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Who Needs Stimulants for ADHD?


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Ritalin. Courtesy of en:User:Sponge via Wikimedia Commons.

In 1970, 150,000 U.S. children were taking stimulant medications. By 2007, that number had risen to 2.7 million, according to pediatrician Sanford Newmark of the University of California, San Francisco. In the video embedded in this post, titled “Do 2.5 Million Kids Really Need Ritalin?” Newmark analyzes the reasons behind the rise in prescriptions, which follows the sharp climb in diagnoses for attention-deficit hyperactivity disorder (ADHD). He also makes a case for fewer scripts, detailing the downsides of these medications and suggesting alternative remedies for ADHD, including changes in diet, supplements, as well as parenting, school and lifestyle interventions. Here are some highlights of Newmark’s talk, along with time stamps indicating when to watch.

2:30- The use of stimulants and the number of kids diagnosed with ADHD have both exploded in recent years; the diagnostic rate and percentage of kids medicated for the disorder differs from state to state, indicating variability in criteria for diagnosing ADHD.

5:02 – What is ADHD? Its defining features are hyperactivity, inattention and impulsivity. In a correct diagnosis, a patient’s symptoms cause impairment in more than one setting—both home and school, for example. Significant deficits should be evident; concentration and impulsivity levels vary normally across the population. If a kid is hyperactive and impulsive but she’s getting great grades and everything is going well, that is not ADHD, Newmark says.

Twin studies show that 70 percent of the incidence of ADHD can be traced to genetics, but no one has identified a specific gene or set of genes responsible for the disorder. Certain environmental influences can also trigger or worsen the condition.

10:33 – The rise in stimulant prescriptions for ADHD could result from four factors.

  • Many children with ADHD went unrecognized in the past. We are better at spotting the disorder today. Newmark believes this is true. Some of the kids who were labeled “stupid” or delinquent decades ago might have had ADHD.
  • We have loosened the definition of ADHD. This is true, says Newmark. In the past, the only kids who received an ADHD diagnosis were so hyperactive they essentially tore apart the doctor’s office as soon as they arrived. Today, kids who can’t focus qualify for the diagnosis as does the preschool kid who can’t sit still at story time.
  • Even with loosened definition, we are diagnosing too many children. Often diagnoses are handed out cavalierly after a brief evaluation, Newmark says. He says that the diagnostic procedure should include an hour visit with the child and an hour follow-up, including interviews with parents and teachers.
  • More people now have ADHD. Our genes haven’t changed but our environment has. Newmark argues that toxins in the prenatal and postnatal environment along with increased TV exposure and stressed parents can spawn symptoms.

22:50 – Why don’t we just take a pill? Stimulants are effective about 70 percent of the time, in the short term, at least. Some kids need them. But they have side effects, principally slowed growth. One in 100 individuals also experience hallucinations while on the drugs. In Newmark’s experience, the drugs seem to sometimes lead to personality changes, too. Over the long term, the drugs’ effects are unclear, although animal studies suggest possible additional harms.

29:30 – What is an integrative approach to ADHD? A doctor considers a child in the context of his or her home, friends, school and community—and not just as a set of symptoms. From that vantage point, a physician can often find nondrug interventions involving changes in diet, lifestyle, schooling and family dynamics.

30:34 – Diet is important. A lot of kids are sensitive to certain foods. In some cases, eating these foods cause behavior changes. Studies have shown that restricted diets can lead to improvements in ADHD symptoms that are comparable to those achieved by taking stimulants. Processed sugar and red food die are common culprits.

What kids eat for breakfast can make a big difference in their thought and behavior. Breakfasts composed of white flour or simple sugars (think, waffles and syrup) have a high glycemic index, which means that they cause blood sugar to rapidly rise–and later plummet, making kids jittery and inattentive around 10am. Fat and fiber slow down this process, so breakfast should include unprocessed cereal with some fat, such as low-fat milk or peanut butter. Kids perform better when they eat a breakfast that has a low glycemic index.

