situations, they are seeking help. They need some kind of relief, and perhaps they see this relief in the form of a pill that will get their children to behave or to sleep. I can certainly understand the desire to go with the easy fix, or the solution that worked for a friend’s kid so maybe it will work for mine. I have a much harder time understanding why these medications are being so readily given by physicians, especially to four-year-old children. (I am referring to cases of overuse here, not situations of legitimate need.)

Perhaps the doctor is feeling pressured by the parent’s continued demands. Perhaps the parent knows exactly how to answer all of the questions, or their perception of the child’s behavior is elevated based on the general stress in their life. Quite frankly I see it as negligence when a child is prescribed a potentially addictive and life-long medication without trying other alternatives while simultaneously seeking extensive input from multiple sources as well as conducting multiple lengthy observations of the child in question. Period.

If a parent reports his or her child can’t sit still, won’t behave, and doesn’t sleep well, any doctor, therapist, teacher, or outside support staff person’s first reaction should be to tell the parent to eliminate all candy, kool-aid, and soda from the child’s diet and make sure that they play outside or do something active for at least 30 minutes to an hour every day for several weeks, and see what happens. If a family is unwilling to take some responsibility in the health of their child, a physician should be unwilling to prescribe medication to a four-year-old. If the family is unable to make these changes, then this must be taken into consideration however, alternatives should be the first step.

In the previously cited 2013 New York Times article Dr. Frieden, the director of the C.D.C, was quoted as saying, “We need to ensure balance. The right medication for A.D.H.D., given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”

I do believe, as Dr. Frieden states, that in some cases medication is necessary and can be life changing. I am thankful that there is help for those individuals and families who have tried everything else and genuinely require a medical solution.

These are children’s lives we are dealing with; children who will potentially grow up chemically dependent in order to function in day to day life. We have no idea what the long term consequences will be of a generation of individuals growing up medicated, but the thought of that future scares me.

What are your thoughts?

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7 Responses to Take a Pill

  1. Lisa Russell says:

    I completely agree with you Nicole, alternatives should be tried first. But, unfortunately we have become a society of the easy fix. If you can take a pill to fix the problem why wouldn’t you over doing the hard alternative of denying your child something, candy or soda, that they want and will pitch a fit to get. There is a time and place for meds and everything should be tried first.

    • Nicole says:

      I do wish, especially with the really young children, that it was standard procedure to have a checklist of all the alternatives that must be tried before writing a prescription, unless there is significant documented evidence from multiple sources that medication is immediately necessary. One article that I read said that France had an incidence of less than .1% of cases of ADHD. I don’t see how anyone can look at that, compared to the U.S., and say that diet and lifestyle won’t make a difference.

      • Lisa Russell says:

        Agreed. I believe that the rise of many of these issues, ADHD, autism etc have to do with things we put in food, soda, artificial colors…..the list goes on. Also our changing environment may have an impact. Not enough time is put into the why.

  2. Donna says:

    It seems everyone needs a basic class in elementary/middle school on eating right and exercise. We were never intended to sit for long periods anyway..kids are being kids. You can’t even get adults to eat right/exercise..things are quite a mess, no wonder kids are messed up. I would expect more from the Drs. who treat these kids. Keep advocating for the kids.

    • Nicole says:

      I will try! It’s frustrating when I don’t have any authority, really, to advocate for individual students unless someone asks for my input or documentation. Some health and wellness education built into the curriculum at every grade level would be a great idea!

  3. ddfalvo says:

    This is such a difficult subject to weigh in on, Nicole. There is too little education about health, nutrition, and medicine in general. I try hard to walk a line between Western and Holistic medicine, and I’m very opinionated about what should/shouldn’t go into my body. Have some strong feelings about an environment that interferes with the way our bodies were created to function. EMFs, processed food, too much time indoors, and way too many chemicals are altering us with each generation.

    I wish all parents approached the idea of medicating children with extreme caution. There are times when it’s necessary, but as you stated, to often it becomes an easy fix.

    I just wish the general public really understood the pros and cons of pharmaceutical choices and the importance of treating the whole body instead a symptom.
    Does anyone really listen to those commercials that quickly state all the horrific side effects of the drug advertised?
    So many issues can be resolved with proper diet and nutrition, and a gentle holistic nudge. In other instances, the need for drugs is absolutely the right choice, but we need to be aware of which is which.

    Love that you are channeling your concern into a conversation. Hopefully the ones who need to hear it are listening. <3

    • Nicole says:

      I also have very strong opinions about nutrition, exercise, and reducing the load of environmental toxins in our bodies. We are being affected by the chemicals in our food and environment, and our children are suffering. I debated for a long time about whether or not to post this, and tried to word everything carefully. I don’t want to judge the individuals, families, or doctors who are doing their best and really need medication. Unfortunately, I see the system being abused. I also read that some kids are sharing or selling their meds at school, and that in some places ADHD meds are being used to increase focus and performance for individuals who do not have a diagnosis. I believe in prevention and I completely agree that the vast majority of the health, and perhaps even mental health, issues in our society could be alleviated by changes in diet and lifestyle. Instead, we keep adding new “fixes” and it’s becoming a dangerous spiral. I appreciate your thoughts and I hope we see some positive changes in our lifetime.

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