Some studies also suggest that supplementing a child’s diet with omega-3 fatty acids, iron (when it is deficient) or zinc can diminish symptoms.

45:16 – Parenting and school interventions can help. Many parents do not know how to parent a child with ADHD. One behavioral approach focuses on positive feedback and consequences given without emotion. At school, Newmark recommends reasonable modifications such as more time to take tests, abbreviated tests or seating changes.

49:12 – Alternative therapies may include herbal remedies, yoga, hypnosis and exercise. Among herbs, valerian and lemon balm can have a calming effect on children, though they do not improve focus. A computer program called Cogmed trains working memory in kids with ADHD, boosting their cognitive capacity. Newmark strongly recommends decreasing the use of electronic media and adding exercise to a child’s daily routine.

54:10 – How does Newmark treat ADHD? He cleans up the diet, checks for deficiencies in iron and other nutrients and suggests parenting, school and lifestyle changes. Then, if necessary, he prescribes stimulants. Yet if kid has real problems—say, he’s about to get kicked out of school—stimulants may have to come first.

For more about alternative therapies for ADHD, see “Can ADHD Be Prevented?.” >>

Video Credit: University of California Television (UCTV)

Ingrid Wickelgren About the Author: Ingrid Wickelgren is an editor at Scientific American Mind, but this is her personal blog at which, at random intervals, she shares the latest reports, hearsay and speculation on the mind, brain and behavior. Follow on Twitter @iwickelgren.

The views expressed are those of the author and are not necessarily those of Scientific American.



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  1. 1. Jerzy v. 3.0. 4:49 am 02/14/2014

    ADHD and drugging children are seen, outside USA, as a strange and cruel custom of Americans.

    Worldwide, a child which cannot concentrate and keep calm is forced to. And finally learns. For concentration is, foremost, a vital skill for itself.

    It would be interesting to see how medicated children fare as adults. I doubt anybody would give a decent job to a young man who in his childhood was drugged but never learned to concentrate.

    Link to this
  2. 2. JeffPgh 4:17 pm 02/14/2014

    Really? I get it that it is fashionable to hate on ADHD, and those who use meds to treat it. For the most part, the dietary changes this guy recommends have shown little effect, when studied under controlled conditions.

    This is a load of anecdotal claptrap with a patina of legitimacy, because a pediatrician gives the talk.

    I’m shocked that, even on a SA blog, this kind of bandwagon garbage appears.

    Link to this
  3. 3. 2centsworth58 5:04 pm 02/14/2014

    Thank you, JeffPgh!

    Link to this
  4. 4. megann22 11:40 pm 02/14/2014

    JeffPgh, I’d be curious to hear what your background is. I was diagnosed with ADHD, and no one ever made any mention of food intolerances/sensitivities. I tried a non-stimulant, and it helped with some sleep issues for a while (and then stopped), and caused me to almost faint so I opted out of drugs. I have had pretty bad memory issues, sleeping issues (waking up to driving through a red light, avoiding the interstate because I fall asleep almost every time at some point/ falling asleep at desk jobs/falling asleep at an industrial bread slicer standing up/falling asleep in class, on all TV, and in the company of friends). It wasn’t until I started developing signs of Rheumatoid Arthritis (which my Dad has, and takes plenty of drugs for) about 70% of the time that I started researching it, and discovered these signs could be from a food intolerance/allergy. Since being mostly gluten/dairy/soy free I have not had nearly so many problems. My dad has stayed fairly consistent with his diet for a while now and his hands and ankles are smaller than they’ve been in years, and he walks with little problems. None of this has been verified scientifically, and who knows if it is all the items or just one (I have been trying to figure it out, but it is hard to know overall) but do I wish someone had suggested at least investigating food options before I blew a lot of money ruining my transcript at college, and essentially having no life while compulsively working, trying to remember and connect memories of life while barely remembering my name sometimes, and now having to make up for the results of all that. I think ADHD is something that is real, but it’s going to be different for different people, because I personally believe it is not a set “thing.” It’s a description of symptoms to me, but not a cause. I would rather know a cause, than treat the symptoms with drugs that are doing god knows what in the long run. I am glad SA ran this.

    Link to this
  5. 5. JeffPgh 12:17 am 02/15/2014

    @megann22, I’m glad that dietary restrictions work for you and your dad. However, diet for controlling ADHD *has* been researched, and the effects are pretty limited. Feel free to read more: http://pediatrics.aappublications.org/content/129/2/330.long

    Link to this
  6. 6. Menno 6:18 am 02/15/2014

    @JeffPgh:

    I (partly) agree with your comments. For instance the diet: Little or no effect has been found between ADHD and (artificial) food colouring or simple sugars.
    Some tantalizing effect has been seen in a rigorous dieting routine in which you start with nearly nothing and slowly add certain foods until you find the culprit. Anything from a banana to broccoli could be at fault for the hyperactivity.
    Even though some children were resistant to the diets regime suggesting another underlying cause.

    Also no link has been found (to my knowledge) between watching tv and ADHD.

    I agree though that ADHD is over diagnosed. We have loosened the definition of what ADHD is meaning more people qualify for the disease.

    But as a society we have also loosened the definition of what hyperactive is as well. Teachers and parents sometimes feel an active child is hyperactive and quickly label a child as having ADHD even though they are not qualified to make such a definition. The trouble with this is that that they start seeking out behaviour that fits with this assesment and ignoring behaviour that doesn’t. They create a self-fulfilling prophecy.
    they start pressuring doctors into diagnosing children or seeking out doctors who agree with there assesment.

    Another problem seems to be that the wrong kind of doctor seems to be diagnosing and supplying the medicine. If I want my walls plastered I don’t ask a plumber to do it. Why then do you visit a medical doctor to diagnose and treat a mental disease? (this is true for the Netherlands but from this video seems to be true for the US as well).

    As for the proposed alternative treatments?
    As said a diet can help but it takes 6 weeks or more to figure out which foods if any are at fault and differ per child. there is no stop gap solution.
    Some herbs might help but this is not better then medicines. The only way for a herb to work is if it contains an active ingredient. This means that it can have the same side effects as traditional medicines.
    Yoga, meditation and mindfulness might help seen as they seem to have positive effect in the general population.

    Link to this
  7. 7. Manir788 9:30 pm 02/15/2014

    Really, it is very dangerous new for U.S. children. I’m very pleased to you for your most helpful information. Feel free to read more on Children Health Care.

    Link to this
  8. 8. ieatquacksforbreakfast 10:24 pm 02/15/2014

    The main reason prescriptions have increased over the past decade is due to increased access to mental healthcare and more people seeking help. The diet link to ADHD has little empirical support and HERBAL REMEDIES? There is NO evidence that any dietary supplement can treat ADHD. Seriously, this sounds like an article straight out of Natural News, not Scientific American! The author is an uneducated and biased quack!

    Link to this
  9. 9. ieatquacksforbreakfast 10:46 pm 02/15/2014

    Oh yeah, what makes this guy a “leading expert on ADHD”? What’s his Hirsch Index? How many ADHD articles has he published in peer-reviewed journals and what’s his Hirsch Index with regard to ADHD?

    Link to this
  10. 10. ieatquacksforbreakfast 8:50 pm 02/17/2014

    You know 2.7 million is about four percent of all American children. That represents the low-end of the estimated number of children who have ADHD (most estimates say between 4-7%). So why the statistic? Because 2.7 million sounds impressive. If you know what it actually represents it’s not controversial or impressive at all. Classic example of lying with statistics. Such a misleading and one-sided article.

    Link to this
  11. 11. DrChris 4:52 am 02/19/2014

    A new approach to ADHD that is having success is the concept of hemisphericity.
    That theory is that in ADHD (and it’s related problems) one side of the brain is lagging behind the other.
    By stimulating the lagging side (via sensory input) this rebalences the brain.
    There is a guy in Switzerland with a great website full of info for the public – http://unritalinsolution.com/

    Link to this
  12. 12. kebil 4:51 pm 02/19/2014

    Megann22 – I am sorry, but none of your symptoms sound like ADHD to begin with, but rather, like classical narcolepsy (which is also treated with stimulants). Falling asleep constantly and uncontrollably is the opposite of being hyperactive.

    I can sympathize with your troubles – I have had a problem with excessive sleepiness as well. I had four months last year where I could not stay awake for longer than a couple of hours at a time, was going to sleep at 8 pm, waking at 7 (having slept all night), and still felt dead tired. I was lucky I was good at my job, and that I was able to keep up – my boss was compassionate and did not get upset when I needed to take naps at work, or when I would fall asleep while working on drawings. I was doing AutoCAD work at the time, so falling asleep was not dangerous, although it did mean that I had to spend a lot more time double checking my work, and getting a coworker to do the same for me. Luckily, it started to clear somewhat by the time my workload picked up, but those were some of the roughest months of my life, and if I had been in any other job in any other company with any other boss, I would surely have been let go.

    Link to this
  13. 13. lesizz 12:59 pm 02/20/2014

    One way to get lowdown on ADHD is to ask adults such as I about these things.

    JeffPgh : Right-on!

    Jerzy v. 3.0. : When you are clueless about a topic you should refrain from commenting.

    “Worldwide, a child which cannot concentrate and keep calm is forced to. And finally learns.”

    A statement seeped in ignorance. A person with ADHD cannot concentrate, their brain simply is not wired that way. It’s not something someone can learn. Pressuring a child to concentrate when (s)he simply cannot causes serious psychological problems. STAY away from our children, whatever you do.

    I am 70 years old, and when I was young no one knew about ADHD and I suffered from not being able to perform as others, and not being able to perform to my own percieved ability. Very fortunately the people who ran the school I went to tried to help me, but did not have the kind of mean hard-nosed attitude expressed by one commenter here.

    In the early 90′s I heard a doctor on talk radio being interviewed about something called “Attention Deficit Disorder”. I saw him soon after and got on Riatlin. It changed my life. THEN I was able to “learn” to use my brain. My self esteem got a good boost. My job performance improved so that for the next several years I received twice the annual salary increase as the aveage from my employer. And yatta-yatta….

    Still, it is with pause that I would want a child of mine on Ritalin. This needs to be done with great care and by a practitioner who is very expert in this area, and has a good instinct in relating to children. And as with any chemical medication, administered as a last resort. There are certainly other means of dealing with ADHD, but sometimes someone just needs the chemical jolt. Even caffein can be of some help. Drugging a mis-diagnosed child is just plain malpractice.

    Link to this
  14. 14. hkraznodar 10:05 am 02/26/2014

    @Jeffpgh – I read the article that you posted a link to and found it very interesting. Particularly the parts that state that dietary changes can have a meaningful impact. It was interesting that some dietary changes apparently do nothing but that where dietary deficiencies are found and consumption changes or supplements are added, the impact can be significant.

    Ranting without citing sources damages your credibility. Pharma products have lifted me from my personal hell so I have a strong testimony of medicating. That doesn’t mean I think that drugs should be the first choice.

    Link to this
  15. 15. rshoff2 10:47 am 03/5/2014

    As with everything, it probably has to do with the degree of ADHD. To some extent, we must conform regardless of our deficit, to learn how to concentrate in our world. It’s a skill based issue. On the other hand when people are actually disabled as a result of ADHD stimulants can be helpful. But they must be managed, and not used as a crutch or abused.

    It wouldn’t surprise me if they are way over prescribed and if they are way over abused. It wouldn’t surprise me if over use of stimulants lead to unnecessary violence, especially when mixed with other drugs including alcohol.

    It wouldn’t surprise me if there are real people with a real need to be treated for ADHD. It would be cruel to make them suffer by abolishing useful treatment because of the abuse of society or other patients.

    It’s complicated.

    Link to this

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